The surgical management of acute bowel ischemia in octogenarian patients to avoid Short Bowel Syndrome: a multicenter study

Background. This is a multicenter study performed in two Ita- lian tertiary care centers: General Emergency Surgery Unit at St. Orsola University Teaching Hospital - Bologna and Department of Surgical Sciences at Umberto I University Teaching Hospital - Ro- me. The aim was to compare the results of different approaches among elderly patients with acute bowel ischemia. Methods. Sixty-three patients were divided in two groups: 1) DSgroup- 28 patients treated in Vascular Unit and 2) GEgroup- 35 patients treated in Emergency Surgery Unit. Results. Mean age was 80 years, significantly higher for the GE- group (p<0.001). Gender was predominantly female in both groups, without statistical difference. Pre-operatively, laboratory tests didn’t show any difference in white blood cell count, serum lactate levels or serum creatinine among patients, while increase of c-reactive protein was observed in DSgroup with significant difference (p<0.001). The main cause of acute bowel ischemia was embolism in DSgroup (p=0.03) and vascular spasm in GEgroup (p<0.001). On CT scan, bowel loop dilation was present in 58.7% of patients without stati- stical difference in both groups. The time lapse from diagnosis to ope- ration didn’t show significant differences between two groups (mean 349.4 min). Pre-operative heparin therapy was administered in DSgroup more frequently (p< 0.001). Among DS patients, throm- bectomy was the most frequent procedure (19 patients) associated with bowel resection in 9 cases. In GEgroup, 22 patients had an ex- plorative laparotomy (p<0.001), 8 had a bowel resection with ana- stomosis and 5 a bowel resection plus stoma. A second look was re- quired more significantly in DSgroup (p<0.002). Post-operative morbidity affected significantly GEgroup (p=0.02). The 3-day sur- vival was significantly higher in the DSgroup (p< 0.001). At di- scharge 32 patients (50.8%) were alive, 21 in DSgroup (p< 0.001). Only one patient among both groups (1.6%) developed a short bowel syndrome. Conclusions. In octogenarian patients with acute bowel ische- mia, surgery should be always pursued whenever the interventional radiology is not assessed as a viable option. Both groups of patients showed an excellent outcome in terms of avoiding a short bowel syn- drome. A multidisciplinary management by a dedicated team could offer the best results to prevent large intestinal resections.