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Vrba R, Řezáč T, Špička P, Klos D, Černá M, Köcher M. Acute mesenteric ischaemia in the elderly - results of combined endovascular and surgical treatment. Primary study. Sci Rep 2025; 15:74. [PMID: 39747507 PMCID: PMC11695676 DOI: 10.1038/s41598-024-84026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 12/19/2024] [Indexed: 01/04/2025] Open
Abstract
Acute mesenteric ischaemia (AMI) is a sudden onset of impaired bowel perfusion. Has a high mortality rate and is difficult to diagnose. Therapy involves endovascular, surgical, or a combination of both. Because of baseline differences, the comparison between endovascular and open surgical treatment is subject to selection bias. The aim of this study was to evaluate the results of treatment of AMI by open or endovascular approach in combination with laparotomy, and evaluation of treatment strategy in similar situations. Clinical data from 21 patients treated for AMI between 2018 and 2022 were retrospectively reviewed and compared. The primary endpoint of the study was in-hospital mortality. The secondary endpoint was the statistical evaluation of risk factors for mortality. All patients underwent acute endovascular revascularisation. Aspiration thromboembolectomy was performed in nine patients, stenting in seven, PTA in one and surgery in three. Endovascular therapy was unsuccessful for technical reasons in 3 patients. None of the monitored parameters reached statistical significance. The best results were achieved in the early diagnosis group. The overall mortality of acute mesenteric ischaemia in our cohort was 34.8%. Acute mesenteric ischaemia is a serious condition affecting mainly elderly patients with a high mortality rate, but the diagnosis of mesenteric ischaemia is not an automatic death sentence. To achieve the best therapeutic outcome, mesenteric ischaemia needs to be diagnosed and treated at an early stage. The best therapeutic outcomes are achieved in centres with 24-hour access to endovascular revascularisation and surgical therapy.
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Affiliation(s)
- R Vrba
- Department of Surgery I, University Hospital Olomouc, Zdravotníku 248/7, Olomouc, 77900, Czech Republic
| | - T Řezáč
- Department of Surgery I, University Hospital Olomouc, Zdravotníku 248/7, Olomouc, 77900, Czech Republic.
| | - P Špička
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hněvotínská 976/3, Olomouc, 77515, Czech Republic
| | - D Klos
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hněvotínská 976/3, Olomouc, 77515, Czech Republic
| | - M Černá
- Department of Radiology, University Hospital Olomouc, Zdravotníku 248/7, Olomouc, 77900, Czech Republic
| | - M Köcher
- Department of Radiology, University Hospital Olomouc, Zdravotníku 248/7, Olomouc, 77900, Czech Republic
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Chen L, Wang J, Zhuo H, Wang Z, Zhang J. Association between periodic variation of air temperature, humidity, atmospheric pressure and hospital admissions for acute occlusive mesenteric ischaemia. Sci Rep 2024; 14:21426. [PMID: 39271708 PMCID: PMC11399351 DOI: 10.1038/s41598-024-72065-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 09/03/2024] [Indexed: 09/15/2024] Open
Abstract
Referring to the intestinal ischemic injury caused by sudden interruption of the blood supply, acute mesenteric ischemia (AMI) is a highly fatal emergency with mortality rates varying from 58 to 80%. The aim of this study was to explore the effect of temperature on AMI admission. This was a retrospective, multicentric study. The medical records of 1477 patients with verified AMI who were consecutively admitted to 3 hospitals anytime between January 2010 and December 2020 were included in the study. Distributed lag non-linear model was applied, the model was adjusted for temperature, atmospheric pressure, relative humidity, year, holiday, day of the week, time and seasonality. AMI exhibited obvious sex preference, AMI patients tended to be male (M/F ratio = 2.3:1) and in their late 50 s. Hospital admissions of acute mesenteric arterial thromboembolism (AMAT) increased significantly with high temperatures on day of exposure and lag 0-14 day. The effect curve of daily average temperature on acute mesenteric venous thromboembolism (AMVT) admission was J-shaped, and the duration of cold effect was longer, while the duration of heat effect was shorter. An increase in hospital admissions of AMVT was found above 20 °C at lag 0-30. For the first time, our study indicated that temperature is significantly associated with the risk of AMI. Although it is not possible to always avoid exposure to extreme temperatures, one should be aware of dramatic temperature fluctuations and take appropriate precautions.
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Affiliation(s)
- Lin Chen
- Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Breast Surgery, The Second Hospital Of Shandong University, Jinan, China
| | - Jun Wang
- Department of General Surgery, Zhangdian District People's Hospital, Zibo, China
| | - Hongqing Zhuo
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital affiliated to Shandong First Medical University, 324 Jing 5 Rd, Jinan, 250021, Shandong Province, China
| | - Zexin Wang
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital affiliated to Shandong First Medical University, 324 Jing 5 Rd, Jinan, 250021, Shandong Province, China
| | - Jizhun Zhang
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital affiliated to Shandong First Medical University, 324 Jing 5 Rd, Jinan, 250021, Shandong Province, China.
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Yu W, Liang Y, Gao J, Xie D, Xiong J. Surgical choice for the treatment of partial intestinal ischemic necrosis caused by acute type a aortic dissection combined with malperfusion of superior mesenteric artery. J Cardiothorac Surg 2024; 19:286. [PMID: 38734628 PMCID: PMC11088173 DOI: 10.1186/s13019-024-02790-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 05/03/2024] [Indexed: 05/13/2024] Open
Abstract
Acute type A aortic dissection is a severe cardiovascular disease characterized by rapid onset and high mortality. Traditionally, urgent open aortic repair is performed after admission to prevent aortic rupture and death. However, when combined with malperfusion syndrome, the low perfusion of the superior mesenteric artery can further lead to intestinal necrosis, significantly impacting the surgery's prognosis and potentially resulting in adverse consequences, bringing. This presents great significant challenges in treatment. Based on recent domestic and international research literature, this paper reviews the mechanism, current treatment approaches, and selection of surgical methods for poor organ perfusion caused by acute type A aortic dissection. The literature review findings suggest that central aortic repair can be employed for the treatment of acute type A aortic dissection with inadequate perfusion of the superior mesenteric artery. The superior mesenteric artery can be windowed and (/or) stented, followed by delayed aortic repair. Priority should be given to revascularization of the superior mesenteric artery, followed by central aortic repair. During central aortic repair, direct blood perfusion should be performed on the distal true lumen of the superior mesenteric artery, leading to resulting in favorable therapeutic outcomes. The research results indicate that even after surgical aortic repair, intestinal ischemic necrosis may still occur. In such cases, prompt laparotomy and necessary necrotic bowel resection are crucial for saving the patient's life.
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Affiliation(s)
- Wenbo Yu
- The First Clinical Medical College of Gannan Medical University, Ganzhou, 341000, China
| | - Yuan Liang
- The First Clinical Medical College of Gannan Medical University, Ganzhou, 341000, China
| | - Jianfeng Gao
- The First Clinical Medical College of Gannan Medical University, Ganzhou, 341000, China
| | - Dilin Xie
- The First Clinical Medical College of Gannan Medical University, Ganzhou, 341000, China
| | - Jianxian Xiong
- First Affiliated Hospital of Gannan Medical University, Ganzhou, 341000, China.
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4
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Kania A, Branchi V, Braun L, Verrel F, Kalff JC, Vilz TO. [Indications and surgical strategy for bowel resection in mesenteric ischemia : Resection margins considering current guidelines and literature as well as the influence of new technical possibilities]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:367-374. [PMID: 38378936 DOI: 10.1007/s00104-024-02041-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/22/2024]
Abstract
Acute mesenteric ischemia (AMI) is still a time-critical and life-threatening clinical picture. If exploration of the abdominal cavity is necessary during treatment, an intraoperative assessment of which segments of the intestines have a sufficient potential for recovery must be made. These decisions are mostly based on purely clinical parameters, which are subject to high level of uncertainty. This review article provides an overview of how this decision-making process and the determination of resection margins can be improved using technical aids, such as laser Doppler flowmetry (LDF), indocyanine green (ICG) fluorescence angiography or hyperspectral imaging (HSI). Furthermore, this article compiles guideline recommendations on the role of laparoscopy and the value of a planned second-look laparotomy. In addition, an overview of strategies for preventing short bowel syndrome is given and other aspects, such as the timing and technical aspects of placement of a preternatural anus and an anastomosis are highlighted.
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Affiliation(s)
- Alexander Kania
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland.
| | - Vittorio Branchi
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - Lara Braun
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - Frauke Verrel
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - Jörg C Kalff
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - Tim O Vilz
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
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Alali M, Cao C, Shin JH, Jeon G, Zeng CH, Park JH, Aljerdah S, Aljohani S. Preliminary report on embolization with quick-soluble gelatin sponge particles for angiographically negative acute gastrointestinal bleeding. Sci Rep 2024; 14:6438. [PMID: 38499668 PMCID: PMC10948793 DOI: 10.1038/s41598-024-56992-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/13/2024] [Indexed: 03/20/2024] Open
Abstract
Prophylactic embolization is usually performed using gelatin sponge particles, which are absorbed within several weeks, for managing angiographically negative gastrointestinal bleeding. This study aimed to evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) with quick-soluble gelatin sponge particles (QS-GSP) that dissolve in less than 4 h for treating angiographically negative gastrointestinal bleeding. We included ten patients (M:F = 7:3; mean age, 64.3 years) who underwent prophylactic TAE with QS-GSP for angiographically negative acute gastrointestinal bleeding between 2021 and 2023. The technical success rate of TAE, clinical outcomes focusing on rebleeding, and procedure-related complications were evaluated. The embolized arteries were the gastroduodenal (n = 3), jejunal (n = 4), and ileal (n = 3) arteries. QS-GSP (150-350 µm or 350-560 µm) were used alone (n = 8) or in combination with a coil (n = 1). A 100% technical success rate was accomplished. In 1 patient (10%), rebleeding occurred 2 days after prophylactic TAE of the gastroduodenal artery, and this was managed by repeat TAE. There were no procedure-related complications. The use of QS-GSP for prophylactic TAE appears to be safe and effective for controlling bleeding among patients with angiographically negative gastrointestinal bleeding. There were no cases of related ischemic complications of the embolized bowels likely attributable to recanalization of the affected arteries following biodegradation of QS-GSP.
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Affiliation(s)
- Meshari Alali
- Department of Radiology, Majmaah University, Almajmaah, Saudi Arabia
| | - Chuanwu Cao
- Department of Radiology, The Tenth People's Hospital, Shanghai, China
| | - Ji Hoon Shin
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Gayoung Jeon
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Chu Hui Zeng
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jung-Hoon Park
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Shakir Aljerdah
- Department of Radiology, Najran University, Najran, Saudi Arabia
| | - Sultan Aljohani
- Department of Radiology, King Salman Bin Abdulaziz Medical City, Medina, Saudi Arabia
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6
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Gerwing M, Eisenblätter M. [Emergency diagnoses in the gastrointestinal tract]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:219-230. [PMID: 38349365 DOI: 10.1007/s00117-024-01270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/22/2024]
Abstract
Gastrointestinal emergencies are a frequent reason for presentation in the emergency department and involve patients of all ages. The patients must undergo an immediate cross-sectional imaging as in many cases the underlying pathology is a life-threatening condition, which often needs surgical or in some cases also interventional radiological treatment. In this overview, the most important differential diagnoses and their characteristics on cross-sectional imaging are presented.
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Affiliation(s)
- Mirjam Gerwing
- Klinik für Radiologie, Universitätsklinikum Münster, Universität Münster, Münster, Deutschland.
| | - Michel Eisenblätter
- Universitätsinstitut für Diagnostische und Interventionelle Radiologie, Universität Bielefeld, Med. Fakultät und Universitätsklinikum OWL, Bielefeld, Deutschland
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Soltanzadeh-Naderi Y, Acosta S. Trends in population-based incidence, diagnostics, and mortality of acute superior mesenteric artery occlusion. Front Surg 2024; 10:1334655. [PMID: 38234455 PMCID: PMC10791993 DOI: 10.3389/fsurg.2023.1334655] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024] Open
Abstract
Acute occlusion of the superior mesenteric artery (SMA) results in lethal intestinal ischemia. Results from two previous population-based studies in Malmö, Sweden, suggest a decreasing incidence of acute SMA occlusion. This study aimed to evaluate trends in the epidemiology of acute SMA occlusion in Malmö. The report was a retrospective population-based study conducted from 2014 to 2019 on patients with acute SMA occlusion residing in Malmö municipality. Patient data were retrieved from Skåne University Hospital and postmortem examinations. Epidemiological data were compared to those of the two earlier studies, in particular to the one conducted from 2000 to 2006. Sixteen patients with acute SMA occlusion resided in Malmö municipality. The incidence of acute SMA occlusion significantly decreased from 5.4/100,000 person-years to 0.8/100,000 person-years. The ratio of acute SMA occlusion to non-occlusive mesenteric ischemia (NOMI) decreased from 12.5:1 to 0.9:1 (p < 0.0001), the proportion of inhabitants aged 80 years or above in the population decreased from 6.0% to 4.3% (p < 0.0001), and the autopsy rate decreased from 25% to 14% (p < 0.0001). The in-hospital mortality rate decreased from 63% to 44% (p = 0.14). The incidence of acute SMA occlusion seems to have decreased significantly in Malmö, probably due to high-resolution computed tomography angiographies being available around the clock to distinguish acute SMA occlusion from NOMI, a reduced proportion of elderly individuals, improved control of medical risk factors, and a decrease in autopsy rates.
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Affiliation(s)
| | - S. Acosta
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
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Bette S, Habeeballah O, Luitjens JH, Kroencke T, Scheurig-Muenkler C, Decker JA. Treatment of acute mesenteric ischemia between 2010 and 2020 - a German nation-wide study. BMC Gastroenterol 2023; 23:300. [PMID: 37674195 PMCID: PMC10481516 DOI: 10.1186/s12876-023-02926-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/12/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Aim of this study was to analyze long-term trends of hospitalizations, treatment regimen and in-hospital mortality of in-patients with acute mesenteric ischemia (AMI) over the past decade and effects of the SARS-CoV2-pandemic. METHODS We analyzed fully anonymized data from the German Federal Statistical Office of patients with AMI between 2010 and 2020. Besides descriptive analyses of age, gender, in-hospital mortality, comorbidity burden and treatment regimen, multivariable logistic regression analyses were performed to identify independent variables associated with in-hospital mortality and different treatment. RESULTS A total of 278,121 hospitalizations (120,667 male [43.4%], mean age 72.1 years) with AMI were included in this study. The total number of hospitalizations increased from 2010 (n = 24,172) to 2019 (n = 26,684) (relative increase 10.4%). In-hospital mortality decreased over the past decade from 36.6% to 2010 to 31.1% in 2019 (rel. decrease 15.2%). Independent risk factors for in-hospital mortality were older age (OR = 1.03 per year), higher comorbidity burden (OR = 1.06 per point in van Walraven score [vWs]), male gender (OR = 1.07), AMI as a secondary diagnosis (OR = 1.44), and the need for surgical (visceral surgery: OR = 1.38, vascular surgery: OR = 3.33) and endovascular treatment (OR = 1.21). We report a decline in hospitalizations during the first wave of infection in spring 2020 (rel. decrease 9.7%). CONCLUSION In-hospital mortality rate has declined over the past decade, but remains high at above 30%. Older age, increased comorbidity and male gender are independent factors for in-hospital mortality. Hospitalizations requiring vascular surgery are associated with high in-hospital mortality, followed by visceral surgery and endovascular approaches. The first wave of the SARS-CoV2-pandemic in spring 2020 implied a decrease in hospital admissions.
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Affiliation(s)
- Stefanie Bette
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Osama Habeeballah
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Jan H Luitjens
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Thomas Kroencke
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
- Centre for Advanced Analytics and Predictive Sciences (CAAPS), University of Augsburg, Universitätsstr. 2, 86159, Augsburg, Germany.
| | - Christian Scheurig-Muenkler
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Josua A Decker
- Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital Augsburg, University of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
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Canlıkarakaya F, Cavit Yüksel B, Er S, Keçelioğlu Y, Neselioglu S. Research of Importance of Thiol, CRP and Lactate in Diagnosing Mesenteric Ischemia At An Early Stage: Animal Model. ULUS TRAVMA ACIL CER 2023; 29:949-955. [PMID: 37681723 PMCID: PMC10560810 DOI: 10.14744/tjtes.2023.45234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/14/2023] [Accepted: 05/24/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION AND PURPOSE Acute mesenteric ischemia is especially seen in the elderly population. It has an increasing incidence in today's world where the average life expectancy is increasing. Early diagnosis is the most important factor reducing morbidity and mortality, and there is still no marker with high sensitivity and specificity for early diagnosis.In this study, we aimed to find a more sensitive and specific serum marker in the early diagnosis of mesenteric ischemia by comparing thiol with the currently used markers C-reactive protein and lactate. MATERIALS AND METHODS In our study, 32 Wistar Albino male rats, 10-12 weeks old, weighing 250-300 g, were used. 32 rats were divided into 4 groups, one of which was the control group. The superior mesenteric artery of the other 3 groups was ligated. Blood samples were taken after 2 hours from the first group, 4 hours from the second group, and 6 hours from the third group. Then the rats were sacrificed. Mesenteric ischemia and its level were observed in sacrificed subjects. The samples were separated under appropriate conditions and analyzed biochemically. RESULTS As the ischemia time increased, CRP increased and this increase was found to be statistically insignificant (p>0.05). The changes in lactate were found to be statistically significant (p<0.05). The difference between the changes of total and native thiol values was found to be statistically significant (p<0.05). CONCLUSION Although CRP is a non-specific parameter in the early diagnosis of acute mesenteric ischemia, lactate maintains its importance as seen in our study. Differences in total thiol and native thiol changes were statistically significant. The fact that this significant difference is observed at the 4th hour values, reveals the importance of these parameters in early diagnosis. Thanks to the economic and fast results of thiol parameters, it is thought that new studies to be added to the literature can lead to the diagnosis of mesenteric ischemia.
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Affiliation(s)
| | - Bülent Cavit Yüksel
- Department of General Surgery, University of Healt Sciences Ankara City Hospital, Ankara -Türkiye
| | - Sadettin Er
- Department of General Surgery, University of Healt Sciences Ankara City Hospital, Ankara -Türkiye
| | - Yasir Keçelioğlu
- Department of General Surgery, University of Healt Sciences Ankara City Hospital, Ankara -Türkiye
| | - Salim Neselioglu
- Department of Medical Biochemistry, Ankara Yildirim Beyazit University, Faculty of Medicine, Ankara-Türkiye
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Kapalla M, Choubey R, Weitz J, Reeps C, Wolk S. Results after intraoperative open and endovascular revascularization of acute mesenteric ischemia requiring a laparotomy. Langenbecks Arch Surg 2023; 408:303. [PMID: 37561214 PMCID: PMC10415437 DOI: 10.1007/s00423-023-03035-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Acute mesenteric ischemia (AMI) is a dreaded condition with a difficult diagnosis and high mortality. Due to different baseline situations, the frequently performed comparison between endovascular and open surgical treatment is interfered with selection bias. The purpose of this study was to review outcomes in AMI treatment with an open or endovascular approach in association with laparotomy and to evaluate the endovascular-first strategy in similar clinical situations. METHODS The clinical data of 74 patients treated for AMI from 2007 to 2021 were retrospectively reviewed and compared. In-hospital mortality was appointed as the primary study endpoint. Risk factors for mortality were identified by using univariate and multivariate analysis. RESULTS In total, 61 patients (82%) were treated open surgically (OT) and, 13 patients (18%) with an endovascular approach (ET) in combination with laparatomy. The etiology of AMI was 49% arteriosclerotic and 51% thromboembolic occlusions. The total in-hospital mortality manifested at 43% (n =32) (OT 41% vs. ET 53.8%; P=0.54). As independent risk factors for in-hospital mortality, pneumatosis intestinalis (P=0.01), increased lactate concentration (P=0.04), and ischemic intestinal sections (P=0.01) were identified. Additionally, on univariate analysis patient age, congestive heart failure (> NYHA II) and atrial fibrillation were related with higher mortality. CONCLUSIONS Morbidity and mortality of AMI remains at a high level. Conventional open or intraoperative endovascular therapy achieved similar results in patients with indication for laparotomy. Advanced disease stage with ischemic intestinal sections at presentation and cardiovascular comorbidities were associated with adverse outcome.
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Affiliation(s)
- Marvin Kapalla
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, TU, Germany.
| | - Rahul Choubey
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, TU, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, TU, Germany
| | - Christian Reeps
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, TU, Germany
| | - Steffen Wolk
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, TU, Germany
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11
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Okamoto K, Saito H, Shimada M, Yamaguchi T, Tsuji T, Moriyama H, Kinoshita J, Nakamura K, Ninomiya I, Takamura H, Inaki N. Successful treatment of nonocclusive mesenteric ischemia in a reconstructed jejunum after esophagectomy and remnant gastric tube resection: a case report. Surg Case Rep 2023; 9:144. [PMID: 37561364 PMCID: PMC10415239 DOI: 10.1186/s40792-023-01726-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/06/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Nonocclusive mesenteric ischemia (NOMI), an ischemic bowel disease without a disruption of the mesenteric blood flow or strangulation of the mesentery or intestine, may cause a lethal clinical course. We report a very rare case of jejunal necrosis caused by NOMI in the pedicled mesentery of the reconstructed jejunum after remnant gastric tube resection for heterochronous gastric tube cancer after esophagectomy. CASE PRESENTATION An 80-year-old man visited our department with chief complaints of fever and appetite loss after 4 months from gastric tube resection and digestive reconstruction with pedicled jejunum. Contrast-enhanced computed tomography (CT) revealed impaired blood flow without torsion of the mesentery, severe wall thickness, and micro-penetration in the reconstructed jejunum and combined pyothorax in the right thoracic cavity. Esophagogastroduodenoscopy demonstrated extensive mucosal necrosis confined to the jejunum, which was elevated in the thoracic cavity. The jejunal necrosis due to NOMI occurring in the reconstructed jejunum was suspected, and lifesaving small bowel resection with right thoracotomy was considered necessary. However, radical operation with right thoracotomy was considered to be excessively invasive and not valid due to the patient's poor physical status, advanced age, and presence of left adrenal metastasis from the remnant gastric cancer. Therefore, we selected the conservative treatment with fasting, transnasal drainage, and administration of antibiotics due to the patient's intention. CT-guided right thoracic drainage for the intrathoracic abscess was needed 10 days after starting treatment and the inflammatory response rapidly improved. Follow-up CT and esophagogastroduodenoscopy revealed the improvement in the ischemic changes in jejunal mucosa without perforation. Intake was initiated at 20 days after symptom onset, and the patient was discharged at 40 hospital days without any complications and sequelae. CONCLUSIONS To the best of our knowledge, this is the first case of NOMI occurring in the reconstructed jejunum after remnant gastric tube resection that was successfully treated with a conservative treatment. For NOMI, it is important to make appropriate diagnosis based on imaging findings and perform proper assessment of the patient's condition. Conservative treatments may be also useful depending on the patient's condition.
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Affiliation(s)
- Koichi Okamoto
- Department of Gastrointestinal Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan.
- Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinadamachi, Ishikawa, Kahoku, 920-0293, Japan.
| | - Hiroto Saito
- Department of Gastrointestinal Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Mari Shimada
- Department of Gastrointestinal Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takahisa Yamaguchi
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa, Ishikawa, 920-8530, Japan
| | - Toshikatsu Tsuji
- Department of Gastrointestinal Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hideki Moriyama
- Department of Gastrointestinal Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Jun Kinoshita
- Department of Gastrointestinal Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Keishi Nakamura
- Department of Gastrointestinal Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Itasu Ninomiya
- Department of Surgery, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui, 910-0846, Japan
| | - Hiroyuki Takamura
- Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinadamachi, Ishikawa, Kahoku, 920-0293, Japan
| | - Noriyuki Inaki
- Department of Gastrointestinal Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
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12
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Reichert M, Roller FC, Kalder J, Hecker M, Bala M, Catena F, Biffl W, Coccolini F, Moore EE, Ansaloni L, Damaskos D, Sartelli M, Padberg W, Hecker A. [Acute mesenteric ischemia-An overview and recommendations (S2k analogous) of the World Society of Emergency Surgery]. CHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00104-023-01913-x. [PMID: 37335317 DOI: 10.1007/s00104-023-01913-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/21/2023]
Abstract
Acute mesenteric ischemia is a severe illness, which if untreated, rapidly leads to a critical condition with sepsis, multiple organ failure and death in affected patients. The diagnosis and initiation of treatment of acute mesenteric ischemia should be performed as early and expeditiously as possible and follows the principle of the shortest possible time to reperfusion. Otherwise, the outcome of the patient rapidly deteriorates. The treatment algorithm should be adapted to the pathogenesis of the ischemia, the clinical condition and symptoms of the patients. With clinical signs of peritonitis, intestinal gangrene must be assumed and the abdomen should be surgically explored to detect and treat possible foci of sepsis at an early stage. The treatment of acute mesenteric ischemia should always be performed by an interdisciplinary team with all surgical and interventional options for intestinal revascularization as well as comprehensive intensive care medicine according to the standards of the Intestinal Stroke Center described in the literature. A short duration to revascularization and treatment in this interdisciplinary concept improves the outcome of patients with acute mesenteric ischemia. The World Society of Emergency Surgery provides expert consensus-based recommendations for the diagnosis and treatment of acute mesenteric ischemia; however, there is still a significant lack of broad high-quality evidence for this critical illness. Recommendations of the German specialist societies are urgently needed to ensure appropriate care, from the initial diagnostics to treatment and aftercare, for patients with suspected mesenteric ischemia in this country.
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Affiliation(s)
- Martin Reichert
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Straße 7, 35392, Gießen, Deutschland
| | - Fritz C Roller
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Gießen, Klinikstraße 33, 35392, Gießen, Deutschland
| | - Johannes Kalder
- Klinik für Herz‑, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Straße 7, 35392, Gießen, Deutschland
| | - Matthias Hecker
- Klinik für Innere Medizin II - Pneumologie, Gastroenterologie, Nephrologie und internistische Intensivmedizin, Universitätsklinikum Gießen, Klinikstraße 33, 35392, Gießen, Deutschland
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Fausto Catena
- Department of General and Emergency Surgery, "Maurizio Bufalini" Hospital, Cesena, Italien
| | - Walter Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, USA
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italien
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, USA
| | - Luca Ansaloni
- Department of Surgery, Pavia University Hospital, Pavia, Italien
| | - Dimitrios Damaskos
- Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, Schottland, United Kingdom
| | | | - Winfried Padberg
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Straße 7, 35392, Gießen, Deutschland
| | - Andreas Hecker
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen, Rudolf-Buchheim-Straße 7, 35392, Gießen, Deutschland.
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13
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Abdelhamid A, Salim M. Erector Spinae Plane Block (ESPB) as an Alternative for Celiac Plexus Blocks: Expanding ESPB Indications for Mesenteric Ischemia Relief. Cureus 2023; 15:e39860. [PMID: 37404427 PMCID: PMC10315009 DOI: 10.7759/cureus.39860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
Mesenteric ischemia is a severe condition associated with abdominal pain which often requires multimodal analgesia, including opioids or sympathetic blocks such as celiac plexus blocks. The erector spinae plane (ESPB) has emerged as a potentially effective alternative for managing pain in various surgical and non-surgical conditions. This case report explores the use of ultrasound-guided ESPB as a novel approach to pain management in a patient with acute on chronic mesenteric ischemia. A 70-year-old male with a history of mesenteric ischemia and multiple comorbidities presented with worsening diffuse abdominal pain. Despite medical and surgical treatment, the patient required a high dose of opioids for pain control. Bilateral ESPBs with continuous infusions were performed at the T6 level under ultrasound guidance. The patient reported immediate and complete relief from abdominal pain following the block, with a significant drop in the pain score. The use of opioids was significantly reduced. This case report demonstrates the potential benefits of ultrasound-guided ESPB as an alternative to traditional pain management techniques in patients with mesenteric ischemia. ESPB may provide safe, simple, and effective analgesia, reducing the need for high-dose opioids and their associated side effects. Further studies are warranted to validate these findings and explore the broader application of ESPB in the management of mesenteric ischemia pain.
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Affiliation(s)
| | - Mohmad Salim
- Anesthesia, Walsall Healthcare NHS Trust, Walsall, GBR
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14
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Bongiovanni S, Bozzolo M, Amabile S, Peano E, Balderi A. Case report: ultrasound assisted catheter directed thrombolysis of an embolic partial occlusion of the superior mesenteric artery. FRONTIERS IN RADIOLOGY 2023; 3:1167901. [PMID: 37492380 PMCID: PMC10365118 DOI: 10.3389/fradi.2023.1167901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/25/2023] [Indexed: 07/27/2023]
Abstract
Acute mesenteric ischemia (AMI) is a severe medical condition defined by insufficient vascular supply to the small bowel through mesenteric vessels, resulting in necrosis and eventual gangrene of bowel walls. We present the case of a 64-year-old man with recrudescence of prolonged epigastric pain at rest of few hours duration, cold sweating and episodes of vomiting. A computed tomography scan of his abdomen revealed multiple filling defects in the mid-distal part of the superior mesenteric artery (SMA) and the proximal part of jejunal branches, associated with small intestine walls thickening, suggesting SMA thromboembolism and initial intestinal ischemia. Considering the absence of signs of peritonitis at the abdominal examination and the presence of multiple arterial emboli was decided to perform an endovascular treatment with ultrasound assisted catheter-directed thrombolysis with EkoSonic Endovascular System-EKOS, which resulted in complete dissolution of the multiple emboli and improved blood flow into the intestine wall. The day after the procedure the patient's pain improved significantly and 5 days after he was discharged home asymptomatic on warfarin anticoagulation. After 1 year of follow-up the patient is fine with no further episodes of mesenteric ischemia or other embolisms.
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Affiliation(s)
- Simone Bongiovanni
- Interventional Radiology Unit, Department of Radiology, A.O. S. Croce e Carle - Cuneo, Cuneo, Italy
| | - Marco Bozzolo
- Postgraduate School in Radiology, University of Turin, Turin, Italy
| | - Simone Amabile
- Postgraduate School in Radiology, University of Turin, Turin, Italy
| | - Enrico Peano
- Interventional Radiology Unit, Department of Radiology, A.O. S. Croce e Carle - Cuneo, Cuneo, Italy
| | - Alberto Balderi
- Interventional Radiology Unit, Department of Radiology, A.O. S. Croce e Carle - Cuneo, Cuneo, Italy
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15
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Tian Y, Dhara S, Barrett CD, Richman AP, Brahmbhatt TS. Antibiotic use in acute mesenteric ischemia: a review of the evidence and call to action. Thromb J 2023; 21:39. [PMID: 37041639 PMCID: PMC10088293 DOI: 10.1186/s12959-023-00486-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/03/2023] [Indexed: 04/13/2023] Open
Abstract
Acute mesenteric ischemia (AMI) is a life-threatening condition with a high mortality rate. The standard practice after making the diagnosis includes aggressive resuscitation, anticoagulation, followed by revascularization and resection of necrotic bowel. The role of empiric antibiotics in the management of AMI is not well defined in the literature. This review article aims to examine our current understanding on this matter, based on bench research and clinical studies. It is demonstrated in animal study model that the ischemia/reperfusion (I/R) injury damages intestinal epithelium, and subsequently lead to barrier dysfunction, a condition that can support bacterial translocation through a complex interplay between the intestinal epithelium, the intestinal immune system and the intestine's endogenous bacterial population. Based on this mechanism, it is possible that the use of antibiotics may help mitigate the consequences of I/R injury, which is examined in few animal studies. In clinical practice, many guidelines support the use of prophylactic antibiotics, based on a meta-analysis of randomized control trials (RCTs) demonstrating the benefit of antibiotics in multi-organ dysfunction syndrome. However, there is no direct reference to AMI in this meta-analysis. Most clinical studies that focus on AMI and mentions the use of antibiotics are retrospective and single institution, and very few comments on the role of antibiotics in their discussions. We conclude that there is limited evidence in literature to support the use of prophylactic antibiotic in AMI to improve outcome. More clinical studies with high level of evidence and basic science research are needed to improve our understanding on this topic and ultimately help build a better clinical pathway for patients with AMI.
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Affiliation(s)
- Yuqian Tian
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sanjeev Dhara
- Division of Vascular Surgery, Department of Surgery, Emory University, Atlanta, GA, USA
| | - Christopher D Barrett
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Aaron P Richman
- Divisions of Trauma and Acute Care Surgery and Surgical Critical Care, Department of Surgery, Boston University Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Tejal S Brahmbhatt
- Divisions of Trauma and Acute Care Surgery and Surgical Critical Care, Department of Surgery, Boston University Medical Center, Boston University School of Medicine, Boston, MA, USA.
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16
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Muhtaroğlu A, Çapoğlu R, Uygur FA, Harmantepe AT, Bayhan Z, Gönüllü E. FAR Ratio as Prognostic Biomarker in AMI. SN COMPREHENSIVE CLINICAL MEDICINE 2023; 5:109. [PMID: 36970580 PMCID: PMC10031717 DOI: 10.1007/s42399-023-01451-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 03/28/2023]
Abstract
Acute mesenteric ischemia (AMI) is a vascular emergency resulting from decreased blood flow caused by the occlusion of the mesenteric vessels, hypoperfusion, or vasospasm. This study aimed to investigate the prognostic value of the fibrinogen-to-albumin (FAR) ratio in patients with acute mesenteric ischemia. A total of 91 patients were enrolled in the study. Patients' demographics such as age and gender, pre- and postoperative hemoglobin, CRP, white blood cell (WBC), neutrophils, preoperative lymphocyte, alanine transaminase (ALT), aspartate transaminase (AST), thrombocytes, and postoperative D-dimer values were recorded. In addition, pre- and postoperative fibrinogen and albumin levels were recorded, and FAR was calculated. Patients were divided into two groups, survivors and non-survivors. The mean pre- and postoperative fibrinogen levels were statistically significantly higher in the non-survivor group than in the survivor group (p < 0.001). The mean pre- and postoperative albumin levels were significantly lower in the non-survivors than in the survivors (p = 0.059, p < 0.001; respectively). The mean pre- and postoperative FAR ratios were considerably higher in the non-survivor than in the survivor groups (p < 0.001). The change between pre- and postoperative fibrinogen, albumin, and FAR values was statistically significant between the non-survivors and the survivors (for all, p < 0.05). The preoperative and postoperative fibrinogen levels were significantly lower, and albumin levels were significantly higher in the survivor compared to the non-survivor patients with AMI. Furthermore, the preoperative and postoperative FAR ratio was significantly higher in the non-survivors. The FAR ratio may be a valuable prognostic biomarker for patients with AMI.
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Affiliation(s)
- Ali Muhtaroğlu
- Department of General Surgery, Giresun University Faculty of Medicine, Giresun University Training and Research Hospital, Aksu District, Mehmet İzmen Street, Number: 145, 28100 Giresun, PC Turkey
| | - Recayi Çapoğlu
- General Surgery Clinic, Sakarya Training and Research Hospital, Adapazari, Turkey
| | - Furkan Ali Uygur
- Department of General Surgery, Giresun University Faculty of Medicine, Giresun University Training and Research Hospital, Aksu District, Mehmet İzmen Street, Number: 145, 28100 Giresun, PC Turkey
| | | | - Zülfü Bayhan
- Department of General Surgery, Sakarya University Faculty of Medicine, Adapazari, Turkey
| | - Emre Gönüllü
- Department of Gastroenterological Surgery, Sakarya University Faculty of Medicine, Adapazari, Turkey
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17
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Karaosmanoglu AD, Onder O, Kizilgoz V, Hahn PF, Kantarci M, Ozmen MN, Karcaaltincaba M, Akata D. Infarcts and ischemia in the abdomen: an imaging perspective with an emphasis on cross-sectional imaging findings. Abdom Radiol (NY) 2023; 48:2167-2195. [PMID: 36933024 PMCID: PMC10024022 DOI: 10.1007/s00261-023-03877-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/19/2023]
Abstract
Infarcts and ischemia of abdominal organs may present with acute abdominal pain, and early diagnosis is crucial to prevent morbidity and mortality. Unfortunately, some of these patients present in poor clinical conditions to the emergency department, and imaging specialists are crucial for optimal outcomes. Although the radiological diagnosis of abdominal infarcts is often straightforward, it is vital to use the appropriate imaging modalities and correct imaging techniques for their detection. Additionally, some non-infarct-related abdominal pathologies may mimic infarcts, cause diagnostic confusion, and result in delayed diagnosis or misdiagnosis. In this article, we aimed to outline the general imaging approach, present cross-sectional imaging findings of infarcts and ischemia in several abdominal organs, including but not limited to, liver, spleen, kidneys, adrenals, omentum, and intestinal segments with relevant vascular anatomy, discuss possible differential diagnoses and emphasize important clinical/radiological clues that may assist radiologists in the diagnostic process.
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Affiliation(s)
| | - Omer Onder
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Volkan Kizilgoz
- Department of Radiology, Erzincan Binali Yıldırım University School of Medicine, 24100, Erzincan, Turkey
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Mecit Kantarci
- Department of Radiology, Erzincan Binali Yıldırım University School of Medicine, 24100, Erzincan, Turkey
- Department of Radiology, Atatürk University School of Medicine, 25240, Erzurum, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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18
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Bötticher G. Akute mesenteriale Durchblutungsstörung – arterielle Thrombose. COLOPROCTOLOGY 2023. [DOI: 10.1007/s00053-023-00691-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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19
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Liu HT, Lai CY, Liao JJ, Chen YJ, Cheng SB, Wu CC. Immediate postoperative parenteral anticoagulant therapy in patients with mesenteric ischemia after intestinal resection: a retrospective cohort study at a single institute. BMC Gastroenterol 2023; 23:56. [PMID: 36890480 PMCID: PMC9996985 DOI: 10.1186/s12876-023-02691-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/22/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Bowel gangrene represents a major fatal event in acute mesenteric ischemia. Intestinal resection is inevitable in patients with peritonitis and bowel gangrene. This retrospective study aimed to elucidate the benefit of postoperative parenteral anticoagulation in patients with intestinal resection. METHODS Patients with acute mesenteric ischemia and bowel gangrene were recruited retrospectively between January 2007 and December 2019. All patients underwent bowel resection. They were categorized into two groups: patients without immediate parenteral anticoagulant therapy (Group A) and those with immediate parenteral anticoagulant therapy (Group B). Thirty-day mortality and survival were analyzed. RESULTS A total of 85 patients were included, with 29 patients in Group A and 56 patients in Group B. Patients in Group B had lower 30-day mortality (16.1%) and a higher 2-year survival rate (45.4%) than patients in Group A (30-day mortality: 51.7%, p = 0.001; 2-year survival rate: 19.0%, p = 0.001). In the 30-day mortality multivariate analysis, patients in Group B had a better outcome (odds ratio = 0.080, 95% confidence interval between 0.011 and 0.605, p = 0.014). Patients in Group B also had a better outcome in the survival multivariate analysis (hazard ratio: 0.435, 95% confidence interval between 0.213 and 0.887, p = 0.022). CONCLUSIONS Immediate postoperative parenteral anticoagulant therapy improves prognosis in patients with acute mesenteric ischemia treated by intestinal resection. Trial registration This research was retrospectively approved by the Institutional Review Board (IRB) I&II of Taichung Veterans General Hospital (TCVGH-IRB No.CE21256B) on July 28th, 2021. The informed consent waiver was also approved by IRB I&II of Taichung Veterans General Hospital. The Declaration of Helsinki and ICH-GCP guidelines were followed during this study.
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Affiliation(s)
- Hsiao-Tien Liu
- Department of Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, ROC. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Chia-Yu Lai
- Organ Transplantation Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Jian-Jhou Liao
- Department of Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, ROC
| | - Yi-Ju Chen
- Department of Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, ROC
| | - Shao-Bin Cheng
- Organ Transplantation Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Chung Wu
- Department of Surgery, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan, ROC.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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20
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Schaab F. Nichtokklusive mesenteriale Ischämie. COLOPROCTOLOGY 2023. [DOI: 10.1007/s00053-023-00692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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21
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Acute Superior Mesenteric Artery Embolism Treated with Percutaneous Mechanical Thrombectomy: a Single-Center Preliminary Application and Experience. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03676-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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22
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Witte M, Neese M, Leuchter M, Philipp M, Klar E, Schafmayer C. Acute Mesenteric Ischemia: Preexisting Comorbidity Determines Short-Term Outcome and Quality of Life in Long-Term Survivors. Visc Med 2022; 38:393-399. [PMID: 36589248 PMCID: PMC9801324 DOI: 10.1159/000526921] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/23/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Acute mesenteric ischemia (AMI), either arterial or venous, is still a devastating disease with poor prognosis. It is unknown, whether AMI is associated with impaired quality of life (QoL) in long-term survivors. Material and Methods This retrospective analysis includes 64 patients with occlusive arterial or venous mesenteric ischemia treated operatively between 2008 and 2016 at the University Medical Center Rostock. Short-term outcome with focus on comorbidities was measured by the Charlson comorbidity index (CCI) an instrument that operationally measures comorbidity based on 17 clinical parameters including age. Operative outcome in view of enterostomy placement and long-term outcome measured as QoL by the EQ-5D in the long-term survivors were evaluated. The EQ-5D is a standardized, self-reported five-dimension QoL questionnaire built to provide a simple and generic measure of health. Results Thirty-day mortality was 60.9%, and in-hospital mortality was 70.3% (n = 45). No patient was discharged with a stoma. Patients with a primary anastomosis after the initial operation for AMI had a high leak rate of 27% (4/15 patients) compared to no dehiscence in the group of patients who had secondary anastomosis during second or third laparotomy. The long-term survivors had significantly lower CCI compared to the 45 nonsurvivors (median 4 [3, 4, 5, 6] vs. 6 [4, 5, 6, 7]). All long-term survivors had QoL assessment. QoL score was significantly impaired compared to an age- and sex-matched reference population. This impairment was not due to disease-specific sequelae such as presence of stool deviation or intestinal failure but due to preexisting risk factors as shown by an inverse relation between the CCI and QoL score. Conclusion Herein, we show for the first time that long-term QoL in patients with AMI is impaired but this impairment is not due to disease-specific aspects but rather general risk factors underlying the presence of a higher level of comorbidities at the time of AMI.
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Affiliation(s)
- Maria Witte
- Department of General, Visceral, Vascular, Thoracic and Transplant Surgery, University Medical Center Rostock, Rostock, Germany
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23
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Straarup D, Gotschalck KA, Mikalone R, Thorlacius-Ussing O. Preoperative findings on non-specific CT in patients with primary acute intestinal ischemia: a case-control study. Eur J Trauma Emerg Surg 2022; 48:3025-3032. [PMID: 34216221 DOI: 10.1007/s00068-021-01741-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/19/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Primary acute intestinal ischaemia (AII) is an abdominal catastrophe caused by intravascular obstruction of blood supply. It is difficult to diagnose. Computerized tomography (CT) scan is the modality of choice for diagnostic evaluation. Majority of previous studies have evaluated CT findings in patients where AII was suspected. However, unveiling the unique radiological findings also in not initially suspected AII patients, might lead to the timely management of AII patients, and is the aim of this study. METHODS In a single-center, retrospective case-control study, preoperative radiological findings from abdominal CT scans in 48 patients with primary AII were compared with 80 non-ischemic controls. Radiological findings were analyzed using multivariable logistical regression with adjustment for age and gender and reported as odds ratios (OR) with 95% confidence intervals (CI) and p values. RESULTS Thirty-nine (81%) cases with AII were referred to an abdominal CT scan without a specific clinical suspicion of AII. Three main radiological categories (intestinal wall pathology [OR 7.4, CI 2.3-24.0, p value < 0.001], gastrointestinal vessel pathology [OR 19.3, CI 4.6-80.5, p value < 0.001) and intestinal diameter [OR 4.7, CI 1.6-13.4, p value 0.004]) were significantly different in AII patients. Subgroup analysis implied that pneumatosis intestinalis, increased contrast enhancement in the bowel wall, inferior mesenteric artery arteriosclerosis and colonic contraction were predictors of AII. CONCLUSION Radiological changes within the intestinal wall, luminal diameter and gastrointestinal vessels are independent predictors of AII. Awareness of these radiological findings, therefore, plays a central role in patients with an indistinct clinical picture in early recognition and treatment of a life-threatening AII. TRIAL REGISTRATION NUMBER NCT04361110 (April 24, 2020), retrospectively registered.
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Affiliation(s)
- David Straarup
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark.
- Department of Surgery, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjørring, Denmark.
| | - Kåre Andersson Gotschalck
- Department of Gastrointestinal Surgery, Randers Regional Hospital, Skovlyvej 15, 8930, Randers, NØ, Denmark
| | - Rasa Mikalone
- Department of Diagnostic Radiology, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark
| | - Ole Thorlacius-Ussing
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Niels Jernes Vej 10, 9220, Aalborg, Denmark
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Kyuno T, Otsuka K, Kobayashi M, Yoshida E, Sato K, Kawagishi R, Kono T, Chiba T, Kimura T, Yonezawa H, Funato O, Takagane A. Time limit to rescue intestine with viability at risk caused by blood flow disruption in patients presenting with acute abdomen. Surg Today 2022; 52:1627-1633. [PMID: 35338428 PMCID: PMC9592629 DOI: 10.1007/s00595-022-02495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/27/2022] [Indexed: 11/24/2022]
Abstract
Purpose Early management is crucial for acute intestinal blood flow disorders; however, no published study has identified criteria for the time limit for blood flow resumption. This study specifically examines the time factors for avoiding intestinal resection. Methods The subjects of this retrospective cohort study were 125 consecutive patients who underwent emergency surgery for a confirmed diagnosis of intestinal strangulation (n = 86), incarceration (n = 27), or volvulus (n = 12), between January 2015 and March 2021. Intestinal resection was performed when intestinal irreversible changes had occurred even after ischemia was relieved surgically. We analyzed the relationship between the time from computed tomography (CT) imaging to the start of surgery (C-S time) and intestinal resection using the Kaplan–Meier method and calculated the estimated intestinal rescue rate. Patient background factors affecting intestinal resection were also examined. Results The time limit for achieving 80% intestinal rescue rate was 200 min in C-S time, and when this exceeded 300 min, the intestinal rescue rate dropped to less than 50%. Multivariate analysis identified the APACHE II score as a significant influencing factor. Conclusion A rapid transition from early diagnosis to early surgery is critical for patients with acute abdomen originating from intestinal blood flow disorders. The times from presentation at the hospital to surgery should be reduced further, especially for severe cases.
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Affiliation(s)
- Takuro Kyuno
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan.
| | - Kanki Otsuka
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Makoto Kobayashi
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Eiji Yoshida
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Kei Sato
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Ryoko Kawagishi
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Tsuyoshi Kono
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Takehiro Chiba
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Toshimoto Kimura
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Hitoshi Yonezawa
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Osamu Funato
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Akinori Takagane
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
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Pankratov AA, Snitsar AV, Vasilchenko MI, Zelenin DA, Matkov IV, Varfalomeev SI, Izrailov RE, Perekhodov SN. [CT angiography and endovascular treatment in acute mesenteric ischemia]. Khirurgiia (Mosk) 2022:50-55. [PMID: 35289549 DOI: 10.17116/hirurgia202203150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To optimize the treatment strategy for acute mesenteric ischemia (AMI). MATERIAL AND METHODS The study included 43 patients aged 76.4±10.3 years. CT angiography and endovascular repair of mesenteric vessels underlie the new treatment approach. RESULTS CT angiography according to the established criteria was performed in 31 patients with suspected AMI throughout 1 year. Sensitivity was 90.0%, specificity - 100%, accuracy - 95%. Endovascular interventions were applied in 13 patients (successful in 8 cases and unsuccessful in 5 patients). Mortality rate was 37.5%. Fifteen patients with clinical signs of peritonitis or after previous unsuccessful interventional revascularization underwent open surgery. Mortality rate was 86.7%. CONCLUSION CT angiography is valuable to diagnose AMI at the stage of reversible changes in bowel wall in some cases. Endovascular revascularization as the first-line treatment has certain prospects.
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Affiliation(s)
- A A Pankratov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Demikhov Moscow City Clinical Hospital, Moscow, Russia
| | - A V Snitsar
- Demikhov Moscow City Clinical Hospital, Moscow, Russia
| | | | - D A Zelenin
- Demikhov Moscow City Clinical Hospital, Moscow, Russia
| | - I V Matkov
- Demikhov Moscow City Clinical Hospital, Moscow, Russia
| | | | - R E Izrailov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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26
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Zhang SY, He BJ, Xu HH, Xiao MM, Zhang JJ, Tong PJ, Mao Q. Concealed mesenteric ischemia after total knee arthroplasty: A case report. World J Clin Cases 2021; 9:6515-6521. [PMID: 34435020 PMCID: PMC8362583 DOI: 10.12998/wjcc.v9.i22.6515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In critical care medicine, mesenteric ischemia (MI) is a life-threatening disease that can be present in both critically ill patients and those undergoing major surgery. For the first time, we report a case of concealed MI with a long course after knee arthroplasty.
CASE SUMMARY A male patient underwent left total knee arthroplasty for gouty arthritis and developed a persistent fever and persistently high levels of serum infection markers after surgery. He was considered to have a periprosthetic site infection and treated with antibiotics and colchicine, periprosthetic debridement was performed, and the spacer was replaced, but no improvement was seen. At 54 d after arthroplasty, the patient developed gastrointestinal symptoms of nausea and vomiting, abdominal distention, and subsequently, cloudiness of consciousness, and hypotensive shock. Finally, the patient was diagnosed with ascending colonic mesentery ischemia with necrosis after laparotomy, which improved after right hemicolectomy.
CONCLUSION Concealed MI without gastrointestinal symptoms after major surgery is rare and easily misdiagnosed. Orthopedic surgeons need to be aware of this complication.
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Affiliation(s)
- Sheng-Yang Zhang
- Department of Orthopedics, Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing 312000, Zhejiang Province, China
| | - Bang-Jian He
- Department of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
| | - Hui-Hui Xu
- Institute of Orthopedics and Traumatology, The First College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Miao-Miao Xiao
- The Second People’s Hospital of Xiaoshan District, Hangzhou 311241, Zhejiang Province, China
| | - Jing-Jing Zhang
- Institute of Orthopedics and Traumatology, The First College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Pei-Jian Tong
- Department of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
| | - Qiang Mao
- Department of Orthopedics and Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
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Davarpanah AH, Ghamari Khameneh A, Khosravi B, Mir A, Saffar H, Radmard AR. Many faces of acute bowel ischemia: overview of radiologic staging. Insights Imaging 2021; 12:56. [PMID: 33914188 PMCID: PMC8085211 DOI: 10.1186/s13244-021-00985-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
Acute bowel ischemia (ABI) can be life threatening with high mortality rate. In spite of the advances made in diagnosis and treatment of ABI, no significant change has occurred in the mortality over the past decade. ABI is potentially reversible with prompt diagnosis. The radiologist plays a central role in the initial diagnosis and preventing progression to irreversible intestinal ischemic injury or bowel necrosis. The most single imaging findings described in the literature are either non-specific or only present in the late stages of ABI, urging the use of a constellation of features to reach a more confident diagnosis. While ABI has been traditionally categorized based on the etiology with a wide spectrum of imaging findings overlapped with each other, the final decision for patient's management is usually made on the stage of the ABI with respect to the underlying pathophysiology. In this review, we first discuss the pathologic stages of ischemia and then summarize the various imaging signs and causes of ABI. We also emphasize on the correlation of imaging findings and pathological staging of the disease. Finally, a management approach is proposed using combined clinical and radiological findings to determine whether the patient may benefit from surgery or not.
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Affiliation(s)
- Amir H Davarpanah
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, USA
| | - Afshar Ghamari Khameneh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bardia Khosravi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, 14117, North Kargar St., Tehran, Iran
| | - Ali Mir
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hiva Saffar
- Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, 14117, North Kargar St., Tehran, Iran.
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28
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Endovascular Revascularization with Stent Implantation in Patients with Acute Mesenteric Ischemia due to Acute Arterial Thrombosis: Clinical Outcome and Predictive Factors. Cardiovasc Intervent Radiol 2021; 44:1030-1038. [PMID: 33825061 PMCID: PMC8190006 DOI: 10.1007/s00270-021-02824-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/10/2021] [Indexed: 02/07/2023]
Abstract
Purpose To determine 30-day-mortality rates and identify predictors for survival in patients undergoing endovascular revascularization for acute mesenteric ischemia (AMI) due to occlusion of the celiac (CA) or superior mesenteric artery (SMA) from arterial thrombosis in the setting of atherosclerosis at the vessel origin. Materials and Methods A retrospective analysis on patients who underwent acute endovascular revascularization to treat AMI caused by thrombotic occlusion of the CA and/or SMA between January 2011 and December 2019 was conducted. 30-day-mortality rates were calculated. Univariate binomial logistic regression analyses (p < 0.05) were performed to assess whether the following factors were associated with 30-day mortality: sex, age, history of smoking, history of abdominal angina, signs of bowel necrosis on pre-interventional CT, one- vs. two-vessel disease, patency of the inferior mesenteric artery, outpatient or inpatient occurrence of ischemia, onset of AMI during ITU stay, elevated pre-interventional serum lactate levels, total leukocyte count, platelet/lymphocyte ratio and neutrophil/lymphocyte ratio. Results 40 patients were included in this analysis. 30-day-mortality rate was 25/40 (62.5%). Median overall survival of patients who survived the first 30 days was 36 ± 18 months. None of the analyzed factors was statistically significantly associated with 30-day mortality. Conclusion Although mortality of patients with AMI due to acute arterial thrombosis remains high, almost 40% of patient who underwent emergent endovascular revascularization survived longer than one month. Since no predictors for the outcome in these patients were identified, all patients with AMI should be offered an immediate revascularization effort.
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29
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Thomsen T, Dietrich CF. [Postmortem sonography helpful in death of unknown origin]. Med Klin Intensivmed Notfmed 2021; 116:254-258. [PMID: 33559701 DOI: 10.1007/s00063-021-00784-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 11/19/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
Postmortem imaging has been used primarily in forensic medicine since 1895. Conventional x‑ray, computed tomography (CT), and magnetic resonance imaging (MRI) are used. In studies, sonography is not considered to be of particular value, especially because of postmortem gas formation in adults. We report three cases in which postmortem sonography within three hours of death allowed clarification of a previously unclear cause of death.
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Affiliation(s)
- T Thomsen
- Klinik für Innere Medizin, Westküstenkliniken, Brunsbüttel, Deutschland
| | - C F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Schänzlihalde 11, 3013, Bern, Schweiz.
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30
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Chai L, Wang Y, Fan FD, Wang DJ. Acute type A aortic dissection with mesenteric malperfusion syndrome: a case report. Shijie Huaren Xiaohua Zazhi 2021; 29:152-158. [DOI: 10.11569/wcjd.v29.i3.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with acute type A aortic dissection and mesenteric malperfusion syndrome (mesMPS) have a high mortality rate. Therefore, the analysis of the timing of open aortic repair and intestinal operation is of great significance for the timely selection of clinical treatment.
CASE SUMMARY The chief complaints of the patient were sudden chest and back bursting pain for 15 h. Emergency "ascending aorta replacement + total arch replacement (island flap anastomosis) + descending aorta stent implantation + coronary artery bypass grafting + autologous vascular access" was performed. The patient's postoperative occult blood test was positive. His blood stool was visible to the naked eye on the 11th day after the open aortic repair. He had abdomen tenderness on the 12th postoperative day. He had abdominal pain and was diagnosed by CT with intestinal obstruction on the 13th postoperative day. Then, he underwent an emergency laparotomy for right hemicolectomy + partial resection of small intestine + cholecystectomy + ileostomy. He was discharged with diagnoses of aortic dissection (type A), coronary dissection, multiple perforations of the colon, congenital ectopic small bowel glands, and acute attack of chronic cholecystitis. More than a year later, he underwent "intestinal adhesion lysis + ileostomy closure + incisional hernia repair". The patient recovered well at the 1-year follow-up.
CONCLUSION We have reported a case of acute type A aortic dissection with mesenteric malperfusion syndrome. In the early stage of mesenteric hypoperfusion syndrome, specific laboratory examination indexes and clinical manifestations are lacking, and mesenteric multidetector CT angiography is a first-line examination method for mesenteric malperfusion. Through the detailed analysis of the patient's condition and the review of the relevant literature, we hope to have a deeper understanding of this condition and provide evidence supporting the formulation of clinical treatment plan.
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Affiliation(s)
- Lin Chai
- Nanjing Drum Tower Hospital, Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Nanjing 210008, Jiangsu Province, China,Department of Cardio-Thoracic Surgery, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Yue Wang
- Department of Cardio-Thoracic Surgery, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Fu-Dong Fan
- Department of Cardio-Thoracic Surgery, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Dong-Jin Wang
- Nanjing Drum Tower Hospital, Graduate School of Peking Union Medical College, Peking Union Medical College, Chinese Academy of Medical Sciences, Nanjing 210008, Jiangsu Province, China,Department of Cardio-Thoracic Surgery, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
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31
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Grotelueschen R, Miller V, Heidelmann LM, Melling N, Ghadban T, Grupp K, Reeh M, Welte MN, Uzunoglu FG, Izbicki JR, Bachmann KA. Acute Mesenteric Infarction: The Chameleon of Acute Abdomen Evaluating the Quality of the Diagnostic Parameters in Acute Mesenteric Ischemia. Dig Surg 2021; 38:149-157. [PMID: 33503619 DOI: 10.1159/000512779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/25/2020] [Indexed: 12/10/2022]
Abstract
INTRODUCTION/OBJECTIVE Acute mesenteric ischemia (AMI) is difficult to diagnose. Since the established parameters have low sensitivity and specificity, the aim of this study is to analyze the diagnostic quality of the established parameters of AMI. METHODS All patients that underwent emergency surgery due to suspected diagnosis of mesenteric ischemia at the University Medical Center Hamburg-Eppendorf between 2008 and 2014 were evaluated. Overall, 275 patients were enrolled and pre-, intra- and postoperative data were evaluated. RESULTS In 200 patients, a mesenteric ischemia was confirmed intraoperatively, and 75 patients had no ischemia. Comparing these groups, the rate of patients with pH < 7.2 (25 vs. 12%; p = 0.021) and elevated mean CRP level (175 ± 117 mg/L vs. 139 ± 104 mg/L; p = 0.019) was significantly higher in ischemic patients. There was no significant difference in the level of preoperative lactate. Concerning abdominal CT scan, a sensitivity and specificity of 61 and 68%, respectively, was found. CONCLUSION New diagnostic parameters are needed. So far, explorative laparotomy is the only reliable diagnostic method to detect mesenteric infarction.
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Affiliation(s)
- Rainer Grotelueschen
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Verena Miller
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Lena M Heidelmann
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany,
| | - Nathaniel Melling
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Tarik Ghadban
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Grupp
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Reeh
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Maria-Noemi Welte
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Faik Güntac Uzunoglu
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kai A Bachmann
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Strait A, Gasper W, Dhaliwal G. The Resolution of Abdominal Pain: an Ominous Sign of Mesenteric Ischemia. J Gen Intern Med 2021; 36:216-219. [PMID: 33150528 PMCID: PMC7859142 DOI: 10.1007/s11606-020-06313-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Adrienne Strait
- School of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Warren Gasper
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
- Vascular Surgery Section, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Gurpreet Dhaliwal
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Medical Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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33
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Pankratov AA, Perehodov SN, Zelenin DA, Izrailov RE, Matkov IV. [Is acute mesenteric ischemia incurable situation? The current state of the problem]. Khirurgiia (Mosk) 2020:105-110. [PMID: 33301263 DOI: 10.17116/hirurgia2020121105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Mortality rates in acute mesenteric ischemia remain at an extremely high level for many decades. Early diagnosis and selection of the optimal method of revascularization are among the ways to optimize tactics. The diagnostic study of choice is CT angiography. Its active and systemic use can help to detect ischemia at the reversible stage. The article examines in detail the indications for the application of this diagnostic study. The question of preference for the revascularization method remains debatable. The arguments of proponents of open and endovascular interventions on mesenteric vessels are presented. Other, still unresolved tactical issues are also considered, such as indications for re-operations and application of the principles of damage control tactics.
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Affiliation(s)
- A A Pankratov
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, Russia.,City Clinical Hospital named after V.P. Demihov of the Moscow City Health Department, Moscow, Russia
| | - S N Perehodov
- City Clinical Hospital named after V.P. Demihov of the Moscow City Health Department, Moscow, Russia
| | - D A Zelenin
- City Clinical Hospital named after V.P. Demihov of the Moscow City Health Department, Moscow, Russia
| | - R E Izrailov
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, Russia
| | - I V Matkov
- City Clinical Hospital named after V.P. Demihov of the Moscow City Health Department, Moscow, Russia
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34
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Almoiliqy M, Wen J, Qaed E, Sun Y, Lian M, Mousa H, Al-Azab M, Zaky MY, Chen D, Wang L, AL-Sharabi A, Liu Z, Sun P, Lin Y. Protective Effects of Cinnamaldehyde against Mesenteric Ischemia-Reperfusion-Induced Lung and Liver Injuries in Rats. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:4196548. [PMID: 33381264 PMCID: PMC7748914 DOI: 10.1155/2020/4196548] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 12/23/2022]
Abstract
The aim of this study was to characterize and reveal the protective effects of cinnamaldehyde (CA) against mesenteric ischemia-reperfusion- (I/R-) induced lung and liver injuries and the related mechanisms. Sprague-Dawley (SPD) rats were pretreated for three days with 10 or 40 mg/kg/d, ig of CA, and then induced with mesenteric ischemia for 1 h and reperfusion for 2 h. The results indicated that pretreatment with 10 or 40 mg/kg of CA attenuated morphological damage in both lung and liver tissues of mesenteric I/R-injured rats. CA pretreatment significantly restored the levels of aspartate transaminase (AST) and alanine transaminase (ALT) in mesenteric I/R-injured liver tissues, indicating the improvement of hepatic function. CA also significantly attenuated the inflammation via reducing myeloperoxidase (MOP) activity and downregulating the expression of inflammation-related proteins, including interleukin-6 (IL-6), interleukin-1β (IL-1β), cyclooxygenase-2 (Cox-2), and tumor necrosis factor receptor type-2 (TNFR-2) in both lung and liver tissues of mesenteric I/R-injured rats. Pretreatment with CA significantly downregulated nuclear factor kappa B- (NF-κB-) related protein expressions (NF-κB p65, NF-κB p50, I kappa B alpha (IK-α), and inhibitor of nuclear factor kappa-B kinase subunit beta (IKKβ)) in both lung and liver tissues of mesenteric I/R-injured rats. CA also significantly downregulated the protein expression of p53 family members, including caspase-3, caspase-9, Bax, and p53, and restored Bcl-2 in both lung and liver tissues of mesenteric I/R-injured rats. CA pretreatment significantly reduced TUNEL-apoptotic cells and significantly inhibited p53 and NF-κB p65 nuclear translocation in both lung and liver tissues of mesenteric I/R-injured rats. CA neither induced pulmonary and hepatic histological alterations nor affected the parameters of inflammation and apoptosis in sham rats. We conclude that CA alleviated mesenteric I/R-induced pulmonary and hepatic injuries via attenuating apoptosis and inflammation through inhibition of NF-κB and p53 pathways in rats, suggesting the potential role of CA in remote organ ischemic injury protection.
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Affiliation(s)
- Marwan Almoiliqy
- Department of Pharmacology, Pharmaceutical College, Dalian Medical University, Dalian 116044, China
- Key Lab of Aromatic Plant Resources Exploitation and Utilization in Sichuan Higher Education, Yibin University, Yibin, 644000 Sichuan, China
| | - Jin Wen
- Department of Pharmacology, Pharmaceutical College, Dalian Medical University, Dalian 116044, China
| | - Eskandar Qaed
- Department of Pharmacology, Pharmaceutical College, Dalian Medical University, Dalian 116044, China
| | - Yuchao Sun
- Department of Pharmacology, Pharmaceutical College, Dalian Medical University, Dalian 116044, China
| | - Mengqiao Lian
- Department of Pharmacology, Pharmaceutical College, Dalian Medical University, Dalian 116044, China
| | - Haithm Mousa
- Department of Clinical Biochemistry, Dalian Medical University, Dalian 116044, China
| | - Mahmoud Al-Azab
- Department of Immunology, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Mohamed Y. Zaky
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian 116044, China
- Molecular Physiology Division, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
| | - Dapeng Chen
- Laboratory Animal Center, Dalian Medical University, Dalian 116044, China
| | - Li Wang
- Department of Pharmacology, Pharmaceutical College, Dalian Medical University, Dalian 116044, China
| | - Abdulkarem AL-Sharabi
- Department of Pharmacology, Pharmaceutical College, Dalian Medical University, Dalian 116044, China
| | - Zhihao Liu
- Department of Pharmacology, Pharmaceutical College, Dalian Medical University, Dalian 116044, China
| | - Pengyuan Sun
- Department of Pharmacology, Pharmaceutical College, Dalian Medical University, Dalian 116044, China
| | - Yuan Lin
- Department of Pharmacology, Pharmaceutical College, Dalian Medical University, Dalian 116044, China
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Alsfasser G, Klar E. [Acute abdomen : What does the nonradiologist expect from the radiologist?]. Radiologe 2020; 60:193-199. [PMID: 32052115 DOI: 10.1007/s00117-020-00647-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The acute abdomen is a life-threatening condition that demands urgent intervention. The required diagnostics should address the core problem and has to be chosen based upon the diagnostic strength of each diagnostic tool. Modalities with limited discriminating information regarding differential diagnosis have to be avoided. Expectancy and thoughts of the radiologist often differ from the view of the clinician in the emergency department. OBJECTIVE The decision about which diagnostic tools are valuable or unnecessary in the emergency setting is made from a surgeon's point of view. Close communication with radiologists is mandatory. We demonstrate the importance of clinical signs and symptoms and their correlation with helpful radiologic diagnostics. CONCLUSION The emergency radiologic diagnostic workup of acute abdomen has to be targeted and the radiologist must answer the questions in order to clarify whether an operation is indicated and to help define the surgical strategy. In emergency surgery as in acute abdomen extended diagnostics to reach a decision is a dangerous waste of time and must be avoided at all costs. Therefore close communication with the radiologist is crucial.
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Affiliation(s)
- G Alsfasser
- Abt. für Allgemein‑, Viszeral‑, Gefäß- und Transplantationschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.
| | - E Klar
- Universitätsmedizin Rostock, Rostock, Deutschland
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Budipramana VS, Putra DA. Rectal Prolapse Concomitant with Uterovaginal Prolapse Protects the Ileum from Necrosis in Transanal Ileum Evisceration through a Traumatic Tear on the Sigmoid Wall. Case Rep Gastroenterol 2020; 14:420-425. [PMID: 32999643 PMCID: PMC7506259 DOI: 10.1159/000508437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/01/2020] [Indexed: 11/19/2022] Open
Abstract
Eviscerated ileum passing through a traumatic tear on the sigmoid wall is a rare case and all the cases reported previously showed that the eviscerated intestines were necrotic. However, in this case, although the huge size of eviscerated intestine had already exceeded the intestinal ischemic time, the small intestine outside the anus was not necrotic. Here we report the case of a 73-year-old female who presented with evisceration of the small intestine out of her anus as long as 200 cm 7 h before. The eviscerated small intestine (ileum) appeared still viable and there were no signs of pain, obstruction, or peritonitis. An intermittent rectal concomitant with uterovaginal prolapse had been experienced by the patient before. On surgery, the ileum was not necrotic and pulled back out of the sigmoid wall tear. The cardinal uterosacral ligament may have an important role in maintaining the uterovagina in place. When this ligament loses its ability to anchor the uterovagina to the sacrum, both the uterovagina and the rectum will lose their fixation to the sacrum and prolapse will occur. Hence, the rectum located posterior to the uterovagina also relieves its squeeze pressure so that it will not disrupt the blood supply of the ileum when the ileum enters through the rectal lumen. Rectal concomitant with uterovaginal prolapse is an important factor to maintain the viability of the eviscerated intestine. Therefore, surgeons are still able to make better preparation before performing surgery.
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Affiliation(s)
- Vicky Sumarki Budipramana
- Department of Surgery, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Deddy Aryanda Putra
- Department of Surgery, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Hospital, Surabaya, Indonesia
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Dovzhanskiy DI, Bischoff MS, Wilichowski CD, Rengier F, Klempka A, Böckler D. Outcome analysis and risk factors for postoperative colonic ischaemia after aortic surgery. Langenbecks Arch Surg 2020; 405:1031-1038. [PMID: 32827052 PMCID: PMC7541358 DOI: 10.1007/s00423-020-01964-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/09/2020] [Indexed: 12/01/2022]
Abstract
Purpose Colonic ischaemia (CI) represents a serious complication after aortic surgery. This study aimed to analyse risk factors and outcome of patients suffering from postoperative CI. Methods Data of 1404 patients who underwent aortic surgery were retrospectively analysed regarding CI occurrence. Co-morbidities, procedural parameters, colon blood supply, procedure-related morbidity and mortality as well as survival during follow-up (FU) were compared with patients without CI using matched-pair analysis (1:3). Results Thirty-five patients (2.4%) with CI were identified. Cardiovascular, pulmonary and renal comorbidity were more common in CI patients. Operation time was longer (283 ± 22 vs. 188 ± 7 min, p < 0.0001) and blood loss was higher (2174 ± 396 vs. 1319 ± 108 ml, p = 0.0049) in the CI group. Patients with ruptured abdominal aortic aneurysm (AAA) showed a higher rate of CI compared to patients with intact AAA (5.4 vs. 1.9%, p = 0.0177). CI was predominantly diagnosed by endoscopy (26/35), generally within the first 4 postoperative days (20/35). Twenty-eight patients underwent surgery, all finalised with stoma creation. Postoperative bilateral occlusion and/or relevant stenosis of hypogastric arteries were more frequent in CI patients (57.8 vs. 20.8%, p = 0.0273). In-hospital mortality was increased in the CI group (26.7 vs. 2.9%, p < 0.0001). Survival was significantly reduced in CI patients (median: 28.2 months vs. 104.1 months, p < 0.0001). Conclusion CI after aortic surgery is associated with considerable perioperative sequelae and reduced survival. Especially in patients at risk, such as those with rAAA, complicated intraoperative course, severe cardiovascular morbidity and/or perioperative deterioration of the hypogastric perfusion, vigilant postoperative multimodal monitoring is required in order to initiate diagnosis and treatment. Electronic supplementary material The online version of this article (10.1007/s00423-020-01964-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dmitriy I Dovzhanskiy
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Moritz S Bischoff
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Christopher D Wilichowski
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Fabian Rengier
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Anna Klempka
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Kühn F, Schiergens TS, Klar E. Acute Mesenteric Ischemia. Visc Med 2020; 36:256-262. [PMID: 33005650 DOI: 10.1159/000508739] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/16/2020] [Indexed: 12/15/2022] Open
Abstract
Background Despite constant improvements in diagnostic as well as interventional and surgical techniques, acute mesenteric ischemia (AMI) remains a life-threatening emergency with high mortality rates. The time to diagnosis of AMI is the most important predictor of patients' outcome; therefore, prompt diagnosis and intervention are essential to reduce mortality in patients with AMI. The present review was performed to analyze potential risk factors and to help find ways to improve the outcome of patients with AMI. Summary Whereas AMI only applies to approximately 1% of all patients with an "acute abdomen," its incidence is rising up to 10% in patients >70 years of age. The initial clinical stage of AMI is characterized by a sudden onset of strong abdominal pain followed by a painless interval. Depending on the extent of disease, the symptoms of nonocclusive mesenteric ischemia (NOMI) and patients with a venous thrombosis can be very different from those of acute occlusive ischemia. Biphasic contrast-enhanced CT represents the gold standard for the diagnosis of arterial and venous occlusion. In case of a central occlusion of the superior mesenteric artery or signs of peritonitis, immediate surgery should be performed. If major bowel resection becomes necessary, critical residual intestinal length limits must be kept in mind. Endovascular techniques for arterial occlusion have taken on a much greater importance today. For stable patients with NOMI, interventional catheter angiography is recommended because it enables diagnosis and treatment with selective application of vasodilators. Depending on its degree, interventional treatment with a transhepatic catheter lysis should be considered for acute and chronic portal vein thrombosis. Key Message The prompt and targeted use of the appropriate diagnostics and interventions appears to be the only way to reduce the persistently high mortality rates for AMI.
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Affiliation(s)
- Florian Kühn
- Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Tobias S Schiergens
- Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Ernst Klar
- Department of General, Visceral, Vascular and Transplantation Surgery, University Medical Center Rostock, Rostock, Germany
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Abstract
Leech therapy, which can lead to complications such as anemia and bleeding, has been used to treat many diseases since ancient times. Furthermore, some substances in leech saliva are known to have anticoagulant effects. Acute mesenteric ischemia, which develops due to mesenteric vascular obstruction, can be treated medically or surgically. Non-occlusive mesenteric ischemia (NOMI) occurs as a result of decreased blood flow in mesenteric vessels due to hypovolemia, hypotension, etc. In this report, we mentioned a 57-year-old male patient who was admitted to the emergency department with syncope and weakness. In his medical history, the patient was stated to have used leech therapy to treat diabetic wounds on his feet, and prolonged and unstoppable bleeding was seen after leech bites. On his physical examination, there was tenderness in all quadrants of the abdomen. Abdominal computed tomography without contrast agent showed hepatic portal venous gas and pneumatosis cystoides intestinalis (PSI). The patient underwent laparotomy owing to the development of acute abdomen during the follow-up. Necrosis was seen in the terminal ileum and entire colon. Low flow in mesenteric vascular vessels of these necrotic segments was indicated with intraoperative Doppler ultrasonography. All necrotic segments were resected and open end-ileostomy was performed. The patient was discharged on the 17th day of follow-up. In conclusion, excessive bleeding caused by leech therapy can cause NOMI.
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Affiliation(s)
- Çağrı Akalın
- Department of General Surgery, Ordu University Training and Research Hospital, Ordu, TUR
| | - Nergis Ekmen
- Department of Gastroenterology, Gazi University Hospital, Ankara, TUR
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Jiang M, Li CL, Pan CQ, Lv WZ, Ren YF, Cui XW, Dietrich CF. Nomogram for predicting transmural bowel infarction in patients with acute superior mesenteric venous thrombosis. World J Gastroenterol 2020; 26:3800-3813. [PMID: 32774059 PMCID: PMC7383843 DOI: 10.3748/wjg.v26.i26.3800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/23/2020] [Accepted: 06/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prognosis of acute mesenteric ischemia (AMI) caused by superior mesenteric venous thrombosis (SMVT) remains undetermined and early detection of transmural bowel infarction (TBI) is crucial. The predisposition to develop TBI is of clinical concern, which can lead to fatal sepsis with hemodynamic instability and multi-organ failure. Early resection of necrotic bowel could improve the prognosis of AMI, however, accurate prediction of TBI remains a challenge for clinicians. When determining the eligibility for explorative laparotomy, the underlying risk factors for bowel infarction should be fully evaluated. AIM To develop and externally validate a nomogram for prediction of TBI in patients with acute SMVT. METHODS Consecutive data from 207 acute SMVT patients at the Wuhan Tongji Hospital and 89 patients at the Guangzhou Nanfang Hospital between July 2005 and December 2018 were included in this study. They were grouped as training and external validation cohort. The 207 cases (training cohort) from Tongji Hospital were divided into TBI and reversible intestinal ischemia groups based on the final therapeutic outcomes. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for TBI using the training data, and a nomogram was subsequently developed. The performance of the nomogram was evaluated with respect to discrimination, calibration, and clinical usefulness in the training and external validation cohort. RESULTS Univariate and multivariate logistic regression analyses identified the following independent prognostic factors associated with TBI in the training cohort: The decreased bowel wall enhancement (OR = 6.37, P < 0.001), rebound tenderness (OR = 7.14, P < 0.001), serum lactate levels > 2 mmol/L (OR = 3.14, P = 0.009) and previous history of deep venous thrombosis (OR = 6.37, P < 0.001). Incorporating these four factors, the nomogram achieved good calibration in the training set [area under the receiver operator characteristic curve (AUC) 0.860; 95%CI: 0.771-0.925] and the external validation set (AUC 0.851; 95%CI: 0.796-0.897). The positive and negative predictive values (95%CIs) of the nomogram were calculated, resulting in positive predictive values of 54.55% (40.07%-68.29%) and 53.85% (43.66%-63.72%) and negative predictive values of 93.33% (82.14%-97.71%) and 92.24% (85.91%-95.86%) for the training and validation cohorts, respectively. Based on the nomogram, patients who had a Nomo-score of more than 90 were considered to have high risk for TBI. Decision curve analysis indicated that the nomogram was clinically useful. CONCLUSION The nomogram achieved an optimal prediction of TBI in patients with AMI. Using the model, the risk for an individual patient inclined to TBI can be assessed, thus providing a rational therapeutic choice.
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Affiliation(s)
- Meng Jiang
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Chang-Li Li
- Department of Geratology, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan 430015, Hubei Province, China
| | - Chun-Qiu Pan
- Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Wen-Zhi Lv
- Department of Artificial Intelligence, Julei Technology Company, Wuhan 430030, Hubei Province, China
| | - Yu-Fei Ren
- Department of Computer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xin-Wu Cui
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Abstract
PURPOSE OF REVIEW Mesenteric ischemia (MI), both acute (AMI) and chronic (CMI), is a challenging diagnosis to make, and early diagnosis and treatment are vital to improve outcomes. This manuscript summarizes the most up to date information on diagnosis and treatment of these disorders. RECENT FINDINGS There have been several significant advancements in the computed tomography (CT) diagnostic imaging as well as medical and endovascular management of AMI and CMI. In appropriate populations, endovascular interventions appear superior to open surgical management with lower mortality, morbidity, and cost of care. Efficient clinical identification and targeted testing are essential to diagnose AMI and CMI. Aggressive resuscitation and early endovascular (or in select cases, surgical) intervention improve outcomes in those with AMI. In those with CMI, considering this on the differential diagnosis and imaging appropriately can identify those that might benefit from intervention and halt progression to acute episodes.
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Affiliation(s)
| | - Paul Feuerstadt
- Division of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA. .,Gastroenterology Center of Connecticut, Yale University School of Medicine, Hamden, CT, USA.
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Dovzhanskiy DI, Hakimi M, Bischoff MS, Wieker CLM, Hackert T, Böckler D. [Colonic ischemia after open and endovascular aortic surgery : Epidemiology, Risk Factors, Diagnosis And Therapy]. Chirurg 2020; 91:169-178. [PMID: 32002560 DOI: 10.1007/s00104-020-01113-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite the successful establishment of endovascular techniques, colonic ischemia continues to be a serious complication of aortic surgery.The risk factors for colonic ischemia include aortic aneurysm rupture, prolonged aortic clamping, perioperative hypotension, the need for catecholamine therapy, occlusion of the hypogastric arteries and renal insufficiency.The clinical presentation of postoperative colonic ischemia is often unspecific. Classic symptoms include abdominal pain, diarrhea, peranal bleeding and rise of inflammatory parameters. A specific laboratory parameter for colonic ischemia does not exist. The diagnostic gold standard is endoscopy. Imaging methods such as sonography or computer tomography play only a supportive role. Transmural ischemia resulting in bowel wall necrosis is an indication for emergency surgery, predominantly colonic resection with creation of artificial anus.
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Affiliation(s)
- Dmitriy I Dovzhanskiy
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - Maani Hakimi
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - Moritz S Bischoff
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - Caro la M Wieker
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - Thilo Hackert
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - Dittmar Böckler
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
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Factors Associated With in-Hospital Death in Patients with Acute Mesenteric Artery Ischemia. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2018. [DOI: 10.2478/jce-2018-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
ABSTRACT
Objective: The aim of the study was to assess the factors associated with increased mortality in patients with acute mesenteric ischemia, emphasizing the importance of an early diagnosis and a prompt surgical intervention in order to avoid lesion progression. Materials and method: A retrospective analytical study was conducted on a study population of 50 male and female patients with acute ischemia of the mesenteric arteries, aged between 36-92 years. Demographic and pathological history characteristics were assessed, together with presented symptoms, laboratory and CT findings, as well as surgical outcome and time-related aspects between presentation in the emergency department and time of surgery, as well as the hospitalization period until discharge or death. Results: Muscular defense (OR = 23.05) and shock (OR = 13.24) as symptoms were strongly associated with a poor prognosis, while elevated values of lactate dehydrogenase (p = 0.0440) and creatine kinase (p = 0.0025) were associated with higher death rates. The time elapsed during investigations in the emergency room was significantly higher in patients who deceased (p = 0.0023), similarly to the total time from the onset of symptoms to the beginning of surgery (p = 0.0032). Surgical outcomes showed that patients with segmental ischemia of the small bowel had significantly higher chances of survival (p <0.0001). Conclusion: Increased mortality rates in patients presenting in the emergency department for acute mesenteric ischemia were observed in patients with occlusion of the superior mesenteric artery, with higher levels of CK and LDH, as well as with longer periods of stay in the emergency department for diagnostic procedures until the commencement of the surgical intervention. Therefore, proper investigations in a timely manner followed by a specific and prompt surgical intervention may avoid unfavorable evolution of patients towards death.
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Luther B, Mamopoulos A, Lehmann C, Klar E. The Ongoing Challenge of Acute Mesenteric Ischemia. Visc Med 2018; 34:217-223. [PMID: 30140688 DOI: 10.1159/000490318] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background The lethality of acute mesenteric ischemia (AMI) remains quite high with 50-70%. The main reasons for that are the fact that AMI is rarely taken into consideration by the differential diagnosis of acute abdomen, the time-consuming diagnostic process, and the lack of a standardized therapeutic concept. The present interdisciplinary review aims to increase awareness among physicians and to help improve clinical outcomes. Methods This clinical therapeutic review is based on author expertise as well as a selective literature survey in PubMed based on the term 'mesenteric ischemia', combined with the terms 'arterial', 'clinical presentation', 'diagnosis', 'therapy', 'surgery', and 'interventional radiology'. Based on these search results as well as on the guidelines of the German Society of Vascular Surgery, the American College of Cardiology, and the American Heart Association, we present an interdisciplinary treatment concept. Results AMI is a vascular emergency that can be successfully treated only within the first hours after the onset of symptoms. Computed tomography angiography is the diagnostic method of choice. Intensive care unit treatment can prevent the occurrence of multiple organ failure. Treatment primarily consists of the revascularization of the mesenteric arteries. Endovascular techniques should be given priority, whereas signs of peritonitis or a central arterial occlusion with high thrombus load primarily require a surgical approach in order to save time and increase patient safety. Additional bowel resections can play a significant role in the treatment of intestinal sepsis. Conclusion Prompt and goal-oriented diagnosis and consistent treatment of AMI within 4-6 h from the onset of symptoms can be decisive for the reduction of AMI-associated lethality. In order for this to happen, a standardized concept of emergency treatment needs to be implemented.
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Affiliation(s)
- Bernd Luther
- Department of Vascular Surgery, Maria Hilf Alexianer Hospital, Krefeld, Germany
| | | | | | - Ernst Klar
- Department of General, Thoracic, Vascular and Transplant Surgery, University Rostock, Rostock, Germany
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Endovascular Treatment for Acute Thromboembolic Occlusion of the Superior Mesenteric Artery and the Outcome Comparison between Endovascular and Open Surgical Treatments: A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1964765. [PMID: 29204438 PMCID: PMC5674482 DOI: 10.1155/2017/1964765] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 08/21/2017] [Accepted: 09/17/2017] [Indexed: 02/07/2023]
Abstract
We reported our experience with endovascular treatment for patients with acute thromboembolic occlusion of the superior mesenteric artery (ATOS) as well as comparing the efficacy between endovascular and traditional open surgical treatments. Eighteen consecutive patients with ATOS who received endovascular treatment and 12 patients who received open surgical treatment between February 2007 and October 2012 at Tianjin Union Medical Center (Tianjin, China) were retrospectively reviewed. Primary clinical outcomes included the technical success, requirement of laparotomy, length of bowel resection, perioperative mortality within 30 days, and surgical complications. The patients were followed up for 0.1 to 98 months. For patients who underwent endovascular treatment, complete technical success was achieved in 8 (44.4%) patients and partial success was achieved in the remaining 10 (55.6%) patients. Laparotomy was required in 6 (33.3%) patients. The 30-day mortality was 16.7%. In comparison to open surgical therapy, endovascular therapy achieved lower requirement of laparotomy (in 33.3% versus in 58.3% of cases, p = 0.18), significantly shorter average length of bowel resection (88 ± 44 versus 253 ± 103 cm, p = 0.01), and lower mortality rate (16.7% versus 33.3%, p = 0.68). The endovascular therapy is a promising treatment alternative for ATOS.
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Defining the Need for Surgery in Small-Bowel Obstruction. J Gastrointest Surg 2017; 21:1136-1141. [PMID: 28409293 DOI: 10.1007/s11605-017-3418-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 03/27/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Small-bowel obstruction is a frequent disorder in emergency medicine and represents a major burden for patients and health care systems worldwide. Within the past years, progress has been made regarding the management of small-bowel obstructions, including the use of contrast agent swallow as a tool in the decision-making process. OBJECTIVES This is a prospective controlled study investigating the central role of contrast agent swallow in the diagnostic and treatment algorithm for small-bowel obstruction at a university department of surgery. Endpoints were the correct identification of patients who needed operative treatment and the accuracy of a conservative treatment decision including the analysis of dropout from this routine algorithm. METHODS We performed a single-center analysis of 181 consecutive patients diagnosed with a small-bowel obstruction based on clinical, radiologic, and sonographic findings. Patients with clinical signs of strangulation or peritonitis underwent immediate surgery (group 1). Patients without signs of peritonitis and incomplete stop in the initial abdominal plain film were considered eligible for Gastrografin® challenge (group 2). RESULTS Seventy-six of the 181 patients (42.0%) underwent immediate surgery. A Gastrografin® challenge was initialized in 105 of the 181 patients (58.0%). Twenty of these 105 patients (19.1%) with persisting or progressive symptoms and absence of contrast agent in the colon after 12 and 24 h subsequently underwent surgery. Here, a segmental bowel resection was necessary in 6 of these 20 patients (30.0%). In 16 out of 20 patients (80.0%) who failed the Gastrografin® challenge, a corresponding correlate in terms of a strangulation was detected intraoperatively. The Gastrografin® challenge had a specificity of 96% and a sensitivity of 100%; accuracy to predict the need for exploration was 96%. CONCLUSION A straightforward algorithm based mainly on contrast agent swallow for patients with small-bowel obstructions enabled a timely and very accurate differentiation between patients qualifying for conservative and operative treatment.
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[Conservative and surgical ileus treatment]. Chirurg 2017; 88:629-644. [PMID: 28508942 DOI: 10.1007/s00104-017-0438-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The diagnosis ileus is one of the most common indications for an emergency laparotomy. In 70% of the cases, the small intestine is affected, and in 30% it is the colorectum. While stuck hernias are a major cause in developing countries, the most common causes in western countries are postoperative adhesions that lead to an acute bowl obstruction. The timeframe for treatment of a complete mechanical obstruction is short as acute ischemia can lead to necrosis with bowl perforation within 6 h. The perioperative lethality for an emergency laparotomy due to an ileus ranges from 5-15%. In addition to the mechanical ileus, primary and secondary paralytic ileus is important in the differential diagnosis. As the genesis of postoperative ileus is multifactorial, a multimodal concept is required for successful treatment.
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Budak YU, Polat M, Huysal K. The use of platelet indices, plateletcrit, mean platelet volume and platelet distribution width in emergency non-traumatic abdominal surgery: a systematic review. Biochem Med (Zagreb) 2016; 26:178-93. [PMID: 27346963 PMCID: PMC4910273 DOI: 10.11613/bm.2016.020] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/28/2016] [Indexed: 12/11/2022] Open
Abstract
Platelet indices (PI) -- plateletcrit, mean platelet volume (MPV) and platelet distribution width (PDW) -- are a group of derived platelet parameters obtained as a part of the automatic complete blood count. Emerging evidence suggests that PIs may have diagnostic and prognostic value in certain diseases. This study aimed to summarize the current scientific knowledge on the potential role of PIs as a diagnostic and prognostic marker in patients having emergency, non-traumatic abdominal surgery. In December 2015, we searched Medline/PubMed, Scopus and Google Scholar to identify all articles on PIs. Overall, considerable evidence suggests that PIs are altered with acute appendicitis. Although the role of PI in the differential diagnosis of acute abdomen remains uncertain, low MPV might be useful in acute appendicitis and acute mesenteric ischemia, with high MPV predicting poor prognosis in acute mesenteric ischemia. The current lack of consistency and technical standards in studies involving PIs should be regarded as a serious limitation to comparing these studies. Further large, multicentre prospective studies concurrently collecting data from different ethnicities and genders are needed before they can be used in routine clinical practice.
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Affiliation(s)
- Yasemin Ustundag Budak
- Department of Clinical Chemistry, Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
| | - Murat Polat
- Department of General Surgery, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Kagan Huysal
- Department of Clinical Chemistry, Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
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Tilsed JVT, Casamassima A, Kurihara H, Mariani D, Martinez I, Pereira J, Ponchietti L, Shamiyeh A, Al-Ayoubi F, Barco LAB, Ceolin M, D'Almeida AJG, Hilario S, Olavarria AL, Ozmen MM, Pinheiro LF, Poeze M, Triantos G, Fuentes FT, Sierra SU, Soreide K, Yanar H. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg 2016; 42:253-70. [PMID: 26820988 PMCID: PMC4830881 DOI: 10.1007/s00068-016-0634-0] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Acute mesenteric ischaemia (AMI) accounts for about 1:1000 acute hospital admissions. Untreated, AMI will cause mesenteric infarction, intestinal necrosis, an overwhelming inflammatory response and death. Early intervention can halt and reverse this process leading to a full recovery, but the diagnosis of AMI is difficult and failure to recognize AMI before intestinal necrosis has developed is responsible for the high mortality of the disease. Early diagnosis and prompt treatment are the goals of modern therapy, but there are no randomized controlled trials to guide treatment and the published literature contains a high ratio of reviews to original data. Much of that data comes from case reports and often small, retrospective series with no clearly defined treatment criteria. METHODS A study group of the European Society for Trauma and Emergency Surgery (ESTES) was formed in 2013 with the aim of developing guidelines for the management of AMI. A comprehensive literature search was performed using the Medical Subject Heading (MeSH) thesaurus keywords "mesenteric ischaemia", "bowel ischaemia" and "bowel infarction". The bibliographies of relevant articles were screened for additional publications. After an initial systematic review of the literature by the whole group, a steering group formulated questions using a modified Delphi process. The evidence was then reviewed to answer these questions, and recommendations formulated and agreed by the whole group. RESULTS The resultant recommendations are presented in this paper. CONCLUSIONS The aim of these guidelines is to provide recommendations for practice that will lead to improved outcomes for patients.
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Affiliation(s)
- J V T Tilsed
- Surgery Health Care Group, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK.
| | - A Casamassima
- Emergency Department, Istituto Clinico Città Studi, Milan, Italy
| | - H Kurihara
- Emergency Surgery and Trauma Unit, Humanitas Research Hospital, Rozzano, Italy
| | - D Mariani
- Department of General Surgery, Ospedale di Legnano, Milan, Italy
| | - I Martinez
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Torrevieja, Torrevieja, Spain
| | - J Pereira
- Surgery 1-Tondela-Viseu Hospital Centre, Viseu, Portugal
| | - L Ponchietti
- Department of Surgery, Milton Keynes Hospital NHS Foundation Trust, Milton Keynes, UK
| | - A Shamiyeh
- 2nd Surgical Department, Kepler University Clinic Linz, Linz, Austria
| | - F Al-Ayoubi
- Division of Trauma and Acute Care Surgery, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - L A B Barco
- Department of Angiology and Vacular Surgery, University Hospital of Torrevieja, Torrevieja, Spain
| | - M Ceolin
- Emergency Surgery and Trauma Unit, Humanitas Research Hospital, Rozzano, Italy
| | - A J G D'Almeida
- Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - S Hilario
- 2nd Surgical Department, Santo André Hospital, Leiria, Portugal
| | - A L Olavarria
- Servicio de Cirugía General y Digestiva, Hospital Galdakao Usansolo, Vizcaya, Spain
| | - M M Ozmen
- Department of Surgery, Medical School, Hacettepe University, 06100, Ankara, Turkey
| | - L F Pinheiro
- General Surgery Department, Hospital São Teotónio, Viseu, Portugal
| | - M Poeze
- Department of Surgery/Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - G Triantos
- Department of General Surgery, Rhodes General Hospital, Rhodes, Greece
| | - F T Fuentes
- General Surgery 2 and Emergency Surgery, University General Hospital Gregorio Marañón, Madrid, Spain
| | - S U Sierra
- Department of Surgery, Galdakao-Usansolo Hospital, Galdakao, Vizcaya, Spain
| | - K Soreide
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - H Yanar
- Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Çapa, Istanbul, Turkey
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Robinson A, Woodman T, Ozdemir B, Phaily A. Embolic superior mesenteric artery (SMA) occlusion secondary to a cardiac sarcoma. BMJ Case Rep 2016; 2016:bcr-2016-214575. [PMID: 27005797 DOI: 10.1136/bcr-2016-214575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
We present a case of embolic acute mesenteric ischaemia (AMI) secondary to an underlying cardiac sarcoma, an exceedingly rare presentation only reported twice before. A 46-year-old man presented to accident and emergency department during the night with severe abdominal pain and vomiting. An urgent CT angiograph demonstrated superior mesenteric artery (SMA) occlusion with ischaemic small bowel. Joint surgical effort from vascular and general surgeons successfully recanalised the SMA and a 20 cm segment of small bowel was resected. Postoperatively, an echocardiogram demonstrated a mass within the left atrium. After cardiothoracic resection, the mass was found to be a rare undifferentiated cardiac sarcoma. Further staining on the embolus retrieved from the SMA revealed scattered spindle cells with a similar immunohistochemistry profile to that of the resected cardiac sarcoma. The patient was subsequently discharged well on lifelong warfarin.
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Affiliation(s)
- Alexander Robinson
- Department of General Surgery, Ashford and Saint Peter's Hospitals NHS Trust, Surrey, UK
| | - Thomas Woodman
- Department of Accident and Emergency, Ashford and Saint Peter's Hospitals NHS Trust, Surrey, UK
| | - Baris Ozdemir
- Department of General Surgery, Ashford and Saint Peter's Hospitals NHS Trust, Surrey, UK
| | - Ary Phaily
- Department of General Surgery, Ashford and Saint Peter's Hospitals NHS Trust, Surrey, UK
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