Acute Mesenteric Ischemia: The Importance of Early Surgical Consultation

2009 ◽  
Vol 75 (3) ◽  
pp. 212-219 ◽  
Author(s):  
Islam G. Eltarawy ◽  
Yasser M. Etman ◽  
Mazen Zenati ◽  
Richard L. Simmons ◽  
Matthew R. Rosengart
Keyword(s):  
Odds Ratio ◽  
Retrospective Cohort ◽  
Mesenteric Ischemia ◽  
Disease Onset ◽  
Lactate Concentration ◽  
Acute Mesenteric Ischemia ◽  
Abdominal Distension ◽  
Ct Imaging ◽  
Appropriate Care ◽  
Elevated Lactate

Acute mesenteric ischemia continues to be associated with high mortality. We hypothesized that delays in surgical consultation and operation are independently associated with increased mortality and sought to identify modifiable characteristics associated with delayed management. We conducted a retrospective cohort study of 72 patients diagnosed with acute mesenteric ischemia. Twenty-six (36%) patients died, of which 14 (54%) had care withdrawn. Delay in operation (>6 hours after surgical consultation) was associated with increased mortality (adjusted OR 3.7; 90% CI, 1.1-12). For patients for whom care was not withdrawn, delay in surgical consultation (>24 hours after disease onset) was associated with increased mortality (adjusted OR, 9.4; 90% CI, 1.3-65), as was delay in operation (adjusted OR, 4.9; 90% CI, 1.1-22). For those managed medically, early surgical consultation was associated with improved mortality (Odds Ratio [OR], 0; 90% Confidence Interval [CI], 0-0.34). Patients with delayed surgical consultation were more likely to have abdominal distension, elevated lactate concentration, acute renal failure, vasopressor administration, and a lack of abdominal pain. The acquisition of CT imaging trended toward an association with delayed surgical consultation ( P = 0.06). We conclude that early surgical consultation is associated with improved outcome even for patients managed without operative intervention, and that CT imaging may delay appropriate care.

scholarly journals Nonocclusive Mesenteric Ischemia Associated with Ogilvie Syndrome

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Takashi Sakamoto ◽  
Toshiyuki Suganuma ◽  
Shinichiro Okada ◽  
Kensuke Nakatani ◽  
Sawako Tamaki ◽  
...  
Keyword(s):  
Small Bowel ◽  
Mesenteric Ischemia ◽  
Colonic Obstruction ◽  
Acute Mesenteric Ischemia ◽  
Pneumatosis Intestinalis ◽  
Abdominal Distension ◽  
Emergency Laparotomy ◽  
Nonocclusive Mesenteric Ischemia ◽  
Ischemic Bowel ◽  
Ogilvie Syndrome

Nonocclusive mesenteric ischemia (NOMI) is one type of acute mesenteric ischemia. Colonic pseudoobstruction, known as Ogilvie syndrome, is a disorder defined by colonic distension in the absence of mechanical obstruction. A relationship between these diseases has not yet been reported, based on a review of the literature. We report a patient with NOMI secondary to Ogilvie syndrome. An 82-year-old woman reported three days of intermittent abdominal pain. Plain computed tomography scan showed colonic obstruction at the rectosigmoid colon. Colonoscopy was performed that showed a large amount of stool and no evidence of tumor or other physical causes of obstruction. We diagnosed the patient with Ogilvie syndrome and continued nonoperative management. On the third hospital day, she complained of abdominal distension. A repeat CT scan showed pneumatosis intestinalis in the small bowel and ascending colon, with portal venous gas. Emergency laparotomy was performed with diagnosis of mesenteric ischemia. Intraoperatively, there were multiple skip ischemic lesions in the small intestine and cecum. We resected the ischemic bowel and performed a distal jejunostomy. Her residual small bowel measured just 20 cm in length. Postoperatively, her general status gradually improved. She was discharged with total parenteral nutrition and a small amount of enteral nutrition.

scholarly journals SINGLE CENTER EXPERIENCE IN MANAGEMENT OF ACUTE MESENTERIC ISCHEMIA AND THE IMMEDIATE OUTCOME FOLLOWING SURGICAL SALVAGE

2021 ◽  
Vol 31 (04) ◽  
pp. 201-203
Author(s):  
Shabbir Ahmad ◽  
Ahmad Naeem Akhtar ◽  
Nazia Farooq ◽  
Ajmal Farooq ◽  
Farman Ali ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Mesenteric Ischemia ◽  
Surgical Intervention ◽  
Acute Mesenteric Ischemia ◽  
Rare Condition ◽  
Abdominal Distension ◽  
Early Presentation ◽  
Late Presenters ◽  
Single Center Experience ◽  
Time Period

Acute Mesenteric Ischemia is a rare condition with an incidence of 5/100,000. Occlusive subtype has the better outcome if early presentation and urgent surgical intervention is made. The study was conducted at Lahore General Hospital, Lahore from Jan, 2016 to Jan, 2018. During this time period 12 patients were enrolled in the study fulfilling the inclusion and exclusion criteria. Mean age was 58 years and all were male (range 45 - 75 years). All 12 patients were symptomatic at presentation with severe abdominal pain (94.3%), abdominal distension (63.6%) and vomiting (40.4%) alone or in combination. 7 patients (58.3%) presented within 24 hours from the onset of symptoms whereas 5 patients (41.6%) presented late. All patients who presented within 24 hours of onset of symptoms survived whereas all patients who presented after 24 hours from the onset of symptoms could not survive. The mortality rate for early presenters was zero % while for late presenters it was 100 %. On whole the mortality rate for our 12 patients with Acute Mesenteric Ischemia was 41.7 %. Conclusion Acute mesenteric ischemia patient presentation within 24 hours from the onset of symptoms with early diagnosis and surgical intervention had much better outcome.

Mortality of acute mesenteric ischemia remains unchanged despite significant increase in utilization of endovascular techniques

Vascular ◽  
2015 ◽  
Vol 24 (1) ◽  
pp. 44-52 ◽  
Author(s):  
Mohammad H Eslami ◽  
Denis Rybin ◽  
Gheorghe Doros ◽  
James T McPhee ◽  
Alik Farber
Keyword(s):  
Mortality Rate ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Mesenteric Ischemia ◽  
Bowel Resection ◽  
Acute Mesenteric Ischemia ◽  
Fold Increase ◽  
Endovascular Techniques ◽  
Contemporary Study

Introduction In this study, we evaluated if increase in utilization of endovascular surgery has affected in-hospital mortality rates among patients with acute mesenteric ischemia. Methods The National Inpatient Sample (2003–2011) was queried for acute mesenteric ischemia using ICD-9 code for acute mesenteric ischemia (557.1). This cohort was divided into patients treated with open vascular surgery (open vascular group) and by endovascular therapies (endovascular group) based on the ICD-9CM procedure codes. Multivariable logistic regression was used to determine temporal trend for mortality while adjusting for confounding variables. Results There was 1.45-fold increase in utilization of endovascular techniques in this study. In-hospital mortality rate, total median charges and length of stay were significantly lower among the endovascular group than the open vascular group despite having significantly higher Elixhauser comorbidities index (3 ± 0.1 vs. 2.7 ± 0.1, p = .003). Over the course of the study period, there was no change in the overall mortality rate despite higher endovascular utilization. Factors associated with increased mortality included age, open surgical repair (Odds ratio: 1.45, 95% Confidence Interval: 1.10–1.91, p = .016) and bowel resection Odds ratio: 2.88, 95% Confidence Interval: 2.01–4.12). Conclusion The mortality rate for acute mesenteric ischemia remains unchanged throughout this contemporary study. Open surgical intervention, bowel resection and age were associated with increased mortality. Endovascular group patients had better survival despite higher morbidity indices.

The Pathogenesis of Nonocclusive Mesenteric Ischemia: Implications for Research and Clinical Practice

2018 ◽  
Vol 34 (10) ◽  
pp. 771-781 ◽  
Author(s):  
Hussam Al-Diery ◽  
Anthony Phillips ◽  
Nicholas Evennett ◽  
Sanjay Pandanaboyana ◽  
Michael Gilham ◽  
...  
Keyword(s):  
Mesenteric Ischemia ◽  
Delayed Diagnosis ◽  
Acute Mesenteric Ischemia ◽  
Ct Scanning ◽  
Abdominal Distension ◽  
Major Surgery ◽  
Future Research ◽  
Abdominal Pressure ◽  
Unexpected Finding ◽  
Nonocclusive Mesenteric Ischemia

Nonocclusive mesenteric ischemia (NOMI) is a condition that can encompass ischemia, inflammation, and infarction of the intestinal wall. In contrast to most patients with acute mesenteric ischemia, NOMI is distinguished by patent arteries and veins. The clinical presentation of NOMI is often insidious and nonspecific, resulting in a delayed diagnosis. Patients most at risk are those with severe acute and critical disease, including major surgery and trauma. Nonocclusive mesenteric ischemia is part of a spectrum, from mild, asymptomatic, and an unexpected finding on CT scanning, through to those exhibiting abdominal distension and peritonitis. Severe NOMI is associated with a significant mortality rate. This review of NOMI pathophysiology was conducted to document current concepts and evidence, to examine the implications for diagnosis and treatment, and to identify gaps in knowledge that might direct future research. The key pathologic mechanisms involved in the genesis of NOMI represent an exaggerated normal physiological response to maintain perfusion of vital organs at the expense of mesenteric perfusion. A supply–demand mismatch develops in the intestine due to the development of persistent mesenteric vasoconstriction resulting in reduced blood flow and oxygen delivery to the intestine, particularly to the vulnerable superficial mucosa. This mismatch can be exacerbated by raised intra-abdominal pressure, enteral nutrition, and the use of certain vasoactive drugs, ultimately resulting in the development of intestinal ischemia. Strategies for prevention, early detection, and treatment are urgently needed.

Acute mesenteric ischemia with necrosis of entire small intestine

2019 ◽  
Vol 98 (4) ◽  
pp. 174-177
Keyword(s):  
Small Intestine ◽  
Mesenteric Ischemia ◽  
Severe Disease ◽  
Acute Mesenteric Ischemia ◽  
Diagnostic Methods ◽  
Entire Small Intestine ◽  
Common Etiology

The case study describes a case of a patient with acute mesenteric ischemia with necrosis of entire small intestine. In following text there is an overview of the incidence of acute mesenteric ischemia, its most common etiology, diagnostic methods and treatment of this severe disease.

An Analysis of Dental Implants Survival and Success

2018 ◽  
Vol 69 (9) ◽  
pp. 2465-2466
Author(s):  
Iustin Olariu ◽  
Roxana Radu ◽  
Teodora Olariu ◽  
Andrada Christine Serafim ◽  
Ramona Amina Popovici ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Medical History ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Demographic Data ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Health Related

Osseointegration of a dental implant may encounter a variety of problems caused by various factors, as prior health-related problems, patients� habits and the technique of the implant inserting. Retrospective cohort study of 70 patients who received implants between January 2011- April 2016 in one dental unit, with Kaplan-Meier method to calculate the probability of implants�s survival at 60 months. The analysis included demographic data, age, gender, medical history, behavior risk factors, type and location of the implant. For this cohort the implants�survival for the first 6 months was 92.86% compared to the number of patients and 97.56% compared to the number of total implants performed, with a cumulative failure rate of 2.43% after 60 months. Failures were focused exclusively on posterior mandible implants, on the percentage of 6.17%, odds ratio (OR) for these failures being 16.76 (P = 0.05) compared with other localisations of implants, exclusively in men with median age of 42 years.

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