Kinetics of serum procalcitonin in patients with acute mesenteric ischemia and bowel infarction after cardiac surgery

2021 ◽  
Author(s):  
Raoul BORIONI ◽  
Mariano GAROFALO ◽  
Franco TURANI ◽  
Luca P. WELTERT ◽  
Carolina PACIOTTI ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Bowel Infarction ◽  
Kinetics Of

The role of computed tomography in the diagnostic pathway of acute mesenteric ischemia: a nested case-control study

2020 ◽  
Vol 61 (11) ◽  
pp. 1444-1451
Author(s):  
Henning Mothes ◽  
Vetlana Mueller-Mau ◽  
Lukas Lehmkuhl ◽  
Thomas Lehmann ◽  
Utz Settmacher ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cardiac Surgery ◽  
Ct Scan ◽  
Contrast Medium ◽  
Mesenteric Ischemia ◽  
Case Control Study ◽  
Acute Mesenteric Ischemia ◽  
Case Control ◽  
Intestinal Pneumatosis ◽  
Control Study

Background Computed tomography (CT) can be used as the primary screening modality for the evaluation of patients suspected of having acute mesenteric ischemia known to show high sensitivity and specificity rates. Purpose To prove the value of CT in patients with pathological abdominal findings following cardiac surgery. Material and Methods In a retrospective case-control study, 12 different CT scan parameters of patients with or without mesenteric ischemia following cardiac surgery were compared using univariate and logistic regression analyses. Results Of 14,176 patients, 133 (0.9%) received an abdominal CT scan during postoperative care due to pathological abdominal findings. Sixty-eight patients were diagnosed with acute mesenteric ischemia. In-hospital mortality was 73.5% for this group. CT parameters with the highest specificity for indicating colonic ischemia were intestinal (99%) or porto-venous (96%) pneumatosis, abnormal contrast medium enhancement (89%), and occlusion of the proximal inferior mesenteric artery (81%). All of those parameters showed low sensitivity levels in the range of 15%–23%. A statistically significant association between acute mesenteric ischemia and CT appearance was obtained for contrast medium enhancement (odds ratio [OR] 12.2, 95% confidence interval [CI] 1.5–99.2) and intestinal pneumatosis (OR 21.0, 95% CI 2.7–165.2) only. Conclusion The typical CT criteria indicating mesenteric ischemia lose their accuracy in patients under critical clinical conditions. As CT remains the first-line diagnostic imaging modality for abnormal abdominal findings following cardiac surgery, negative signs should not prevent early laparotomy if clinical suspicion remains high.

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

Acute Portomesenteric Venous Thrombosis: Diagnosis and Treatment

2018 ◽  
Vol 02 (03) ◽  
pp. 249-255
Author(s):  
Stephen Allison ◽  
David Shin ◽  
Guy Johnson
Keyword(s):  
Venous Thrombosis ◽  
Endovascular Therapy ◽  
Medical Management ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Diagnosis And Treatment ◽  
Bowel Infarction ◽  
Radiologic Imaging ◽  
Portomesenteric Venous Thrombosis

AbstractAcute portomesenteric venous thrombosis (PMVT) is an unusual cause of acute mesenteric ischemia. Because of its rarity and nonspecific presentation, radiologic imaging plays a key role in the diagnosis of acute PMVT. Medical management with anticoagulation is the mainstay of therapy, with surgery reserved for patients suspected of having peritonitis or bowel infarction. However, endovascular therapy has an evolving role and may serve as an important adjunct to anticoagulation in selected patients with acute PMVT.

Arterial Endovascular Interventions in Acute Mesenteric Ischemia

2018 ◽  
Vol 02 (03) ◽  
pp. 210-216
Author(s):  
Geoffrey Miller ◽  
James Stone ◽  
Luke Wilkins
Keyword(s):  
Mesenteric Ischemia ◽  
Treatment Plan ◽  
Treatment Options ◽  
Traumatic Injury ◽  
Acute Mesenteric Ischemia ◽  
Medical Emergency ◽  
Cross Sectional ◽  
Bowel Infarction ◽  
Endovascular Interventions ◽  
Sudden Decrease

AbstractAcute mesenteric ischemia (AMI) is a true medical emergency and requires a multi-disciplinary treatment approach. AMI occurs when there is a sudden decrease in blood flow resulting in hypoperfusion to the intestines and may lead to bowel infarction. There are many potential etiologies of AMI that include arterial embolus, arterial, or venous thrombosis; traumatic injury; aortic dissection; intestinal obstruction; non-occlusive mesenteric ischemia, and vasculitis. Given mortality rates that approach 90%, rapid diagnosis is essential to decrease risk of bowel infarction. While surgical management has traditionally been the treatment of choice, endovascular management is being used with increasing frequency. Further, utilizing endovascular treatment options together with surgical intervention has shown promising results. The endovascular approach to treatment of AMI will depend on the underlying etiology. In addition, the acuity of patient presentation, presence, or absence of bowel infarction; patient stability; and availability of a hybrid operating room will influence the treatment plan of a patient with AMI. Early diagnosis with advanced cross-sectional imaging along with assessment of the underlying risk factors will optimize chances of early intervention and improve patient outcomes.

scholarly journals Acute Mesenteric Ischemia after Cardiac Surgery: An Analysis of 52 Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Cuneyt Eris ◽  
Senol Yavuz ◽  
Serhat Yalcinkaya ◽  
Arif Gucu ◽  
Faruk Toktas ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Left Ventricular ◽  
Inotropic Support ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
Gastrointestinal Complications ◽  
Iabp Support

Objective. Acute mesenteric ischemia (AMI) is a rare but serious complication after cardiac surgery. The aim of this retrospective study was to evaluate the incidence, outcome, and perioperative risk factors of AMI in the patients undergoing elective cardiac surgery.Methods. From January 2005 to May 2013, all patients who underwent cardiac surgery were screened for participation, and patients with registered gastrointestinal complications were retrospectively reviewed. Univariate analyses were performed.Results. The study included 6013 patients, of which 52 (0.86%) patients suffered from AMI, 35 (67%) of whom died. The control group (150 patients) was randomly chosen from among cases undergoing cardiopulmonary bypass (CPB). Preoperative parameters including age (), renal insufficiency (), peripheral vascular disease (), preoperative inotropic support (), poor left ventricular ejection fraction (), cardiogenic shock (), and preoperative intra-aortic balloon pump (IABP) support () revealed significantly higher levels in the AMI group. Among intra- and postoperative parameters, CPB time (), dialysis (), inotropic support (), prolonged ventilator time (), and IABP support () appeared significantly higher in the AMI group than the control group.Conclusions. Prompt diagnosis and early treatment should be initiated as early as possible in any patient suspected of AMI, leading to dramatic reduction in the mortality rate.

scholarly journals Clinical cases of surgical treatment of bowel infarction caused by acute mesenteric ischemia combined with colon cancer

2018 ◽  
Vol 99 (4) ◽  
pp. 708-711
Author(s):  
F Sh Akhmetzyanov ◽  
N A Valiev ◽  
V I Egorov ◽  
M V Rozengarten ◽  
D V Burba
Keyword(s):  
Colon Cancer ◽  
Surgical Treatment ◽  
Emergency Surgery ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Colon Resection ◽  
Cancer Center ◽  
Bowel Infarction ◽  
Surgical Interventions ◽  
Clinical Cases

The article contains description of such serious pathology in emergency surgery as bowel infarction caused by acute mesenteric ischemia in two patients with colorectal cancer admitted to Tatarstan regional clinical cancer center. Patients were admitted for emergency indications with the clinic of an acute abdomen. Both patients underwent an emergency surgery of laparotomy, enterectomy with colon resection and anastomosis. Both patients had satisfactory immediate postoperative results. One patient died 8 months later due to the progression of the underlying disease, the second one is alive to the present day with a satisfactory quality of life and the only complain of frequent loose bowel movements. Most patients with acute mesenteric ischemia are operated on with trial diagnostic laparotomy, and mortality rate for this pathology reaches 90% or more. The presented clinical cases familiarize physicians with an opportunity of successful surgical treatment of patients with acute mesenteric ischemia combined with colon cancer and demonstate expediency and need for surgical interventions with extensive colon resection.

scholarly journals TOWARDS A BETTER COMPREHENSION OF ACUTE MESENTERIC ISCHEMIA AFTER CARDIAC SURGERY. AN ANALYSIS OF 33 PATIENTS.

2021 ◽  
Author(s):  
Raoul Borioni ◽  
alessandro bellisario ◽  
Luca Weltert ◽  
Franco Turani ◽  
Mariano Garofalo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Mesenteric Ischemia ◽  
De Novo ◽  
Acute Mesenteric Ischemia ◽  
Clinical Scenarios ◽  
Number Of Patients ◽  
Group 2 ◽  
Group 1

Background. Acute mesenteric ischemia (AMI) after cardiac surgery is a rare but serious complication associated to high mortality. The time of onset is the key point to correctly evaluate the clinical scenarios. Methods. Data from adult patients who underwent laparotomy for AMI after elective or urgent cardiac surgery were reviewed (January 2005 - December 2019) to report their anatomoclinical features in relationship to time of onset. Early events (within 48 hours) were allocated to Group 1, whereas late onsets were allocated to Group 2. Results. The incidence of risk factors for non occlusive mesenteric ischemia was higher in Group 1 (chronic renal failure 80% vs 38.8%, P <0.05, use of inotropes 60% vs 5.5%, P <0.01, early oligo-anuria requiring CRRT 80% vs 16.6%, P <0.01, prolonged ventilation 46.6% vs 5.5%, P <0.05), where a significative occurrence of postoperative de novo atrial fibrillation was noted in Group 2 (55% vs 5.5%, P <0.01). The number of patients who required bowel resection was proportionally higher in the Group 2 Conclusions. Two well distincted categories of AMI after cardiac surgery can be classified. The first consists of patients with well-known risk factors developing ischemia as a result of severe visceral hypoperfusion The second consists of patients with low comorbidity who experience late AMI as a consequence of“trigger events”, mainly de novo atrial fibrillation. This classification may be useful to better alert the medical staff to the possibility of bowel ischemia at any time after cardiac surgery, promoting early diagnosis and treatment.

scholarly journals FROM THE HISTORY OF ACUTE MESENTERIC OCCLUSION (THE EPOCH OF NEW TIME). Part I

2015 ◽  
pp. 37-41
Author(s):  
O. Sh. Oynotkinova ◽  
A. V. Esipov ◽  
M. D. Pacenko ◽  
D. A. Mironenko ◽  
A. V. Tyschuk
Keyword(s):  
Nineteenth Century ◽  
Emergency Surgery ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Modern Medicine ◽  
Bowel Infarction ◽  
Acute Infarction ◽  
History Of ◽  
Time Part ◽  
Historical Periods

Acute mesenteric occlusions and acute bowel infarction were described in the middle of the nineteenth century. In spite of the achievements of modern medicine acute mesenteric ischemia is still one of the most dangerous pathologies in emergency surgery. This survey covers the historical periods of research of certain aspects of acute infarction of mesenteric circulation, which shaped our modern perception of this disease.

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