Obstructive Ileus Secondary to Acute Mesenteric Ischaemia: Internal Medicine Perspective

Acute mesenteric ischemia (AMI) could be a rare but potentially life-threatening condition due to poor understanding of the clinical presentation of abdominal pain and the differential diagnosis when it is not suspected and partly because of an unacceptable delay in making the diagnosis. A 59 years old man was brought to the hospital with abdominal pain, accompanied by obstructive ileus and sepsis. An urgent CT-scan showed the feature of intestinal infarction and portal vein thrombus. After giving fluid resuscitation and antibiotic injection, he was consulted to the surgery division and had jejunum resection. Since the etiology of the disease was suspected to be acute mesenteric venous thrombosis, he was given intravenous anticoagulants postoperatively and the condition improved. The clinical diagnosis of acute mesenteric ischemia is troublesome, and in most cases, abdominal pain is the main symptom. Ileus and sepsis are two complications that may mask the initial signs and symptoms of AMI. From the internal medicine’s point of view, the proper treatment of this disease is early diagnosis, the rebuilding of blood flows with anticoagulants, surgery division discussion, and post-operative supportive care. The underlying cause should be established to determine long-term management essential to anticipate a repeat.

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Pathophysiology and Imaging Diagnosis of Acute Mesenteric Ischemia

Digestive Disease Interventions ◽

10.1055/s-0038-1667344 ◽

2018 ◽

Vol 02 (03) ◽

pp. 195-209

Author(s):

Claire Sandstrom

Keyword(s):

Clinical Features ◽

High Mortality ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

Imaging Diagnosis ◽

Imaging Evaluation ◽

Threatening Condition ◽

Life Threatening ◽

Prompt Diagnosis ◽

Delay In Treatment

AbstractAcute mesenteric ischemia is a potentially life-threatening condition associated with high mortality, particularly with any delay in treatment. Prompt diagnosis with imaging is crucial to achieve a favorable outcome. Both arterial and venous etiologies can result in ischemia, and the radiologist plays a central role in the initial evaluation of a patient with suspected acute mesenteric ischemia to guide management decisions. This article will review the appropriate imaging evaluation of a patient with suspected acute mesenteric ischemia. The overlapping and the distinguishing findings on imaging, as well as the relevant clinical features, will be discussed for the spectrum of both common and uncommon etiologies of mesenteric ischemia.

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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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Ultrasound diagnosis of dissecting thoracic aortic aneurysms: procedure with a handheld device and a video-illustrated case

Tropical Doctor ◽

10.1177/0049475520959906 ◽

2021 ◽

Vol 51 (1) ◽

pp. 10-15

Author(s):

Kenneth V Iserson ◽

Sri Devi Jagjit ◽

Balram Doodnauth

Keyword(s):

Aortic Dissection ◽

Correct Diagnosis ◽

Signs And Symptoms ◽

Aortic Aneurysms ◽

Thoracic Aortic Aneurysms ◽

Handheld Device ◽

Thoracic Aortic Dissection ◽

Threatening Condition ◽

Life Threatening ◽

Handheld Ultrasound

Acute thoracic aortic dissection is an uncommon, although not rare, life-threatening condition. With protean signs and symptoms that often suggest more common cardiac or pulmonary conditions, it can be difficult to diagnose. Ultrasound has proven useful in making the correct diagnosis. This case demonstrates that training gained using standard ultrasound machines can be easily and successfully adapted to newer handheld ultrasound devices. The examination technique using the handheld device is illustrated with photos and a video.

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A rare case of fat embolism syndrome secondary to abdominal liposuction and gluteal fat infiltration

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa441 ◽

2020 ◽

Vol 2020 (12) ◽

Author(s):

Salvador Recinos ◽

Sabrina Barillas ◽

Alejandra Rodas ◽

Javier Ardebol

Keyword(s):

Right Ventricular Dysfunction ◽

Signs And Symptoms ◽

Fat Embolism ◽

Fat Infiltration ◽

Fat Embolism Syndrome ◽

Embolism Syndrome ◽

Threatening Condition ◽

Life Threatening ◽

Bone Marrow Harvesting ◽

Dermatologic Manifestations

Abstract Fat embolism syndrome (FES) is a rare, life-threatening condition habitually associated with traumatic events such as fractures and, less commonly, burns, liposuction and bone marrow harvesting and transplant [ 1]. The biochemical theory for this condition suggests that fat droplets embolize and convert into fatty acids, eventually leading to toxic injury and inflammation, which results in increased vascular permeability, edema and hemorrhage [ 2]. FES may have an asymptomatic interval lasting 12–72 hours after the insult; however, in some cases, signs have also been seen intraoperatively. Pulmonary signs and symptoms are customarily the earliest and manifest in 75% of patients. Nevertheless, neurologic and dermatologic manifestations are also characteristic, and most severe cases could perhaps present with disseminated intravascular coagulation, right ventricular dysfunction, shock or death. The following case consists of a 37-year-old patient that presented with fat embolism syndrome during liposuction and gluteal fat infiltration.

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Atraumatic Splenic Rupture in a SARS-CoV-2 Patient: Case Report and Review of Literature

Case Reports in Surgery ◽

10.1155/2021/5553619 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Marcello Agus ◽

Maria Elena Ferrara ◽

Paola Bianco ◽

Cristina Manieli ◽

Paolo Mura ◽

...

Keyword(s):

Abdominal Pain ◽

Splenic Rupture ◽

Delayed Diagnosis ◽

Caucasian Woman ◽

Threatening Condition ◽

Life Threatening ◽

Atraumatic Splenic Rupture ◽

Rupture Of The Spleen ◽

Delay Of Diagnosis ◽

Possible Cause

Splenic rupture in the absence of trauma or previously diagnosed disease is rare. Due to the delay of diagnosis and treatment, this is a potentially life-threatening condition. We report a case of atraumatic splenic rupture in a SARS-CoV-2 patient. This report is of particular interest as it first identifies SARS-CoV-2 infection as a possible cause of spontaneous rupture of the spleen. A 46-year-old Caucasian woman presented at the emergency department pale and sweaty, complaining of syncopal episodes, tachycardia, hypotension, diarrhea, intense abdominal pain, diffuse arthromyalgia, and fever from the day before. RT-PCR was positive for SARS-CoV-2 infection. CT scan demonstrated extensive hemoperitoneum due to rupture of the splenic capsule. The patient required an emergency open splenectomy because of an unresponsive hemorrhagic shock. At the end of the surgery, the patient was relocated to a COVID-19 dedicated facility. COVID-19 is a new disease of which all manifestations are not yet known. Inpatients affected by SARS-CoV-2 infection with abdominal pain and spontaneous splenic rupture should be considered to avoid a delayed diagnosis.

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Endoscopic follow-up of cyanoacrylate obliteration of gastric varices

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032009000100020 ◽

2009 ◽

Vol 46 (1) ◽

pp. 81-84 ◽

Cited By ~ 7

Author(s):

Fernanda Prata Martins ◽

Erika Pereira de Macedo ◽

Gustavo Andrade de Paulo ◽

Frank Shigueo Nakao ◽

José Celso Ardengh ◽

...

Keyword(s):

Abdominal Pain ◽

Portal Hypertension ◽

Gastric Varices ◽

Study Endpoint ◽

Mild Abdominal Pain ◽

Threatening Condition ◽

Life Threatening ◽

Related Mortality ◽

Overall Mortality

Bleeding from gastric varices is a life-threatening condition. We report our experience with cyanoacrylate injection. Twenty three patients with portal hypertension and gastric varices underwent intra-variceal injection of a cyanoacrylate/lipiodol solution (1:1). Study endpoint was variceal obliteration. Mean follow-up was 25.3 months. Variceal obliteration was achieved in 87% of patients. Recurrence occurred in one patient (4.3%) and rebleeding in another case (4.3%). Mild abdominal pain was described in 13% of patients. Overall mortality was 21.7% and rebleeding related mortality rate was 4.3%. Our results confirm that cyanoacrylate injection is effective and safe to eradicate gastric varices.

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

10.36106/gjra/2000940 ◽

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

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Acute Gastric Volvulus and Atrial Fibrillation with RVR: A Coincidence or Association

Case Reports in Critical Care ◽

10.1155/2017/9403601 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Omar Nadhem ◽

Omar Salh ◽

Faisal Khasawneh

Keyword(s):

Atrial Fibrillation ◽

Abdominal Pain ◽

Diaphragmatic Hernia ◽

Gastric Volvulus ◽

Shortness Of Breath ◽

Threatening Condition ◽

Acute Gastric Volvulus ◽

Ventricular Response ◽

Life Threatening ◽

Upper Abdominal

Gastric volvulus is a rare and life-threatening condition that involves the abnormal rotation of the stomach around its axis by more than 180°. The association between acute gastric volvulus and atrial fibrillation with rapid ventricular response is rare with only few cases that have been reported. Our patient was an 86-year-old female who presented with upper abdominal pain, distension, nausea, and shortness of breath. Clinical and laboratory workup revealed acute gastric volvulus with diaphragmatic hernia. On presentation, she was also in atrial fibrillation with rapid ventricular response. She was successfully treated by laparotomy with reduction of the gastric volvulus and repair of the diaphragmatic hernia, with significant improvement.

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Considerations for Continuing Semielective and Emergency Otolaryngological Procedures During the COVID-19 Pandemic

Ear Nose & Throat Journal ◽

10.1177/0145561320952506 ◽

2020 ◽

Vol 100 (1) ◽

pp. 19-25

Author(s):

Sarina K. Mueller ◽

Maximilian Traxdorf ◽

Konstantinos Mantsopoulos ◽

Antoniu-Oreste Gostian ◽

Matti Sievert ◽

...

Keyword(s):

Quality Of Life ◽

Emergency Surgery ◽

Transmission Rate ◽

Medical Personnel ◽

Human Beings ◽

Threatening Condition ◽

Long Time ◽

Life Threatening

Introduction: During the COVID-19 pandemic, worldwide over 600,000 human beings died due to the cause of the disease. In order to deescalate the transmission rate and to avoid crush loading the countries medical health systems social distancing, face masks, and lockdowns have been considered essential by the majority of governments. Whereas some countries have highly reduced or completely stopped otorhinolaryngological procedures, other countries have continued selected surgeries. The objective of this study was to analyze procedures and outcomes of continuing semielective and emergency surgeries during the COVID-19 pandemic. Methods: Retrospective analysis of n = 750 patients who received semi-elective or emergency surgery between March 26 and June 16, 2020, in the Otolaryngology Department of the Friedrich-Alexander-University of Erlangen-Nürnberg. All patients were screened for COVID symptoms and swabbed for SARS-CoV-2 prior to surgery. Results: Of the n = 750 patients, n = 699 patients received semielective surgery and n = 51 emergency surgery. For 27 patients, the swab result could not be awaited due to a life-threatening condition. In these cases, surgery was performed in full protective equipment. No patient was tested positive during or after the surgery (follow-up 45 to 127 days). No member of the medical personnel showed symptoms or was tested positive after contact with patients. Due to the continuation of surgeries, patients’ lives were saved and improvement of long-term quality-of-life and outcomes is anticipated. Conclusions: Continuing selected otorhinolaryngological surgeries is crucial for patients’ health, survival, and long-time quality of life, yet, the protection of the medical personnel has to be granted.

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Fatal Mesenteric Ischemia Induced by Synthetic Cannabinoids: A Case Report and Literature Review

Case Reports in Emergency Medicine ◽

10.1155/2017/6964078 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5

Author(s):

David Hakimian ◽

Orr Tomer ◽

Nurith Hiller ◽

Samuel N. Heyman ◽

Sarah Israel

Keyword(s):

Abdominal Pain ◽

Mesenteric Ischemia ◽

Synthetic Cannabinoids ◽

Medicine Department ◽

Cerebral Vasoconstriction ◽

Life Threatening ◽

Crampy Abdominal Pain ◽

New Compounds ◽

Repeated Consumption ◽

Emergency Medicine Department

Worldwide use of synthetic cannabinoids (SCs) is rapidly increasing, in part due to the generation of numerous new compounds, sidestepping legal restrictions. Their detection using standard toxicology panels is difficult, due to their vast heterogeneity and lack of structural resemblance to cannabinoids. Sympathetic overactivity and arterial spasm play a role in some of the life-threatening reactions to SCs, such as coronary or cerebral vasoconstriction. Here we report a patient with repeated consumption of SCs that led to mesenteric ischemia and death. A 29-year-old man was frequently evaluated in the Emergency Medicine Department for recurrent transient crampy abdominal pain, associated with the use of the SCs colloquially known as “Mr. Nice Guy.” He was finally hospitalized with a protracted attack, associated with diarrhea and leukocytosis. Initial evaluation including computed tomography was unremarkable. Diarrhea and leukocytosis gradually resolved, but bouts of hypertension and abdominal pain occurred in association with repeated consumption of the SCs. On the fifth hospital day, the patient developed abrupt abdominal pain, associated with profound shock and signs of peritoneal irritation and succumbed within an hour. Postmortem CT scan was consistent with intestinal perforation most probably due to a nonobstructive mesenteric infarction. There was no evidence of a single vessel infarction.

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