Acute mesenteric ischemia (AMI) is a severe condition associated with high mortality and morbidity. When left untreated, it can have devastating consequences for patients. Our study, which is consistent with numerous previous studies, revealed a mortality rate exceeding 50%, with 52% of patients succumbing to the condition. This mortality rate aligns with earlier studies, where mortality ranged from 50–69%. For example, Alhan et al. (2012) reported a hospital mortality rate of 55.1% in Turkey, with multiorgan failure being the leading cause of death in 43% of cases [9]. Similarly, Acosta-Merida et al. (2006), in Spain, reported a perioperative mortality rate of 65.2% among 132 patients, emphasizing the severity of AMI when no intervention or only laparotomy without revascularization is performed [10].
This study, which involved 31 participants, provides a detailed overview of the cohort. The mean age was 55.29 years, reflecting a diverse age distribution. Notably, 64.52% of the participants were male, underscoring the importance of gender-specific factors in understanding outcomes. Previous studies have shown that AMI typically manifests in patients in their late 60 s and 70 s, with a median age of approximately 67 years[10]. While chronic mesenteric ischemia is more prevalent in females than in males, acute mesenteric ischemia affects both sexes almost equally, as observed in various studies. However, our study revealed a greater prevalence in males than in females, which is consistent with findings from previous studies, where the majority of AMI patients were male[11–16].
Chronic diseases play a significant role in the delayed diagnosis and poor prognosis of AMI and are often cited as major risk factors for mortality. In this study, most patients had multiple chronic conditions, with diabetes mellitus being the most common (61%), followed by hypertension (58%), coronary artery disease (38%), and heart failure (32%). Comparatively, a study conducted at Massachusetts General Hospital by Chou et al. (2021) revealed that hypertension was the most common chronic condition, present in 74% of patients, followed by coronary artery disease and atrial fibrillation[17]. The presence of multiple chronic conditions complicates the management of AMI and is associated with higher mortality rates, as observed in our study and others, such as the 30-year review by Alhan et al. (2012), which highlighted the impact of cardiovascular comorbidities on patient outcomes[9].
Timely diagnosis is crucial for preserving the intestinal blood supply and preventing ischemia. Although AMI has a relatively low incidence, it is often overlooked in the differential diagnosis of acute abdominal pain. In our study, arterial emboli were the most common cause of AMI, diagnosed in 90% of the patients, with the remaining 10% attributed to mesenteric venous thrombosis. Although the type of AMI was not significantly associated with mortality in this study, timely detection and intervention were critical for improving survival rates. Patients diagnosed within the first 24 hours had a significantly greater survival rate than those diagnosed later, a finding that aligns with previous studies, such as those by Yıldırım et al. (2017) and Kassahun et al. (2008)[18, 19], which demonstrated that delays in diagnosis beyond 24 hours result in markedly lower survival rates.
Advanced age is a well-known prognostic factor for mortality in AMI patients. In our study, the mean age difference between survivors and nonsurvivors was not statistically significant, but the slightly higher mean age among those who died suggests that older age may still contribute to poorer outcomes. This observation is consistent with earlier studies, which identified advanced age as a negative prognostic factor for survival in AMI patients[9, 20].
The presence of chronic diseases, particularly cardiovascular conditions, was a major contributor to mortality in our cohort. Patients with a history of ischemic stroke and heart failure had the highest mortality rates, with all patients who had a history of ischemic stroke dying during the study period. Other chronic conditions, including chronic obstructive pulmonary disease (COPD), arrhythmias, and peripheral arterial disease, are also associated with high mortality rates, further emphasizing the role of comorbidities in the prognosis of AMI. These findings are in line with long-term studies, which have consistently shown that elderly patients with significant cardiovascular comorbidities are at the highest risk of poor outcomes[21].
The clinical presentation of AMI varies widely, making diagnosis challenging. AMI is characterized by sudden, severe abdominal pain that is disproportionate to physical examination findings. In our study, nearly all patients presented with abdominal pain, with a majority describing it as severe and localized to the right lower quadrant. This finding is consistent with the American Gastroenterological Association's recommendations for the evaluation of significant abdominal pain in at-risk individuals[22]. Other common symptoms in our cohort included nausea, vomiting, constipation, and fever, which are typical of AMI but can also be observed in other conditions, further complicating the diagnosis[22–26].
Hemodynamic instability was observed in a significant proportion of our patients and was strongly associated with increased mortality rates. Patients who were hemodynamically unstable had a mortality rate of more than 70%, whereas the mortality rate was 23% for those who were stable. This finding underscores the importance of early stabilization and aggressive management in patients presenting with AMI, as also reported in studies from Taiwan and other regions[27–29].
While not specific for AMI, laboratory tests can provide valuable clues. In our study, severe leukocytosis was significantly associated with mortality, with 77% of deceased patients presenting with elevated white blood cell counts. This finding is consistent with earlier studies, which identified leukocytosis as a marker of severe intestinal ischemia[11, 13, 27]. Elevated lactate levels were also common in our study and were associated with higher mortality rates, supporting the use of lactate as a potential prognostic marker, although its sensitivity and specificity in diagnosing AMI remain debated[30–34].
Various radiological modalities, including abdominal X-ray, ultrasound, and CT angiography, were used to diagnose AMI in our study. The latter was particularly valuable, aligning with other studies that have demonstrated its efficacy in detecting mesenteric ischemia[35]. Surgical intervention was the primary treatment for most patients in our cohort, with bowel resection being the most common procedure. The need for a second-look laparotomy and the high rate of postoperative complications, including surgical site infections and short bowel syndrome, highlight the complex and often protracted nature of AMI management[12, 36, 37].
Finally, the postsurgical mortality rate in our study was 48%, with most deaths occurring within the first week after surgery. This rate is higher than those reported in some studies, such as a Swedish study where the 30-day postsurgery mortality rate was 33%[38]. These differences may reflect variations in patient populations, healthcare settings, and the timing of surgical intervention.
This study has several limitations that should be acknowledged. The relatively small sample size and single-center design may limit the generalizability of the findings. Additionally, the observational nature of the study means that causal relationships between identified risk factors and outcomes cannot be definitively established. Further multicenter studies with larger sample sizes are needed to confirm these findings and explore additional factors that may influence outcomes in AMI patients.
Conclusion: AMI is associated with a high mortality rate, particularly in settings with limited healthcare resources. This study provides valuable insights into factors associated with poor outcomes in a Yemeni population, highlighting the need for early diagnosis, prompt surgical intervention, and comprehensive management of underlying cardiovascular risk factors. By addressing these areas, it may be possible to improve survival rates and reduce the burden of AMI in Yemen and similar regions.