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2 "mesenteric ischemia"
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Original Article
Surgery
Failure of early creatinine recovery predicts poor survival after emergency surgery for bowel perforation or infarction
Hyun Il Kim, Min Hong Lee, Byung Jun Jeon, Yoon Mo Kim, Mi Kyung Oh, Min Gyu Kim
Acute Crit Care. 2026;41(1):126-135.   Published online February 27, 2026
DOI: https://doi.org/10.4266/acc.003625
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  • 7 Download
AbstractAbstract PDF
Background
Early postoperative recovery of kidney function is critical in emergency bowel surgery. This study evaluated the prognostic value of preoperative creatinine elevation (PCE) and early creatinine recovery (ECR).
Methods
A total of 424 patients underwent emergency surgery for bowel perforation or ischemia from January 2019 to December 2024. Sixteen trauma-related cases (including procedure-related injuries) were excluded, leaving 408 patients for analysis. Of these, 35 patients with end-stage renal disease or chronic kidney disease—either pre-existing or newly diagnosed during hospitalization—were excluded. ECR was defined as a decrease in serum creatinine to <1.3 mg/dl by postoperative day (POD) 3. PCE was defined as serum creatinine >1.3 mg/dl. Associations with postoperative complications and 30-day mortality were estimated using multivariable logistic regression and reported as adjusted odds ratios (aORs) with 95% CIs.
Results
PCE occurred in 18.5% (69/373) of the tested patients; among these, 58.0% (40/69) achieved ECR by POD 3. Failure of ECR was associated with severe complications (93.1% vs. 27.5%, P<0.001) and higher mortality (72.4% vs. 7.5%, P<0.001). In multivariable analysis, ECR failure independently predicted complications (aOR, 28.72; 95% CI, 5.44–151.58) and 30-day mortality (aOR, 32.38; 95% CI, 7.74–135.41; P<0.001 for both).
Conclusions
Failure to achieve ECR is independently associated with poor survival after emergency laparotomy for peritonitis. This finding supports the use of a creatinine-based checkpoint to trigger intensified monitoring and targeted rescue interventions.
Case Report
Thoracic surgery
Early laparoscopic exploration for acute mesenteric ischemia after cardiac surgery
Sue Hyun Kim, Ho Young Hwang, Min Jung Kim, Kyu Joo Park, Ki-Bong Kim
Acute Crit Care. 2020;35(3):213-217.   Published online April 19, 2019
DOI: https://doi.org/10.4266/acc.2018.00423
  • 13,348 View
  • 228 Download
  • 5 Web of Science
  • 6 Crossref
AbstractAbstract PDF
Acute mesenteric ischemia (AMI) after cardiac surgery is a rare but fatal complication. Early diagnosis and intervention can be lifesaving. We report two cases of patients who underwent early diagnostic laparoscopy for suspicious AMI after cardiac surgery and demonstrated favorable outcomes. An 83-year-old male with severe left ventricular dysfunction underwent off-pump coronary artery bypass grafting. Severe ileus with gaseous distension of the small bowel was developed on the 3rd postoperative day and computed tomographic angiography (CTA) showed pneumatosis intestinalis of small bowel suggestive of AMI. An immediate bedside laparoscopy was performed and it showed preserved perfusion of small bowel. He recovered without complication under supportive medical management. Another 69-year-old male who underwent aortic valve replacement complained of whole abdominal tenderness with severe distension on the 3rd postoperative day. The CTA found segmental non-enhancing bowel wall with air bubbles suggestive of AMI with possible microperforation. A diagnostic laparoscopy demonstrated small-bowel infarction with pus-like fluid collection in the peritoneal cavity. The operation was converted to laparotomy and complete resection of ischemic segments of small bowel was done. He recovered well without any other complications and discharged home on the 35th postoperative day.

Citations

Citations to this article as recorded by  
  • The Challenge of Pneumatosis Intestinalis: A Contemporary Systematic Review
    Gennaro Perrone, Mario Giuffrida, Valentina Donato, Gabriele Luciano Petracca, Giorgio Rossi, Giacomo Franzini, Sara Cecconi, Alfredo Annicchiarico, Elena Bonati, Fausto Catena
    Journal of Personalized Medicine.2024; 14(2): 167.     CrossRef
  • Gastrointestinal complications after cardiac surgery
    Klara Schwarzova, Sameer Damle, Frank William Sellke, Michael Phillip Robich
    Trauma Surgery & Acute Care Open.2024; 9(1): e001324.     CrossRef
  • The role of bed-side laparoscopy in the management of acute mesenteric ischemia of recent onset in post-cardiac surgery patients admitted to ICU
    Carlo Bergamini, Giovanni Alemanno, Alessio Giordano, Desiré Pantalone, Giovanni Fontani, Anna Maria Di Bella, Veronica Iacopini, Paolo Prosperi, Jacopo Martellucci
    European Journal of Trauma and Emergency Surgery.2022; 48(1): 87.     CrossRef
  • Minimally invasive acute care surgery
    Caroline E. Reinke, Robert B. Lim
    Current Problems in Surgery.2022; 59(2): 101031.     CrossRef
  • In Brief
    Caroline E. Reinke, Robert B. Lim
    Current Problems in Surgery.2022; 59(2): 101033.     CrossRef
  • Mesenteric ischemia postcardiac surgery—Elusive and less stratified complexity
    Mohammed Idhrees, Ian Williams, Mohamad Bashir, Bashi V. Velayudhan
    Journal of Cardiac Surgery.2022; 37(7): 2040.     CrossRef
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