INTRODUCTION: This is a multicenter study performed in two Italian tertiary care centers: Emergency General Surgery Unit at St. Orsola University Teaching Hospital-Bologna and Department of Surgical Sciences at Umberto I University Teaching Hospital-Rome. The aim was to compare the results of different approaches among patients with acute bowel ischemia over 65 years of age.

METHODS: Sixty-three patients were divided in two groups: 1) VSgroup- 28 patients treated at Department of Surgical Sciences and 2) GEgroup- 35 patients treated in Emergency General Surgery Unit. Mean age was 80 years, significantly higher for the GEgroup (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 VSgroup with significant difference (p<0.001). The main cause of acute bowel ischemia was embolism in VSgroup (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 statistical difference in both groups.

RESULTS: The time lapse from diagnosis to operation didn’t show significant differences between two groups (mean 349.4 min). Pre-operative heparin therapy was administered in VSgroup more frequently (p< 0.001). In VSgroup, thrombectomy was the most frequent procedure (19 patients) associated with bowel resection in 9 cases. In GEgroup, 22 patients had an explorative laparotomy (p<0.001) , 8 had a bowel resection with anastomosis and 5 a bowel resection plus stoma. A second look was required more significantly in VSgroup (p<0.001). Post-operative morbidity affected significantly GEgroup (p=0.02). The 3-day survival was significantly higher in the VSgroup (p< 0.001). At discharge 32 patients (50.8%) were alive, 21 in VSgroup (p< 0.001). Only one patient among both groups (1.6%) had a short bowel syndrome.

CONCLUSIONS: In elderly patients with acute bowel ischemia, 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 syndrome. A multidisciplinary management by a dedicated team could offer the best results to prevent large intestinal resections.