scholarly journals Post-traumatic hollow viscus perforation with mesenteric and bowel ischemia

2021 ◽  
Author(s):  
Niharika Prasad
Keyword(s):  
Mesenteric Ischemia ◽  
Young Male ◽  
Acute Mesenteric Ischemia ◽  
Exploratory Laparotomy ◽  
Bowel Ischemia ◽  
Hollow Viscus ◽  
Cross Sectional ◽  
Occlusive Mesenteric Ischemia ◽  
Partial Colectomy ◽  
Hollow Viscus Perforation

Abstract BackgroundHollow viscus perforation and acute mesenteric ischemia are life-threatening conditions that must be recognized and managed appropriately. Computed tomography (CT) helps to visualize the bowel wall directly, as well as in the timely diagnosis of secondary signs of bowel ischemia.Case PresentationA young male presented with blunt trauma to the upper abdomen. A supine radiograph was suspicious of pneumoperitoneum and CT was performed to rule out perforation. The above finding was confirmed on CT, in addition, lack of enhancement of a segment of colon and non-occlusive mesenteric ischemia was evident. He was managed with exploratory laparotomy and repair of the perforation with partial colectomy.ConclusionsThe radiologist should be familiar with signs of pneumoperitoneum on supine radiographs for detection of hollow viscus perforation. These must be viewed with an index of high suspicion in symptomatic patients, post-trauma, and, further cross-sectional imaging may still be required.

Combined Endovascular and Surgical Retrograde Superior Mesenteric Artery Recanalization

2018 ◽  
Author(s):  
Syed M. Peeran
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Atherosclerotic Lesion ◽  
Acute Mesenteric Ischemia ◽  
Exploratory Laparotomy ◽  
Chronic Mesenteric Ischemia ◽  
Hybrid Technique ◽  
Current Standard ◽  
Stent Deployment

Acute mesenteric ischemia is a life-threatening vascular emergency associated with a very high mortality rate. In the setting of necrotic bowel, the current standard of care requires a laparotomy with bowel resection and surgical or endovascular revascularization of the superior mesenteric artery. Unfortunately, mesenteric bypass confers high perioperative mortality, in some reports up to 45%. A hybrid technique that employs an exploratory laparotomy, catheterization of the distal superior mesenteric artery, and stent deployment across the atherosclerotic lesion was first described in 2004 for the treatment of acute-on-chronic mesenteric ischemia. This chapter describes the appropriate clinical indications, the technical aspects of performing this hybrid procedure, as well as the challenges and common pitfalls encountered.

scholarly journals Can the Preoperative Serum Lactate Level Predict the Extent of Bowel Ischemia in Patients Presenting to the Emergency Department with Acute Mesenteric Ischemia?

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Peter C. Ambe ◽  
Kai Kang ◽  
Marios Papadakis ◽  
Hubert Zirngibl
Keyword(s):  
Lactate Level ◽  
Mesenteric Ischemia ◽  
Clinical Decision Making ◽  
Elevated Serum ◽  
Acute Mesenteric Ischemia ◽  
Serum Lactate ◽  
Bowel Ischemia ◽  
Serum Lactate Level ◽  
Ischemic Bowel ◽  
Preoperative Serum

Purpose. Early recognition of acute mesenteric ischemia (AMI) can be challenging. Extensive bowel necrosis secondary to AMI is associated with high rates of mortality. The aim of this study was to investigate the association between preoperative serum lactate level and the extent of bowel ischemia in patients with AMI. Methods. Data of patients with abdominal pain and elevated serum lactate undergoing emergency laparotomy for suspected AMI within 24 hours of presentation was retrospectively abstracted. The length of the ischemic bowel segment was compared with the preoperative serum lactate level. Results. 36 female and 39 male patients, with median age 73.1 ± 12.3 years, were included for analysis. The median preoperative lactate was 2.96 ± 2.59 mmol/l in patients with ≤50 cm, 6.86 ± 4.08 mmol/l in patients with 51–100 cm, 4.73 ± 2.76 mmol/l in patients with >100 cm ischemic bowel, and 14.07 ± 4.91 mmol/l in the group with multivisceral ischemia. Conclusion. Although elevated serum lactate might permit an early suspicion and thus influence the clinical decision-making with regard to prioritization of surgery in patients with suspected AMI, a linear relationship between serum lactate and the extent of bowel ischemia could not be established in this study.

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 Bowel Ischemia in COVID-19: A Systematic Review

2021 ◽  
Author(s):  
Suyog Patel ◽  
Chamry Parikh ◽  
Deepak Verma ◽  
Ramaswamy Sundararajan ◽  
Upasana Agrawal ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Bowel Ischemia ◽  
Qualitative Assessment ◽  
Gastrointestinal Complications ◽  
Angiotensin Converting Enzyme 2 ◽  
Holistic Review ◽  
Gastric Decompression ◽  
Mesenteric Vessels

Abstract: Background: Gastrointestinal complications of this COVID-19 have been reported over the last year. One such manifestation is bowel ischemia. This study thus aims to provide a more holistic review of our current understanding of COVID-19 induced bowel ischemia. Method and Results: A meticulous search was performed using different keywords in PubMed, EMBASE, and Google Scholar. Fifty-two articles were included in our study after applying inclusion and exclusion criteria and performing the qualitative assessment of the studies. A total of 25,702 patients were included in our study after the completion of the qualitative assessment. Discussion: COVID-19 commonly presents in the GIT as diarrhea, vomiting, and nausea. The mechanism of bowel ischemia is associated with the formation of emboli which is related to COVID-19’s high affinity for angiotensin-converting enzyme-2 on enterocytes, affecting the superior mesenteric vessels. Clinically, patients presented with abdominal pain and vomiting. CT angiography of the abdomen and pelvis showed acute mesenteric ischemia. Management was usually initiated with gastric decompression, fluid resuscitation, and hemodynamic support. Surgical intervention was also sought. Conclusion: Mesenteric ischemia presenting in patients with COVID-19 has to be considered when symptoms of severe abdominal pain are present. More research and guidelines are required to be able to triage patients with COVID-19 to suspect mesenteric ischemia and to help in diagnosis and management.

scholarly journals The Utility of Biomarkers in Diagnosing and Predicting Outcomes in Acute Mesenteric Ischemia

2021 ◽  
Vol 17 (2) ◽  
pp. 119-126
Author(s):  
Cătălin Alexandru Pirvu ◽  
Felix Bratosin ◽  
Cristian Nica ◽  
Dan Cârțu ◽  
Patrascu Ștefan ◽  
...  
Keyword(s):  
Mesenteric Ischemia ◽  
Complete Blood Count ◽  
Significant Risk ◽  
Acute Mesenteric Ischemia ◽  
Cross Sectional ◽  
Vascular Intervention ◽  
Predicted Probability ◽  
General Surgeons ◽  
Cross Sectional Design ◽  
Acute Condition

Background: Acute intestinal ischemia stands as the most lethal acute condition encountered by general surgeons and one of the deadliest pathologies in medicine triggered by thromboembolic events. The patients’ survival decreases dramatically to a lower than 30% rate when diagnosed after 24 hours, thus early diagnosis with proper surgical or vascular intervention is mandatory. This study aims to determine the utility of biomarkers and routine blood tests in assessing the severity and mortality risk for patients with acute mesenteric ischemia. Methods: The study was developed on a prospective cross-sectional design over a period of five years, finding a total of 147 patients who underwent emergency surgery after a high suspicion of acute mesenteric ischemia. The available biomarkers used in our Clinic comprised a complete blood count, total bilirubin, CK, CK-MB, LDH, AST, ALT, amylase, and cholinesterase. Results: The leukocyte count (OR=1.105), hemoglobin (OR=3.912), LDH (OR=1.144), NLR (OR=1.154), and LLR (OR=1.286) were all independent and significant risk factors for AMI diagnosis. These covariates proved a good and reliable tool for diagnosing AMI with a 75.3% predicted probability. Conclusion: The prediction tool proved reliable, although it should only be considered in the clinical context where the surgeon suspects a case of acute mesenteric ischemia. The proposed model should be further investigated and validated in larger studies.

Endovascular Techniques in Mesenteric Ischemia

2018 ◽  
Author(s):  
Sarah E Strot ◽  
M Ashraf Mansour
Keyword(s):  
Mesenteric Ischemia ◽  
Hybrid Approach ◽  
Acute Mesenteric Ischemia ◽  
Vascular Occlusion ◽  
Standard Of Care ◽  
Celiac Artery ◽  
Bowel Ischemia ◽  
Chronic Mesenteric Ischemia ◽  
Hybrid Technique ◽  
Invasive Treatment

Mesenteric ischemia is a rare cause of abdominal pain but is a highly morbid and life-threatening condition. Despite significant improvements in diagnostic and therapeutic options, diagnosis continues to be a challenge and contributes to the high-mortality rate. Open exploration and revascularization should not be delayed if peritonitis or bowel ischemia is present, but with advances in technology and available endovascular devices, endovascular therapy has become a feasible option. It is being used to treat acute mesenteric ischemia in select patients and is now often the standard of care in many institutions for the treatment of chronic mesenteric ischemia. The use of aspiration embolectomy, thrombolytics, and angioplasty with stenting offers very sick patients a less invasive treatment option and may reduce the time to revascularization, reducing bowel ischemia. Additionally, a hybrid approach can offer the best of both open and endovascular treatments, allowing evaluation of the intra-abdominal contents for ischemia while avoiding a traditional arterial bypass.   This review contains 16 figures and 65 references Key Words: acute mesenteric ischemia, celiac artery, chronic mesenteric ischemia, embolism, endovascular, hybrid technique, mesenteric arteriography, mesenteric vascular occlusion, superior mesenteric artery, thrombosis

scholarly journals Impact of Inter-Hospital Transfer on Outcomes in Patients Undergoing Emergency Abdominal Surgery: A Tertiary Referral Center’s Perspective

2021 ◽  
Author(s):  
Joël L. Lavanchy ◽  
Jean-Baptiste Dubuis ◽  
Alice Osterwalder ◽  
Sebastian Winterhalder ◽  
Tobias Haltmeier ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Surgical Stress ◽  
Bowel Ischemia ◽  
Care Hospital ◽  
Hollow Viscus ◽  
Hospital Transfer ◽  
Transfer Group ◽  
Perforation Group ◽  
Emergency Abdominal Surgery ◽  
Hollow Viscus Perforation

Abstract Background In trauma patients, the impact of inter-hospital transfer has been widely studied. However, for patients undergoing emergency abdominal surgery (EAS), the effect of inter-hospital transfer on outcomes is largely unknown. Methods This is a single-center, retrospective observational study. Outcomes of transferred patients undergoing EAS were compared to patients primarily admitted to a tertiary care hospital from 01/2016 to 12/2018 using univariable and multivariable analyses. The primary outcome was in-hospital mortality. Results Some 973 patients with a median (IQR) age of 58.1 (39.4–72.2) years and a median body mass index of 25.8 (22.5–29.3) kg/m2 were included. The transfer group comprised 258 (26.3%) individuals and the non-transfer group 715 (72.7%). The population was stratified in three subgroups: (1) patients with low surgical stress (n = 483, 49.6%), (2) with hollow viscus perforation (n = 188, 19.3%) and (3) with potential bowel ischemia (n = 302, 31.1%). Neither in the low surgical stress nor in the hollow viscus perforation group was the transfer status associated with mortality. However, in the potential bowel ischemia group inter-hospital transfer was a predictor for mortality (OR 3.54, 95%CI 1.03–12.12, p = 0.045). Moreover, in the hollow viscus perforation group inter-hospital transfer was a predictor for reduced hospital length of stay (RC -10.02, 95%CI −18.14/−1.90, p = 0.016) and reduced severe complications (OR 0.38, 95%CI 0.18–0.77, p = 0.008). Conclusion Other than in patients with low surgical stress or hollow viscus perforation, in patients with potential bowel ischemia inter-hospital transfer was an independent predictor for higher mortality. Taking into account the time sensitiveness of bowel ischemia, efforts should be made to avoid inter-hospital transfer in this vulnerable subgroup of patients.

scholarly journals UNCOMMON CAUSE OF ACUTE MESENTERIC ISCHEMIA

2019 ◽  
Vol 6 (2) ◽  
pp. 41-44
Author(s):  
Luis Fernando Barbosa Silva ◽  
Viviane de Deus Silva ◽  
Larissa Mendonça Ferreira ◽  
João Guilherme Silva Oliveira ◽  
Silvio Alves Silva
Keyword(s):  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Exploratory Laparotomy ◽  
The United States ◽  
Mortality Rates ◽  
Cancer Epidemiology ◽  
Atherosclerotic Plaques ◽  
Academic Field ◽  
Duct Cancer ◽  
Very High

Acute mesenteric ischemia is not a common affection, it happens in 1 to 1,000 people in the United States. Acute mesenteric ischemia should always be one of the differential diagnoses for abdominal pain as it is difficult to diagnose and has very high mortality rates. Among its causes, the most uncommon remains the obstruction caused by displacement of atherosclerotic plaques. Therefore, the description of a case of acute mesenteric ischemia caused by detachment of a plaque in the thoracic aorta is contributing to academic field. The present case was treated by immediate exploratory laparotomy with resection of the distended segments and implantation of an endoprosthesis via femoral artery. Keywords: Bile duct cancer. Epidemiology. Cholelithiasis. Anatomicopathological. Cholecystectomy. RESUMO A isquemia mesentérica aguda não é comum, atinge 1 a cada 1000 habitantes nos Estados Unidos. Por ser de difícil diagnóstico e de elevada mortalidade deve sempre ser um dos diagnósticos diferenciais para dor abdominal. Dentre suas causas, mais incomum ainda é a obstrução causada por deslocamento de placa aterosclerótica. Portanto, torna-se útil demonstrar um caso de isquemia mesentérica aguda causada por descolamento de placa da aorta torácica, tratado por laparotomia exploradora imediata com ressecção das alças em sofrimento e implantação de endoprótese torácica reta via femoral.   Palavras-chave: Câncer de ducto biliar. Epidemiologia. Colelitíase. Anatomopatológico. Colecistectomia.

scholarly journals Accuracy of citrulline, I-FABP and d-lactate in the diagnosis of acute mesenteric ischemia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Alexandre Nuzzo ◽  
Kevin Guedj ◽  
Sonja Curac ◽  
Claude Hercend ◽  
Claude Bendavid ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Mesenteric Ischemia ◽  
Acute Abdominal Pain ◽  
Acute Mesenteric Ischemia ◽  
Cross Sectional Study ◽  
Diagnostic Study ◽  
Cross Sectional ◽  
Fatty Acid Binding ◽  
Stroke Center ◽  
New Biomarkers

AbstractEarly diagnosis of acute mesenteric ischemia (AMI) remains a clinical challenge, and no biomarker has been consistently validated. We aimed to assess the accuracy of three promising circulating biomarkers for diagnosing AMI—citrulline, intestinal fatty acid-binding protein (I-FABP), and d-lactate. A cross-sectional diagnostic study enrolled AMI patients admitted to the intestinal stroke center and controls with acute abdominal pain of another origin. We included 129 patients—50 AMI and 79 controls. Plasma citrulline concentrations were significantly lower in AMI patients compared to the controls [15.3 μmol/L (12.0–26.0) vs. 23.3 μmol/L (18.3–29.8), p = 0.001]. However, the area under the receiver operating curves (AUROC) for the diagnosis of AMI by Citrulline was low: 0.68 (95% confidence interval = 0.58–0.78). No statistical difference was found in plasma I-FABP and plasma d-lactate concentrations between the AMI and control groups, with an AUROC of 0.44, and 0.40, respectively. In this large cross-sectional study, citrulline, I-FABP, and d-lactate failed to differentiate patients with AMI from patients with acute abdominal pain of another origin. Further research should focus on the discovery of new biomarkers.

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