Acute mesenteric ischemia: analysis of cases admitted to a hospital during 10 years (2001–2010)

Acute mesenteric ischemia is a rare disorder; it occurs in an average of 0.4% of acute surgery cases. Its diagnosis is often difficult because of the poor symptoms, and mortality of the patients is still as high as 70–90%. Aims: The aims of the study were to assess the importance of time factor that may influence the outcome of the disease and to find out whether it is possible to decrease the high mortality of patients. Method: Among patients admitted to Szent Pantaleon Hospital in Hungary between January 2001 and December 2010, patients whose surgery or autopsy findings confirmed intestinal necrosis were analyzed. A total of 114 patients with acute mesenteric ischemia were included in the study. Results: 55% of the patients had typical symptoms. 43.8% of the patients underwent surgery and among these patients the mortality rate was 70% despite surgical intervention. The survival rate was 72.3% when surgery was performed within less than 12 hours after the onset of symptoms, but only 20% of patients survived when surgery was delayed between 24 and 48 hours after the onset of symptoms. Conclusion: With early diagnosis and intervention, patients with acute mesenteric ischemia may have a better a chance to survive. Orv. Hetil., 2012, 153, 1424–1432.

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Problems of the Diagnosis and Treatment of Acute Mesenteric Ischemia: a SingleCenter Experience

Journal of Anesthesia & Pain Medicine ◽

10.33140/japm/03/04/00004 ◽

2018 ◽

Vol 3 (4) ◽

Keyword(s):

Blood Flow ◽

Mortality Rate ◽

Early Diagnosis ◽

High Mortality ◽

Mesenteric Ischemia ◽

Intestinal Resection ◽

Acute Mesenteric Ischemia ◽

Mesenteric Arteries ◽

Diagnosis And Treatment ◽

Number Of Patients

Objective: To improve the diagnosis and treatment of acute mesenteric ischemia by using available methods of early diagnosis and modern methods of treatment. Summary Background Data: The number of patients with disorders of the mesenteric circulation is increasing all over the world. In comparison with the occlusion of the coronary, cerebral arteries and peripheral veins, acute obstruction of the mesenteric arteries and veins is diagnosed much later, which causes a high mortality rate from 53 to 100%. Methods: In this study the experience of treatment of 162 patients with acute mesenteric ischemia was analyzed. All patients underwent treatment in Institute of Urgent and Recovery Surgery (IURS NAMS, Donetsk, Ukraine) from 2002 to 2017. Results: From 162 patients: 112 patients were with acute occlusive and 50 patients with acute nonocclusive mesenteric ischemia. The intravital diagnosis was not confirmed in 26 patients (16 %). 119 of patients died, the level of mortality was 73, 5%. 104 patients were operated, 32 patients were discharged (30,8 %), 72 patients died, a mortality rate was 69,2 %. Operations with restore of blood flow were performed in 14 patients, 5 patients died, 9 patients left the hospital. Conservative therapy was performed in 22 patients, in 11 patients with good results (50 %). Conclusions: The early diagnosis of this pathology is crucial and it can reduce the high mortality rate of patients with AMI. Treatment of OAMI should be carried out in a community of general, vascular and endovascular surgeons. Restoration of blood flow through mesenteric vessels with the help of endovascular technology and implementation of thrombembolectomy during open surgical intervention in a number of cases allows to avoid intestinal resection.

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A rapid preliminary prediction model for intestinal necrosis in acute mesenteric ischemia: a retrospective study

BMC Gastroenterology ◽

10.1186/s12876-021-01746-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xinsuo Zhuang ◽

Fumei Chen ◽

Qian Zhou ◽

Yuanrun Zhu ◽

Xiaofeng Yang

Keyword(s):

Logistic Regression ◽

Retrospective Study ◽

Prediction Model ◽

Mesenteric Ischemia ◽

Surgical Intervention ◽

Univariate Analysis ◽

Acute Mesenteric Ischemia ◽

Intestinal Necrosis ◽

Wbc Count ◽

Early Surgical Intervention

Abstract Background Acute mesenteric ischemia (AMI) is a life-threatening condition. However, there is no accurate method to predict intestinal necrosis in AMI patients that may facilitate early surgical intervention. This study thus aimed to explore a simple and accurate model to predict intestinal necrosis in patients with AMI. Methods A single-center retrospective study was performed on the data of 132 AMI patients treated between October 2011 and June 2020. The patients were divided into the intestinal necrosis and non-intestinal necrosis groups. The clinical characteristics and laboratory data were analyzed by univariate analysis, and the variables with statistical significance were further analyzed by multivariate logistic regression analysis. The independent predictors of intestinal necrosis were determined and a logistic prediction model was established. Finally, the accuracy, sensitivity, and specificity of the model in predicting intestinal necrosis were evaluated. Results Univariate analysis showed that white blood cell (WBC) count, blood urea nitrogen (BUN) level, neutrophil ratio, prothrombin time (PT), and LnD-dimer were associated with intestinal necrosis. According to logistic regression multivariate analysis, WBC count, BUN level and LnD-dimer were independent predictors of intestinal necrosis. These parameters were used to establish a clinical prediction model of intestinal necrosis (CPMIN) as follows: model score = 0.349 × BUN (mmol/L) + 0.109 × WBC × 109 (109/L) + 0.394 × LnD − Dimer (ug/L) − 7.883. The area under the receiver operating characteristics (ROC) curve of the model was 0.889 (95% confidence interval: 0.833–0.944). Model scores greater than − 0.1992 predicted the onset of intestinal necrosis. The accuracy, specificity, and sensitivity of the model were 82.6%, 78.2%, and 88.3%, respectively. The proportion of intestinal necrosis in the high-risk patient group (CPMIN score ≥ − 0.1992) was much greater than that in the low-risk patient group (CPMIN score < − 0.1992; 82.7% vs. 15.0%, p < 0.001). Conclusion The CPMIN can effectively predict intestinal necrosis and guide early surgical intervention to improve patient prognosis. Patients with AMI who are classified as high-risk should be promptly treated with surgery to avoid the potential complications caused by delayed operation. Patients classified as low-risk group can receive non-surgical treatment. This model may help to lower the morbidity and mortality from AMI. However, this model’s accuracy should be validated by larger sample size studies in the future.

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A Rapid Prediction Model for Intestinal Necrosis in Acute Mesenteric Ischemia: A Retrospective Study

10.21203/rs.3.rs-152495/v1 ◽

2021 ◽

Author(s):

Xinsuo Zhuang ◽

Fumei Chen ◽

Qian Zhou ◽

Yuanrun Zhu ◽

Xiaofeng Yang

Keyword(s):

Logistic Regression ◽

Retrospective Study ◽

Prediction Model ◽

Mesenteric Ischemia ◽

Surgical Intervention ◽

Univariate Analysis ◽

Acute Mesenteric Ischemia ◽

Intestinal Necrosis ◽

Wbc Count ◽

Early Surgical Intervention

Abstract Background：Acute mesenteric ischemia (AMI) is a life-threatening condition. However, there is no accurate method to predict intestinal necrosis in AMI patients that may facilitate early surgical intervention. This study thus aimed to explore a simple and accurate model to predict intestinal necrosis in patients with AMI.Methods: A single-center retrospective study was performed on the data of 132 AMI patients treated between October 2011 and June 2020. The patients were divided into the intestinal necrosis and non-intestinal necrosis groups. The clinical characteristics and laboratory data were analyzed by univariate analysis, and the variables with statistical significance were further analyzed by multivariate logistic regression analysis. The independent predictors of intestinal necrosis were determined and a logistic prediction model was established. Finally, the accuracy, sensitivity, and specificity of the model in predicting intestinal necrosis were evaluated. Results: Univariate analysis showed that white blood cell (WBC) count, blood urea nitrogen (BUN) level, neutrophil ratio, prothrombin time (PT), and LnD-dimer were associated with intestinal necrosis. According to logistic regression multivariate analysis, WBC count, BUN level and LnD-dimer were independent predictors of intestinal necrosis. These parameters were used to establish a clinical prediction model of intestinal necrosis (CPMIN) as follows: model score = 0.349×BUN (mmol/L) +0.109×WBC×109+0.394×LnD-Dimer-7.883. The area under the receiver operating characteristics (ROC) curve of the model was 0.889 (95% confidence interval: 0.833–0.944). Model scores greater than -0.1992 predicted the onset of intestinal necrosis. The accuracy, specificity, and sensitivity of the model were 82.6%, 78.2%, and 88.3%, respectively. The proportion of intestinal necrosis in the high-risk patient group (CPMIN score ≥ -0.1992) was much greater than that in the low-risk patient group (CPMIN score < -0.1992; 82.7% vs. 15.0%, p<0.001).Conclusion：The CPMIN can effectively predict intestinal necrosis and guide early surgical intervention to improve patient prognosis. Patients with AMI who are classified as high-risk should be promptly treated with surgery to avoid the potential complications caused by delayed operation. Patients classified as low-risk group can receive non-surgical treatment. This model may help to lower the morbidity and mortality from AMI.

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

Pakistan Postgraduate Medical Journal ◽

10.51642/ppmj.v31i04.410 ◽

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.

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Evaluation of outcome in Mesenteric Ischemia

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.17.05.02.03 ◽

2017 ◽

Vol 5 (2) ◽

pp. 13

Author(s):

Samad Shams Vahdati ◽

Ozgur Tatli ◽

Mohammad Taghizadieh ◽

Roshan Fahimi ◽

Neda Gholamzadeh ◽

...

Keyword(s):

Emergency Department ◽

Mortality Rate ◽

Early Diagnosis ◽

Physical Examination ◽

Mesenteric Ischemia ◽

Clinical Signs ◽

Acute Mesenteric Ischemia ◽

P Value ◽

Threatening Condition ◽

Life Threatening

Background: Acute mesenteric ischemia (AMI) is an infrequent but a complicated life threatening condition. It is the leading causes of mortality with the rate of 60-100%. The purpose of our study is to investigate demographic outcomes of the patients referred to the emergency department of Imam Reza hospital with the diagnosis of AMI. Methods and materials: All patients with the diagnosis of AMI from March 2014 to March 2016 who were referred to emergency department of Imam Reza hospital, were studied. Demographic characteristics (age, sex, the period from symptom onset till laparotomy), risk factors and the last outcomes of patients were noted in the check lists for each patient. P value less than 0.05 was determined as significant. Results: from 111 patients, 76 cases (68.8%) were male, 35 cases (31.5%) were female. Chief complaint of all patients was stomachache. Period of arriving to the emergency room in 5 cases (4.5%) was 1-6 hours, in 3 cases (2.7%) was 6-12 hours, and in 103 cases (92.8%) has taken more than 12 hours. In 55 cases (49.5%), there was a significant relationship between clinical signs and physical examination findings, whereas in 56 cases (50.5%) there was no relation. In our study 42 cases (37.8%) were treated, whereas the morbidity and mortality rate were respectively 7 (6.3%) and 62 (55.9%). According to the results of our study the most important finding was pain which was disproportionate to physical examination findings (P value< 0.052). Conclusion: Acute mesenteric ischemia is a severe and progressive disease so early diagnosis and appropriate treatment are very important. One of the main reasons of higher mortality rate in AMI is difficulty in early diagnosis, before necrosis occurrence. Major factor that determines the survival rate is the accurate diagnosis before necrosis and peritonitis happens.

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D-dimer as a marker for early diagnosis of acute mesenteric ischemia

Thrombosis Research ◽

10.1016/j.thromres.2005.04.025 ◽

2006 ◽

Vol 117 (4) ◽

pp. 463-467 ◽

Cited By ~ 37

Author(s):

Hüseyin Altinyollar ◽

Mustafa Boyabatli ◽

Uğur Berberoğlu

Keyword(s):

Early Diagnosis ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

D Dimer

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Mean Platelet Volume: Is It a Predictive Parameter in Diagnosis of Acute Mesenteric Ischemia?

International Surgery ◽

10.9738/intsurg-d-14-00268.1 ◽

2015 ◽

Vol 100 (5) ◽

pp. 962-965 ◽

Cited By ~ 3

Author(s):

Ahmet Türkoğlu ◽

Mesut Gül ◽

Abdullah Oğuz ◽

Zübeyir Bozdağ ◽

Burak Veli Ülger ◽

...

Keyword(s):

Early Diagnosis ◽

Mean Platelet Volume ◽

Mesenteric Ischemia ◽

Area Under The Curve ◽

Acute Mesenteric Ischemia ◽

The Elderly ◽

Control Group ◽

Characteristic Analysis ◽

Platelet Volume ◽

Cell Counts

Our objective for this study was to discuss the usability of mean platelet volume, which is associated with numerous vascular pathologies, in the early diagnosis of acute mesenteric ischemia. Acute mesenteric ischemia is an uncommon, life-threatening clinical condition mostly seen in the elderly. Early diagnosis of acute mesenteric ischemia and correction of blood circulation before necrosis occurs are important factors affecting prognosis. A total of 95 patients who underwent emergency surgery for acute mesenteric ischemia and 90 healthy volunteers as control group were included in this study. Age, gender, hemoglobin values, white blood cell counts, mean platelet volume, and platelet counts are recorded for evaluation. The mean platelet volume values were significantly higher in patients with acute mesenteric ischemia than in the controls (9.4 ± 1.1 fL and 7.4 ± 1.4 fL, respectively; P < 0.001). Receiver-operating characteristic analysis demonstrated a cutoff value of mean platelet volume as 8.1 fL (area under the curve, 0.862), a sensitivity of 83.2%, and a specificity of 80%. As a result, in the patients who are admitted to the hospital with acute nonspecific abdominal pain and suspected of having acute mesenteric ischemia, high mean platelet volume values in routine hemograms support the diagnosis of acute mesenteric ischemia.

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Predictors Of Transmural Intestinal Necrosis In Patients Presenting With Acute Mesenteric Ischemia On Computed Tomography.

Journal of Cardiovascular Computed Tomography ◽

10.1016/j.jcct.2020.06.141 ◽

2020 ◽

Vol 14 (3) ◽

pp. S72-S73

Author(s):

I. Atre ◽

K. Eurboonyanun ◽

A. O'Shea ◽

R. Lahoud ◽

A. Shih ◽

...

Keyword(s):

Computed Tomography ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

Intestinal Necrosis

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MOS Sensors Array for the Discrimination of Lung Cancer and At-Risk Subjects with Exhaled Breath Analysis

Chemosensors ◽

10.3390/chemosensors9080209 ◽

2021 ◽

Vol 9 (8) ◽

pp. 209

Author(s):

Davide Marzorati ◽

Luca Mainardi ◽

Giulia Sedda ◽

Roberto Gasparri ◽

Lorenzo Spaggiari ◽

...

Keyword(s):

Lung Cancer ◽

Survival Rate ◽

Mortality Rate ◽

Early Diagnosis ◽

Gas Sensor ◽

Electronic Nose ◽

Gas Sensors ◽

Breath Analysis ◽

Exhaled Breath ◽

Exhaled Breath Analysis

Lung cancer is characterized by a tremendously high mortality rate and a low 5-year survival rate when diagnosed at a late stage. Early diagnosis of lung cancer drastically reduces its mortality rate and improves survival. Exhaled breath analysis could offer a tool to clinicians to improve the ability to detect lung cancer at an early stage, thus leading to a reduction in the associated survival rate. In this paper, we present an electronic nose for the automatic analysis of exhaled breath. A total of five a-specific gas sensors were embedded in the electronic nose, making it sensitive to different volatile organic compounds (VOCs) contained in exhaled breath. Nine features were extracted from each gas sensor response to exhaled breath, identifying the subject breathprint. We tested the electronic nose on a cohort of 80 subjects, equally split between lung cancer and at-risk control subjects. Including gas sensor features and clinical features in a classification model, recall, precision, and accuracy of 78%, 80%, and 77% were reached using a fourfold cross-validation approach. The addition of other a-specific gas sensors, or of sensors specific to certain compounds, could improve the classification accuracy, therefore allowing for the development of a clinical tool to be integrated in the clinical pipeline for exhaled breath analysis and lung cancer early diagnosis.

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