LAUSR

Bowel ischaemia (BI) is a life-threatening emergency with a mortality rate of 60–80%, which requires early diagnosis and surgical intervention. Clinical presentation is nonspecific, being characterised by initial discrepancy between severe abdominal pain and minimal clinical findings, abdominal CT has poor sensitivity and specificity. BI remains a diagnostic challenge for clinicians and often is an autopsy finding (1–1.5% of all adults’ autopsy). We conducted a thematic review to identify major issues which led to fail to recognise BI. Data was collected retrospectively from NELA database on 626 patients who underwent emergency laparotomy, between 2013–2021 at Bedford Hospital, including preoperative clinical-radiological data, operation details, postoperative complications according to Clavien-Dindo (CD) classification and mortality. A total of 68 (10.8%) patients had BI as intra-operative finding, average age 71.3 (37–99), 35 (51.4%) female and 33 (48.5%) male. 25 (36.7%) had BI as indication for emergency laparotomy. 65 (95.5%) presented as emergency versus 3 (0.5%) as elective admission. The average waiting time for surgery was 8.9 hours. 53 (77.9%) patients received CT AP (46 triple phase, 4 angiogram, 3 without contrast), presence of BI was highlighted in 11 (21.1%) cases. In 14 (20.5%) patients a stoma was fashioned during laparotomy. 28 (41.2%) complications were recorded, of which 8 (28.5%) CD grade I, 5 (17.8%) CD grade 3b and 13 (46.4%). Our results showed a mortality rate of 19.1% at 30 days postoperatively. We recommend strong clinical suspicion and aggressive approach should be adopted to improve the clinical outcome of BI.