scholarly journals Problems of the Diagnosis and Treatment of Acute Mesenteric Ischemia: a SingleCenter Experience

2018 ◽  
Vol 3 (4) ◽  
Keyword(s):  
Blood Flow ◽  
Mortality Rate ◽  
Early Diagnosis ◽  
High Mortality ◽  
Mesenteric Ischemia ◽  
Intestinal Resection ◽  
Acute Mesenteric Ischemia ◽  
Mesenteric Arteries ◽  
Diagnosis And Treatment ◽  
Number Of Patients

Objective: To improve the diagnosis and treatment of acute mesenteric ischemia by using available methods of early diagnosis and modern methods of treatment. Summary Background Data: The number of patients with disorders of the mesenteric circulation is increasing all over the world. In comparison with the occlusion of the coronary, cerebral arteries and peripheral veins, acute obstruction of the mesenteric arteries and veins is diagnosed much later, which causes a high mortality rate from 53 to 100%. Methods: In this study the experience of treatment of 162 patients with acute mesenteric ischemia was analyzed. All patients underwent treatment in Institute of Urgent and Recovery Surgery (IURS NAMS, Donetsk, Ukraine) from 2002 to 2017. Results: From 162 patients: 112 patients were with acute occlusive and 50 patients with acute nonocclusive mesenteric ischemia. The intravital diagnosis was not confirmed in 26 patients (16 %). 119 of patients died, the level of mortality was 73, 5%. 104 patients were operated, 32 patients were discharged (30,8 %), 72 patients died, a mortality rate was 69,2 %. Operations with restore of blood flow were performed in 14 patients, 5 patients died, 9 patients left the hospital. Conservative therapy was performed in 22 patients, in 11 patients with good results (50 %). Conclusions: The early diagnosis of this pathology is crucial and it can reduce the high mortality rate of patients with AMI. Treatment of OAMI should be carried out in a community of general, vascular and endovascular surgeons. Restoration of blood flow through mesenteric vessels with the help of endovascular technology and implementation of thrombembolectomy during open surgical intervention in a number of cases allows to avoid intestinal resection.

scholarly journals Nonoсclusive mesenteric ischemia (literature review)

2021 ◽  
pp. 76-83
Author(s):  
V.S. Khomenko ◽  
◽  
V.P. Perepelitsіa ◽  
I.O. Kuchynskyi ◽  
A.V. Sirotkin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Literature Review ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Care Physician ◽  
Diagnosis And Treatment ◽  
Diagnostic Tools ◽  
Mesenteric Blood Flow ◽  
Wide Range ◽  
Occlusive Mesenteric Ischemia

Non-occlusive mesenteric ischemia is a relatively rare but extremely complex pathology in terms of diagnosis. A wide range of reasons for the development of non-occlusive impression dramatically complicates the diagnosis and differentiation with other abdominal pathology. The vast majority of publications in the domestic literature on acute disorders of mesenteric blood flow, mostly address the problems of diagnosis and treatment of occlusive types of mesenteric ischemia, while the topic of non-occlusive ischemia remains insufficiently covered. Given that in half of the cases NOMI is diagnosed at the stage of irreversible necrotic changes of the intestine – there is a real need to generalize the root causes and mechanisms of neoclustive mesenteric ischemia, modern methods of diagnosis and treatment. Purpose – to analyze of the causes, prevalence, classification, diagnosis and treatment of non-occlusive disorders of mesenteric blood flow. This research, based on literature review, showed that acute non-occlusive mesenteric ischemia (NOMI) is associated with poor prognosis due to the lack of accurate diagnostic measures. First of all, clarity regarding biochemical markers. Therefore, the research and development of the latter is seen as a priority. Contrast methods of examination (computed tomography, angiography) are the only possible diagnostic tools. Pharmacological correction is fundamental and presupposes the use of drugs with a vasodilating effect systemically or locally (catheter-associated). An important issue is the development of pharmacological agents that allow targeted action on the pathogenetic mechanisms of the development of NOMI. A multidisciplinary approach involving a specialized doctor, a surgeon, an X-ray endovascular surgeon and an intensive care physician in the treatment of a patient with suspected NOMI is the foundation for the success of therapy. The question of the use of laparoscopy remains controversial, given the invasiveness of the method and the difficulty of interpreting the changes detected in the early phase of the disease. No conflict of interests was declared by the authors. Key words: acute mesenteric ischemia, non-occlusive disorders of mesenteric blood flow.

scholarly journals Evaluation of outcome in Mesenteric Ischemia

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.  

Acute mesenteric ischemia: analysis of cases admitted to a hospital during 10 years (2001–2010)

2012 ◽  
Vol 153 (36) ◽  
pp. 1424-1432 ◽  
Author(s):  
Erzsébet Szabóné Révész
Keyword(s):  
Survival Rate ◽  
Mortality Rate ◽  
Early Diagnosis ◽  
Mesenteric Ischemia ◽  
Surgical Intervention ◽  
Acute Mesenteric Ischemia ◽  
Intestinal Necrosis ◽  
Acute Surgery ◽  
The Poor ◽  
Study Results

Acute mesenteric ischemia is a rare disorder; it occurs in an average of 0.4% of acute surgery cases. Its diagnosis is often difficult because of the poor symptoms, and mortality of the patients is still as high as 70–90%. Aims: The aims of the study were to assess the importance of time factor that may influence the outcome of the disease and to find out whether it is possible to decrease the high mortality of patients. Method: Among patients admitted to Szent Pantaleon Hospital in Hungary between January 2001 and December 2010, patients whose surgery or autopsy findings confirmed intestinal necrosis were analyzed. A total of 114 patients with acute mesenteric ischemia were included in the study. Results: 55% of the patients had typical symptoms. 43.8% of the patients underwent surgery and among these patients the mortality rate was 70% despite surgical intervention. The survival rate was 72.3% when surgery was performed within less than 12 hours after the onset of symptoms, but only 20% of patients survived when surgery was delayed between 24 and 48 hours after the onset of symptoms. Conclusion: With early diagnosis and intervention, patients with acute mesenteric ischemia may have a better a chance to survive. Orv. Hetil., 2012, 153, 1424–1432.

D-dimer as a marker for early diagnosis of acute mesenteric ischemia

2006 ◽  
Vol 117 (4) ◽  
pp. 463-467 ◽  
Author(s):  
Hüseyin Altinyollar ◽  
Mustafa Boyabatli ◽  
Uğur Berberoğlu
Keyword(s):  
Early Diagnosis ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
D Dimer

scholarly journals Mean Platelet Volume: Is It a Predictive Parameter in Diagnosis of Acute Mesenteric Ischemia?

2015 ◽  
Vol 100 (5) ◽  
pp. 962-965 ◽  
Author(s):  
Ahmet Türkoğlu ◽  
Mesut Gül ◽  
Abdullah Oğuz ◽  
Zübeyir Bozdağ ◽  
Burak Veli Ülger ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Mean Platelet Volume ◽  
Mesenteric Ischemia ◽  
Area Under The Curve ◽  
Acute Mesenteric Ischemia ◽  
The Elderly ◽  
Control Group ◽  
Characteristic Analysis ◽  
Platelet Volume ◽  
Cell Counts

Our objective for this study was to discuss the usability of mean platelet volume, which is associated with numerous vascular pathologies, in the early diagnosis of acute mesenteric ischemia. Acute mesenteric ischemia is an uncommon, life-threatening clinical condition mostly seen in the elderly. Early diagnosis of acute mesenteric ischemia and correction of blood circulation before necrosis occurs are important factors affecting prognosis. A total of 95 patients who underwent emergency surgery for acute mesenteric ischemia and 90 healthy volunteers as control group were included in this study. Age, gender, hemoglobin values, white blood cell counts, mean platelet volume, and platelet counts are recorded for evaluation. The mean platelet volume values were significantly higher in patients with acute mesenteric ischemia than in the controls (9.4 ± 1.1 fL and 7.4 ± 1.4 fL, respectively; P &lt; 0.001). Receiver-operating characteristic analysis demonstrated a cutoff value of mean platelet volume as 8.1 fL (area under the curve, 0.862), a sensitivity of 83.2%, and a specificity of 80%. As a result, in the patients who are admitted to the hospital with acute nonspecific abdominal pain and suspected of having acute mesenteric ischemia, high mean platelet volume values in routine hemograms support the diagnosis of acute mesenteric ischemia.

PP-019 The Effect of Serum, Intestinal and Peritoneal Visfatin Levels on Early Diagnosis of Acute Mesenteric Ischemia

2015 ◽  
Vol 115 ◽  
pp. S103-S104
Author(s):  
Alper Uçak ◽  
Veysel Temizkan ◽  
Hüseyin Şen ◽  
Erman Caner Bulut ◽  
Murat Fatih Can ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia

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 Master of the Masquerade: An Atypical Presentation of Acute Aortic Dissection

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Ramy Mando ◽  
Daniel Tim ◽  
Anthony DeCicco ◽  
Justin Trivax ◽  
Ivan Hanson
Keyword(s):  
Mortality Rate ◽  
Early Diagnosis ◽  
Aortic Dissection ◽  
High Mortality ◽  
Acute Aortic Dissection ◽  
Atypical Presentation ◽  
Aggressive Management ◽  
Life Threatening

Acute aortic dissection (AAD) is associated with unacceptably high mortality rate. As such, early diagnosis and aggressive management are essential in order to avoid life-threatening complications. Herein, we report an atypical presentation of AAD and clinical sequelae.

scholarly journals Necessity of revascularization for acute mesenteric ischemia in symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery

Vascular ◽  
2019 ◽  
Vol 28 (1) ◽  
pp. 109-114
Author(s):  
Hiroyuki Otsuka ◽  
Atsushi Uehata ◽  
Keiji Sakurai ◽  
Toshiki Sato ◽  
Hiromichi Aoki ◽  
...  
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Laboratory Data ◽  
Acute Mesenteric Ischemia ◽  
True Lumen ◽  
Bowel Necrosis ◽  
Abnormal Laboratory ◽  
Number Of Patients ◽  
Residual Ratio

Objectives We evaluated the necessity of revascularization for acute mesenteric ischemia in symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery. Methods This retrospective study included 28 consecutive, symptomatic patients with spontaneous isolated dissection of the superior mesenteric artery treated at our hospital between December 2005 and December 2017. Patients with concomitant aortic dissection were excluded. We reviewed the patients’ clinical presentation; laboratory evaluations; computed tomography findings, including the true lumen residual ratio (i.e., the minimum true lumen size compared to the diameter of the transverse section of the dissected artery) at the time of admission; the number of patients who were suspected of having bowel ischemia; and the number of patients who required surgical or endovascular treatment and their outcomes. Additionally, to evaluate the true lumen residual ratio in symptomatic patients with bowel ischemia, the true lumen residual ratio in those with abnormal laboratory data were compared with that in those without abnormal laboratory data. Initial true lumen residual ratio values were also compared with final values. Furthermore, we assessed the clinical details of patients who had bowel necrosis. Categorical variables were compared using the χ2 test or Fisher’s exact test, and continuous values were presented as either the mean ± standard deviation or median (interquartile range 25–75%). Variables were analyzed using Student’s t-test or the Mann–Whitney U test. Results The patients’ age ranged between 41 and 85 years, and 25 were men. Although nine patients were suspected of having acute mesenteric ischemia, only one underwent bowel resection. None of the patients had an indication for revascularization. The true lumen residual ratio of the nine patients with abnormal laboratory data were significantly lower than those of the 19 without abnormal laboratory data (10 [0–25]% vs. 40 [20–50]%, p = 0.005). The patient who underwent bowel resection had a true lumen residual ratio of 10%; however, there was no obvious abnormal laboratory data suggestive of bowel necrosis. Dissections were managed conservatively in all patients. True lumen residual ratio increased from initial value of 30 (10–48)% to 98 (60-100)%at the final imaging study ( p < 0.0001). There were no adverse events related to the mesenteric circulation during the follow-up period of 2–11 years. Conclusions Reintervention is rarely required for spontaneous isolated dissection of the superior mesenteric artery, even in symptomatic patients, and spontaneous resolution of the luminal compromise is the rule.

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