Intestinal tachyarrhythmias during small bowel ischemia

1999 ◽  
Vol 277 (5) ◽  
pp. G993-G999 ◽  
Author(s):  
Scott A. Seidel ◽  
Sanjay S. Hegde ◽  
L. Alan Bradshaw ◽  
J. K. Ladipo ◽  
William O. Richards
Keyword(s):  
Small Bowel ◽  
Mesenteric Ischemia ◽  
Intestinal Ischemia ◽  
Intestinal Tract ◽  
Bowel Ischemia ◽  
Digital Recording ◽  
Control Activity ◽  
Electrical Control ◽  
New Zealand White Rabbits

The electrical control activity (ECA) of the bowel is the omnipresent slow electrical wave of the intestinal tract. Characterization of small bowel electrical activity during ischemia may be used as a measure of intestinal viability. With the use of an animal model of mesenteric ischemia, serosal electrodes and a digital recording apparatus utilizing autoregressive spectral analysis were used to monitor the ECA of 20 New Zealand White rabbits during various lengths of ischemia. ECA frequency fell from 18.2 ± 0.5 cycles per minute (cpm) at baseline to 12.2 ± 0.9 cpm ( P < 0.05) after 30 min of ischemia and was undetectable by 90 min of ischemia in all animals. Tachyarrhythmias of the ECA were recorded in 55% of the animals as early as 25 min after ischemia was induced and lasted from 1 to 48 min. Frequencies ranged from 25 to 50 cpm. These tachyarrhythmias were seen only during ischemia, suggesting that they are pathognomonic for intestinal ischemia. The use of the detection of ECA changes during intestinal ischemia may allow earlier diagnosis of mesenteric ischemia.

scholarly journals Acute Mesenteric Ischemia in COVID-19 Patients

2021 ◽  
Vol 11 (1) ◽  
pp. 200
Author(s):  
Dragos Serban ◽  
Laura Carina Tribus ◽  
Geta Vancea ◽  
Anca Pantea Stoian ◽  
Ana Maria Dascalu ◽  
...  
Keyword(s):  
Small Bowel ◽  
Mesenteric Ischemia ◽  
Intestinal Ischemia ◽  
Clinical Laboratory ◽  
Fluid Management ◽  
Acute Mesenteric Ischemia ◽  
Bowel Ischemia ◽  
Reactive Protein ◽  
Contrast Enhanced Ct ◽  
The Moment

Acute mesenteric ischemia is a rare but extremely severe complication of SARS-CoV-2 infection. The present review aims to document the clinical, laboratory, and imaging findings, management, and outcomes of acute intestinal ischemia in COVID-19 patients. A comprehensive search was performed on PubMed and Web of Science with the terms “COVID-19” and “bowel ischemia” OR “intestinal ischemia” OR “mesenteric ischemia” OR “mesenteric thrombosis”. After duplication removal, a total of 36 articles were included, reporting data on a total of 89 patients, 63 being hospitalized at the moment of onset. Elevated D-dimers, leukocytosis, and C reactive protein (CRP) were present in most reported cases, and a contrast-enhanced CT exam confirms the vascular thromboembolism and offers important information about the bowel viability. There are distinct features of bowel ischemia in non-hospitalized vs. hospitalized COVID-19 patients, suggesting different pathological pathways. In ICU patients, the most frequently affected was the large bowel alone (56%) or in association with the small bowel (24%), with microvascular thrombosis. Surgery was necessary in 95.4% of cases. In the non-hospitalized group, the small bowel was involved in 80%, with splanchnic veins or arteries thromboembolism, and a favorable response to conservative anticoagulant therapy was reported in 38.4%. Mortality was 54.4% in the hospitalized group and 21.7% in the non-hospitalized group (p < 0.0001). Age over 60 years (p = 0.043) and the need for surgery (p = 0.019) were associated with the worst outcome. Understanding the mechanisms involved and risk factors may help adjust the thromboprophylaxis and fluid management in COVID-19 patients.

scholarly journals Acute fulminant necrotizing mesenteric lymphadenitis causing bowel ischemia

2019 ◽  
Vol 2019 (11) ◽  
Author(s):  
John Alfred Carr
Keyword(s):  
Case Report ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Intestinal Ischemia ◽  
Bowel Ischemia ◽  
Vascular Thrombosis ◽  
Mesenteric Lymphadenitis ◽  
Small Intestinal

Abstract This case report documents the medical progression of a 56-year-old man who presented with a small bowel obstruction and was found to have acute fulminant necrotizing mesenteric lymphadenitis causing small intestinal ischemia. A large portion of the proximal jejunal mesentery was necrotic with vascular thrombosis leading to small bowel ischemia and obstruction. He was successfully managed surgically and survived. The evaluation and possible aetiologies are discussed.

Electron Microscopic Detection and Characterization of Nonhuman Primate Enteric Viruses

1982 ◽  
Vol 40 ◽  
pp. 306-307
Author(s):  
G. C. Smith ◽  
R. L. Heberling ◽  
S. S. Kalter
Keyword(s):  
Electron Microscopy ◽  
Animal Model ◽  
Nonhuman Primate ◽  
Clinical Condition ◽  
Intestinal Tract ◽  
Enteric Viruses ◽  
Electron Microscopic ◽  
Microscopic Detection

A number of viral agents are recognized as and suspected of causing the clinical condition “gastroenteritis.” In our attempts to establish an animal model for studies of this entity, we have been examining the nonhuman primate to ascertain what viruses may be found in the intestinal tract of “normal” animals as well as animals with diarrhea. Several virus types including coronavirus, adenovirus, herpesvirus, and picornavirus (Table I) were detected in our colony; however, rotavirus, astrovirus, and calicivirus have not yet been observed. Fecal specimens were prepared for electron microscopy by procedures reported previously.

scholarly journals Adhesive Small Bowel Obstruction and the six w’s: Who, How, Why, When, What, and Where to diagnose and operate?

2021 ◽  
pp. 145749692098276
Author(s):  
M. Podda ◽  
M. Khan ◽  
S. Di Saverio
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Conservative Management ◽  
Bowel Ischemia ◽  
Current Evidence ◽  
First Episode ◽  
Adhesive Small Bowel Obstruction ◽  
Highly Effective

Background and Aims: Approximately 75% of patients admitted with small bowel obstruction have intra-abdominal adhesions as their cause (adhesive small bowel obstruction). Up to 70% of adhesive small bowel obstruction cases, in the absence of strangulation and bowel ischemia, can be successfully treated with conservative management. However, emerging evidence shows that surgery performed early during the first episode of adhesive small bowel obstruction is highly effective. The objective of this narrative review is to summarize the current evidence on adhesive small bowel obstruction management strategies. Materials and Methods: A review of the literature published over the last 20 years was performed to assess Who, hoW, Why, When, What, and Where diagnose and operate on patients with adhesive small bowel obstruction. Results: Adequate patient selection through physical examination and computed tomography is the key factor of the entire management strategy, as failure to detect patients with strangulated adhesive small bowel obstruction and bowel ischemia is associated with significant morbidity and mortality. The indication for surgical exploration is usually defined as a failure to pass contrast into the ascending colon within 8–24 h. However, operative management with early adhesiolysis, defined as operative intervention on either the calendar day of admission or the calendar day after admission, has recently shown to be associated with an overall long-term survival benefit compared to conservative management. Regarding the surgical technique, laparoscopy should be used only in selected patients with an anticipated single obstructing band, and there should be a low threshold for conversion to an open procedure in cases of high risk of bowel injuries. Conclusion: Although most adhesive small bowel obstruction patients without suspicion of bowel strangulation or gangrene are currently managed nonoperatively, the long-term outcomes following this approach need to be analyzed in a more exhaustive way, as surgery performed early during the first episode of adhesive small bowel obstruction has shown to be highly effective, with a lower rate of recurrence.

Small Bowel Obstruction

2010 ◽  
Vol 21 (2) ◽  
pp. 187-194
Author(s):  
Colleen Trevino
Keyword(s):  
Small Bowel ◽  
Physical Examination ◽  
Surgical Intervention ◽  
Signs And Symptoms ◽  
Bowel Ischemia ◽  
Key Factors ◽  
The Past ◽  
Factors Influencing ◽  
Imaging Response

Strategies for the management of small bowel obstructions have changed significantly over the years. Nonoperative medical management has become the mainstay of treatment of many small bowel obstructions. However, the key to the management of small bowel obstructions is identifying those patients who need surgical intervention. Identification of those at risk for bowel ischemia and bowel death is an art as much as it is a science. Using the current literature and the past knowledge regarding small bowel obstructions, the clinician must carefully identify the signs and symptoms that suggest the need for operative intervention. Classification of the obstruction, history and physical examination, imaging, response to decompression and resuscitation, and resolution or progression of symptoms are the key factors influencing the management of small bowel obstructions.

SMALL BOWEL ISCHEMIA/REPERFUSION (II/R) ALTERS COLONIC SMOOTH MUSCLE FUNCTION.

Shock ◽  
1998 ◽  
Vol 9 (Supplement) ◽  
pp. 13
Author(s):  
DT Dempsey ◽  
BS Myers ◽  
JP Ryan ◽  
J Carroll ◽  
SI Myers
Keyword(s):  
Smooth Muscle ◽  
Small Bowel ◽  
Muscle Function ◽  
Ischemia Reperfusion ◽  
Bowel Ischemia ◽  
Smooth Muscle Function

Characterization of Monoclonal Antihuman Small Bowel and Colon Specific Mucin Antibodies

1990 ◽  
Vol 93 (5) ◽  
pp. 621-630
Author(s):  
Thomas P. Prindiville ◽  
Mary Cantrell ◽  
M. E. Gershwin ◽  
Boris H. Ruebner
Keyword(s):  
Small Bowel

Predictive value of procalcitonin for intestinal ischemia and/or necrosis in pediatric patients with adhesive small bowel obstruction (ASBO)

2017 ◽  
Vol 52 (10) ◽  
pp. 1616-1620 ◽  
Author(s):  
Eduardo Bracho-Blanchet ◽  
Alfredo Dominguez-Muñoz ◽  
Emilio Fernandez-Portilla ◽  
Cristian Zalles-Vidal ◽  
Roberto Davila-Perez
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Predictive Value ◽  
Intestinal Ischemia ◽  
Pediatric Patients ◽  
Adhesive Small Bowel Obstruction

Predictors of Ischemic Bowel in Patients with Small Bowel Obstruction

2016 ◽  
Vol 82 (10) ◽  
pp. 992-994 ◽  
Author(s):  
Michael P. O'Leary ◽  
Angela L. Neville ◽  
Jessica A. Keeley ◽  
Dennis Y. Kim ◽  
Christian De Virgilio ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Bowel Ischemia ◽  
Wall Thickening ◽  
Ischemic Bowel ◽  
Operative Exploration ◽  
Common Etiology ◽  
History Of ◽  
Exploratory Laparoscopy

Preoperative diagnosis of ischemic bowel in patients with small bowel obstruction (SBO) is a clinical challenge. The aim of this study was to identify preoperative variables associated with ischemic bowel found at operative exploration. We performed a 5-year retrospective review of patients admitted to a university affiliated, county funded hospital who underwent exploratory laparoscopy or laparotomy for SBO. Patients were excluded if they had a known preoperative malignancy or hernia on physical examination. Multivariate logistic regression was used to determine factors independently associated with bowel ischemia or ischemic perforation. One hundred and sixteen patients underwent exploratory surgery for SBO. Mean age was 52 ± 14 years and most were male [64 (55.2%)]. Adhesions [92 (79.3%)] were the most common etiology of obstruction. Leukocytosis ( P = 0.304) and acidosis ( P = 0.151) were not significantly associated with ischemia or ischemic perforation. In addition, history of prior SBO ( P = 0.618), tachycardia ( P = 0.111), fever ( P = 0.859), and time from admission to operation ( P = 0.383) were not predictive of ischemic bowel. However, hyponatremia (≤134 mmol/L) and CT scan findings of wall thickening or a suspected closed loop were independently associated with bowel ischemia. Awareness of these predictors should heighten the concern for ischemic bowel in patients presenting with SBO.

Electrical activity of small intestinal smooth muscle and its temperature dependence

1975 ◽  
Vol 229 (5) ◽  
pp. 1268-1276 ◽  
Author(s):  
TY El-Sharkawy ◽  
EE Daniel
Keyword(s):  
Smooth Muscle ◽  
Membrane Potential ◽  
Electrical Activity ◽  
Temperature Dependence ◽  
Intestinal Smooth Muscle ◽  
Plateau Phase ◽  
Control Activity ◽  
Electrical Control ◽  
Electrical Control Activity ◽  
Small Intestinal

Some important features of the intracellularly recorded electrical control activity of rabbit jejunal smooth muscle and its temperature dependence are reported in this study. This activity consisted of repetitive 18-mV depolarizations (control potentials (CP) or slow waves), which at 37degreesC lasted 2 s and had a frequency of 18/min and arose from a membrane potential of --55 mV. In some cells periods between CP's exhibited "diastolic" progressive depolarizations (intercontrol-potential depolarization), which may be the trigger of the CP in driving cells. While CP was usually monophasic, some cells persistently exhibited a notch early in the plateau phase. We suggest that CP consists of two components, an "initial depolarization" and a "secondary depolarization," which are usually fused together to give a monophasic potential. Cooling reduced CP frequency and prolonged its duration and caused more cells to show notching. While amplitude and rate of CP initial depolarization had low Q10's, duration and rates of onset and offset of the secondary depolarization had higher Q10's. Thus, the process responsible for secondary depolarization is more sensitive to temperature thant that underlying initial depolarization of the CP.

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