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.

OUR SURGICAL EXPERIENCE IN ACUTE MESENTERIC ISCHEMIA- VARIOUS PATHOPHYSIOLGICAL TYPES – A CASE SERIES

2021 ◽  
pp. 25-29
Author(s):  
B. Santhi ◽  
A. Ramprasath ◽  
R. Saradha
Keyword(s):  
Abdominal Pain ◽  
Early Diagnosis ◽  
Elderly Patients ◽  
Mesenteric Ischemia ◽  
Hospital Admissions ◽  
Case Series ◽  
Arterial Occlusion ◽  
Acute Mesenteric Ischemia ◽  
Delayed Presentation ◽  
Surgical Critical Care

BACKGROUND: Mesenteric ischemia is a frequently lethal condition resulting from critically reduced perfusion to the gastrointestinal tract. It accounts for 1-2% of hospital admissions for abdominal pain. Mortality due to mesenteric ischemia ranges from 24% to 96% with an average of 69%. AIM: The aim of this case series is to outline the clinical presentation and challenges in diagnosis of acute mesenteric ischemia and emphasize the importance of early diagnosis and intervention in reducing the mortality and morbidity. This article presents a series of 4 cases of the 3 major types of acute mesenteric ischemia – 2 cases of Acute Mesenteric Arterial Thrombosis(AMAT), one case of Acute Mesenteric Arterial Embolism(AMAE) and one case of Mesenteric Venous Thrombosis(MVT). MATERIALS AND METHODS: A total number of 4 patients who had undergone emergency laparotomy for acute mesenteric ischemia during the month of December 2020 in the Department of General Surgery, Government Kilpauk Medical College were studied. All 4 cases have been analysed during this study period of one month and followed up until discharge from the hospital. RESULTS: This case series consisted of 4 cases. Out of 4 cases, 3 were cases of Superior Mesenteric Arterial Occlusion due to thrombus and emboli and 1 was a case of Superior Mesenteric Vein Occlusion by thrombus. All 4 were male patients. All 4 patients presented with sudden onset of abdominal pain with or without vomiting. Abdominal distension, constipation and clinical features suggestive of bowel gangrene was not seen in all cases. Out of 4 cases, 2 cases were diagnosed early and taken up for immediate surgery and had a better outcome postoperatively with shorter hospital stay. Denitive diagnosis could not be made at time of admission for one case and was taken up for surgery late after the general condition of the patient deteriorated and extensive gangrene of the small bowel was seen during surgery. One case succumbed to septic shock after surgery following delayed presentation. This case series attempts to highlight that the key to successful management in acute mesenteric ischemia is a high index of suspicion leading to early diagnosis, aggressive resuscitation and early mesenteric revascularization. CONCLUSION: Despite the remarkable advances in in vascular surgical technique, vascular imaging, percutaneous intervention and surgical critical care, mesenteric ischemia remains a complex and often disheartening disease. Acute mesenteric ischemia is a life threatening vascular emergency that requires a high degree of clinical suspicion and early intervention to avoid a poor outcome. As Acute Mesenteric Ischemia often affects elderly patients, we have to consider the possibility of acute mesenteric ischemia in all elderly patients presenting with abdominal pain that is out of proportion to the ndings on physical examination

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.

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

Mesenteric Ischemia

2016 ◽  
Author(s):  
Ugo A. Ezenkwele
Keyword(s):  
Abdominal Pain ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Computed Tomographic Angiography ◽  
Low Flow ◽  
Chronic Mesenteric Ischemia ◽  
Flow State ◽  
Nonocclusive Mesenteric Ischemia ◽  
Vasodilator Therapy ◽  
Bowel Infarction

Acute mesenteric ischemia is interruption of intestinal blood flow by embolism, thrombosis, or a low-flow state. Bowel infarction is the end result of a process initiated by mediator release and inflammation. On clinical assessment, the early hallmark is severe abdominal pain but minimal physical findings. The abdomen remains soft, with little or no tenderness. Mild tachycardia may be present. Early diagnosis is difficult, but selective mesenteric angiography and computed tomographic angiography have the most sensitivity; other imaging studies and serum markers can show abnormalities but lack sensitivity and specificity early in the course of the disease, when diagnosis is most critical. Treatment is by embolectomy, anticoagulation, revascularization of viable segments, or resection; sometimes vasodilator therapy is successful. If diagnosis and treatment take place before infarction occurs, mortality is low; after intestinal infarction, mortality approaches 30 to 70%. For this reason, in the emergency department, clinical diagnosis should supersede diagnostic tests, which may delay treatment. This review contains 6 highly rendered figures, 4 tables, and 33 references. Key words: acute mesenteric ischemia; bowel necrosis; chronic mesenteric ischemia; mesenteric occlusive disease; mesenteric venous thrombosis; nonocclusive mesenteric ischemia; postprandial abdominal pain; superior mesenteric artery thromboembolism

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.

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.

scholarly journals Acute mesenteric ischemia: a review of 50 cases

2019 ◽  
Vol 6 (7) ◽  
pp. 2272 ◽  
Author(s):  
Sara Ranchordás ◽  
Cátia Cunha ◽  
Rita Roque ◽  
Luís Féria ◽  
Rui Maio
Keyword(s):  
Risk Factors ◽  
Abdominal Pain ◽  
Cardiovascular Risk ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Exploratory Laparotomy ◽  
Laboratory Studies ◽  
Univariable Analysis ◽  
Chi Square ◽  
Operative Complications

Background: Acute mesenteric ischemia is a rare but highly lethal cause of abdominal pain. Diagnosis should be prompt to ensure early treatment and avoid progression of the disease. The aim of the study was to describe the population presenting with acute mesenteric ischemia submitted to surgery, evaluate their outcome and determine possible predictors of mortality.Methods: Retrospective analysis of all patients who underwent surgery due to mesenteric ischemia between May 2013 and January 2015. A total of 50 patients were included. Pre-operative patient risk factors, diagnostic and surgical approach, post-operative complications and outcome were analysed. Statistical analysis was performed using SPSS v. 20. Univariable analysis was performed using T student and chi square tests.Results: Mean age was 79 years. Most patients (n=43) had cardiovascular risk factors. Clinical and laboratory studies findings were non-specific. During surgery, 28% were found to have extensive ischemia. Exclusive exploratory laparotomy was done in 11 cases due to extensive ischemia. Thrombectomy was performed in 6 cases. Eleven patients were submitted to reoperation.  In-hospital mortality was 68% (n=34). Patients who died had more frequently systemic findings and extensive ischemia. Patients with extensive vs. segmental ischemia were also compared and no statistically significant differences regarding preoperative findings were found. Mortality was significantly higher in patients with extensive ischemia.Conclusions:Timely diagnosis and treatment are essential to improve the outcome of AMI but tools to perform this are still lacking. Mortality remains high, especially when ischemia is extensive at the time of surgery.  

Retrograde Superior Mesenteric Artery Stenting in Case of SMA Shuttering

2021 ◽  
pp. 153857442110729
Author(s):  
Jason Zhang ◽  
Rohan Basu ◽  
Ann Gaffey ◽  
Julia Glaser ◽  
Venkat Kalapatapu
Keyword(s):  
Superior Mesenteric Artery ◽  
Endovascular Repair ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Endovascular Procedures ◽  
Acute Mesenteric Ischemia ◽  
Signs And Symptoms ◽  
Celiac Artery ◽  
Bowel Ischemia ◽  
Thoracoabdominal Aneurysm

This case describes a patient who underwent endovascular repair for an extent V thoracoabdominal aneurysm with planned coverage of the celiac artery. Following deployment of the stent graft, the superior mesenteric artery was shuttered, and the patient subsequently developed signs and symptoms of bowel ischemia. The patient underwent successful retrograde open superior mesenteric artery stenting with resolution of her symptoms. Although retrograde open mesenteric artery stenting (ROMS) has been primarily shown to be effective in acute mesenteric ischemia, this case demonstrates that ROMS can be used as a salvage option for shuttering during endovascular procedures.

scholarly journals Bowel Ischemia in ICU Patients: Diagnostic Value of I-FABP Depends on the Interval to the Triggering Event

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Stefan Ludewig ◽  
Rami Jarbouh ◽  
Michael Ardelt ◽  
Henning Mothes ◽  
Falk Rauchfuß ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Diagnostic Value ◽  
Bowel Ischemia ◽  
Icu Patients ◽  
Fatty Acid Binding ◽  
Sensitivity Specificity ◽  
Serum And Urine

Background. Intestinal fatty acid-binding protein (I-FABP) has been shown to be of high diagnostic value in patients with acute mesenteric ischemia. Whether these results can be reproduced in critically ill patients on the ICU was to be investigated. Materials and Methods. I-FABP was measured in serum and urine of 43 critically ill patients in ICU when mesenteric ischemia was suspected. Bowel ischemia was confirmed in 21 patients (group 1). 22 patients who survived at least seven days without confirmation of ischemia were assigned to group 2. I-FABP levels were compared between the groups, and interval from the event that has triggered ischemia to I-FABP measurement was recorded. Results. For the identification of patients with mesenteric ischemia, sensitivity, specificity, and area under the curve (AUC) for serum and urine I-FABP were 33.3%, 95.5%, and 0.565 and 81.3%, 70.0%, and 0.694, respectively. I-FABP measurements performed within 12 to 48 h after the event that triggered ischemia showed a sensitivity, specificity, and AUC for serum and urine of 75%, 100%, and 0.853 and 100%, 73.3%, and 0.856, respectively. Conclusions. In ICU patients, one single I-FABP measurement at the time of clinical suspicion failed to reliably detect or exclude mesenteric ischemia. A higher diagnostic value of I-FABP was only confirmed in the early stages of mesenteric ischemia. I-FABP may be used most appropriately in perioperative monitoring.

Sign in / Sign up

Export Citation Format

Share Document