Difficulties in the Radiation Diagnosis of Acute Mesenteric Thrombosis in Patients with Chronic Critical Illness

Acute mesenteric ischemia is an acute disruption of blood supply to part of the intestine, which, if untreated, leads to bowel wall necrosis and a patient’s death. Computed tomography (CT) plays a leading role in detecting mesenteric ischemia and in making the initial diagnosis, especially in patients with chronic critical illness, when productive contact is impossible. The final diagnosis is established during surgery or postmortem examination. Timely diagnosis and surgical treatment are a basic tool to reduce high mortality rates from this disease. The article presents the possibilities of CT in imaging and making the primary diagnosis of mesenteric ischemia and mesenteric thrombosis.

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Color Doppler sonography of small bowel wall changes in 21 consecutive cases of acute mesenteric ischemia

Clinical Imaging ◽

10.1016/j.clinimag.2009.12.014 ◽

2010 ◽

Vol 34 (2) ◽

pp. 161-162

Author(s):

E.M. Danse ◽

A. Kartheuser ◽

H.M. Paterson ◽

P.-F. Laterre

Keyword(s):

Small Bowel ◽

Mesenteric Ischemia ◽

Doppler Sonography ◽

Bowel Wall ◽

Color Doppler ◽

Acute Mesenteric Ischemia ◽

Color Doppler Sonography

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Ūminė mezenterinė išemija po širdies operacijos

Lietuvos chirurgija ◽

10.15388/lietchirur.2010.4.2101 ◽

2010 ◽

Vol 8 (4) ◽

pp. 0-0

Author(s):

Judita Andrejaitienė

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Mortality Rate ◽

Blood Circulation ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

Therapeutic Options ◽

Elapsed Time ◽

Occlusive Mesenteric Ischemia ◽

Mesenteric Thrombosis

Judita Andrejaitienė Kauno medicinos universiteto Biomedicininių tyrimų institutas, Intensyviosios terapijos ir kraujotakos tyrimų laboratorija, KMU BMTI Intensyviosios terapijos ir kraujotakos tyrimo laboratorija, Eivenių g. 4, LT-50009 KaunasEl. paštas: [email protected] Ūminė mezenterinė išemija po širdies operacijų yra retai pasitaikanti, tačiau gyvybei grėsminga kraujagyslių patologija, apibūdinama kaip staigus simptominis žarnyno kraujotakos sutrikimas (sulėtėjimas arba nutrūkimas), galintis sukelti žarnyno infarktą. Šios patologijos išeitys priklauso nuo ligos trukmės, t. y., kiek laiko praeina nuo ligos nustatymo iki gydymo, diagnostika – ypač sunki ir dažnai užtrunka dėl nespecifinių laboratorinių bei radiologinių tyrimų rezultatų. Gal todėl užmirštama apie šios (dažniausiai letalios baigties) ligos simptomus. Kai ūminė mezenterinė išemija įvyksta ankstyvuoju pooperaciniu laikotarpiu ligoniams po širdies operacijų naudojant dirbtinę kraujo apytaką, šių ligonių būklė yra labai sudėtinga dėl klastingo klinikinio pasireiškimo, ypač sunkios diagnostikos bei gydymo ir tai sąlygoja didelį pooperacinį mirštamumą. Šio atvejo pristatymu ir literatūros apžvalga siekiama atkreipti kolegų dėmesį į galimas pooperacines komplikacijas ligoniams po širdies operacijų, pateikiama ūminės mezenterinės išemijos patofiziologinių mechanizmų samprata, diagnostikos testai, taip pat siekiama pabrėžti, kokia sudėtinga diferencinė diagnostika ir koks didelis mirštamumas, priminti gydymo pasirinkimo galimybes ir atverti perspektyvias tyrimo sritis. Reikšminiai žodžiai: širdies operacija, dirbtinė kraujo apytaka, hipoperfuzija, ūminė mezenterinė išemija, neokliuzinė mezenterinė išemija, mezenterinė trombozė. Acute mesenteric ischemia following cardiac surgery Judita Andrejaitienė Institute for Biomedical Research Kaunas University of Medicine, Laboratory of Intensive Care and Blood Circulation Research, Eivenių str. 4, LT-50009 Kaunas, LithuaniaE-mail: [email protected] Acute mesenteric ischemia is a highly-lethal surgical emergency in which the outcome is closely dependent on the elapsed time to diagnosis and treatment. The diagnosis is typically difficult and delayed due to nonspecific results of biological and radiological tests. Since prompt treatment is the key to a better outcome, acute mesenteric ischemia remains a challenging condition because of controversial algorithms and numerous therapeutic options. Acute mesenteric ischemia can complicate the post-operative course of patients following cardiopulmonary bypass (CPB). Several factors contribute to the systemic hypo-perfusion state, which is the most frequent pathophysiologic event. The condition has a more subtle clinical presentation, is more difficult to diagnose and treat, leading to a higher mortality rate. This report is an updated review of acute mesenteric ischemia in CPB with respect to the pathophysiologic events, diagnostic tests, therapeutic options, mortality rate and promising new areas of research. Keywords: cardiac surgery, cardiopulmonary bypass, hypoperfusion, acute mesenteric ischemia, non-occlusive mesenteric ischemia, mesenteric thrombosis.

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Acute mesenteric ischemia with necrosis of entire small intestine

Perspectives in Surgery ◽

10.33699/pis.2019.98.4.174-177 ◽

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.

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Damage Control Surgery in Acute Mesenteric Ischemia

Case Medical Research ◽

10.31525/ct1-nct03966430 ◽

2019 ◽

Author(s):

Keyword(s):

Mesenteric Ischemia ◽

Damage Control ◽

Acute Mesenteric Ischemia ◽

Damage Control Surgery

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Use of indocianine green fluorescence in acute mesenteric ischemia

Annals of Mediterranean Surgery ◽

10.22307/2603.8706.2020.02.005 ◽

2020 ◽

Vol 3 (2) ◽

Author(s):

Jaime Bonnín-Pascual

Keyword(s):

Indocyanine Green ◽

Terminal Ileum ◽

Mesenteric Ischemia ◽

Intestinal Anastomosis ◽

Acute Mesenteric Ischemia ◽

Left Colon ◽

Infrared Light ◽

High Morbidity ◽

Green Fluorescence ◽

Clinical Cases

Introduction: Acute mesenteric ischemia has a high morbidity and mortality and constitutes an intraoperative challenge in the management of ischemic areas. In this context, we analyze the use of indocyanine green fluorescence to assess intestinal vascularization through 3 clinical cases. Case presentation: we present 3 clinical cases operated for acute mesenteric ischemia. Evaluation of intestinal viability is performed under infrared light after intravenous infusion of 25 mg of indocyanine green. Case 1 is a 42-year-old male with multiple antecedents of severe vascular disease, presenting with a massive acute mesenteric ischemia involving multiple intestinal segments. Fluorescence allows two adjusted bowel resections with double intestinal anastomosis. Case 2 is a 74-year-old woman with a history of non-anticoagulated atrial fibrillation who is decided to perform an urgent surgery when an esophageal, gastric and portal system pneumatosis is observed, as indirect signs of ischemia, in urgent CT. During the surgical act there is an ischemia of the terminal ileum and right colon without clear signs of involvement at the esophageal-gastric level. The assessment after administration of ICG discriminates the clear ischemic involvement from terminal ileum to ascending colon and patched in the transverse and left colon, without esophageal or gastric involvement. Case 3 is a 49-year-old woman with aortoiliac and visceral Takayasu disease and revascularization surgery of the celiac trunk. Given the increase in abdominal pain, a new CT scan demonstrates colonic pneumatosis. Urgent laparotomy shows necrosis at the level of the left colon and hypoperfusion of the cecum. The administration of ICG finds a lack of uptake of the entire colon. A subtotal colectomy with ileostomy and mucous fistula is performed. Introduction: Acute mesenteric ischemia has a high morbidity and mortality and constitutes an intraoperative challenge in the management of ischemic areas. In this context, we analyze the use of indocyanine green fluorescence to assess intestinal vascularization through 3 clinical cases. Case presentation: we present 3 clinical cases operated for acute mesenteric ischemia. Evaluation of intestinal viability is performed under infrared light after intravenous infusion of 25 mg of indocyanine green. Case 1 is a 42-year-old male with multiple antecedents of severe vascular disease, presenting with a massive acute mesenteric ischemia involving multiple intestinal segments. Fluorescence allows two adjusted bowel resections with double intestinal anastomosis. Case 2 is a 74-year-old woman with a history of non-anticoagulated atrial fibrillation who is decided to perform an urgent surgery when an esophageal, gastric and portal system pneumatosis is observed, as indirect signs of ischemia, in urgent CT. During the surgical act there is an ischemia of the terminal ileum and right colon without clear signs of involvement at the esophageal-gastric level. The assessment after administration of ICG discriminates the clear ischemic involvement from terminal ileum to ascending colon and patched in the transverse and left colon, without esophageal or gastric involvement. Case 3 is a 49-year-old woman with aortoiliac and visceral Takayasu disease and revascularization surgery of the celiac trunk. Given the increase in abdominal pain, a new CT scan demonstrates colonic pneumatosis. Urgent laparotomy shows necrosis at the level of the left colon and hypoperfusion of the cecum. The administration of ICG finds a lack of uptake of the entire colon. A subtotal colectomy with ileostomy and mucous fistula is performed. Conclusions: The fluorescence with ICG provides a better visualization of the intestinal vascularization in the AMI, and allows to determine the limits of the affected tissue to perform adjusted resections.

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