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.

Intestinal tachyarrhythmias during small bowel ischemia

1999 ◽  
Vol 277 (5) ◽  
pp. G993-G999 ◽  
Author(s):  
Scott A. Seidel ◽  
Sanjay S. Hegde ◽  
L. Alan Bradshaw ◽  
J. K. Ladipo ◽  
William O. Richards
Keyword(s):  
Small Bowel ◽  
Mesenteric Ischemia ◽  
Intestinal Ischemia ◽  
Intestinal Tract ◽  
Bowel Ischemia ◽  
Digital Recording ◽  
Control Activity ◽  
Electrical Control ◽  
New Zealand White Rabbits

The electrical control activity (ECA) of the bowel is the omnipresent slow electrical wave of the intestinal tract. Characterization of small bowel electrical activity during ischemia may be used as a measure of intestinal viability. With the use of an animal model of mesenteric ischemia, serosal electrodes and a digital recording apparatus utilizing autoregressive spectral analysis were used to monitor the ECA of 20 New Zealand White rabbits during various lengths of ischemia. ECA frequency fell from 18.2 ± 0.5 cycles per minute (cpm) at baseline to 12.2 ± 0.9 cpm ( P < 0.05) after 30 min of ischemia and was undetectable by 90 min of ischemia in all animals. Tachyarrhythmias of the ECA were recorded in 55% of the animals as early as 25 min after ischemia was induced and lasted from 1 to 48 min. Frequencies ranged from 25 to 50 cpm. These tachyarrhythmias were seen only during ischemia, suggesting that they are pathognomonic for intestinal ischemia. The use of the detection of ECA changes during intestinal ischemia may allow earlier diagnosis of mesenteric ischemia.

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 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.

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

AN EMERGENT MANAGEMENT OF ACUTE SUPERIOR MESENTERIC ARTERY EMBOLISM WITH ILEAL GANGRENE

2021 ◽  
pp. 3-4
Author(s):  
Nishant Agarwal ◽  
Abhishek Kaushal ◽  
Shrey Aren ◽  
Srikanth Muraleedhar ◽  
Sudhir Kumar Panigrahi
Keyword(s):  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mesenteric Ischemia ◽  
Intestinal Ischemia ◽  
Hospital Admissions ◽  
Bowel Resection ◽  
Acute Mesenteric Ischemia ◽  
Artery Embolism ◽  
Visceral Arteries ◽  
Bowel Gangrene

Acute mesenteric ischemia (AMI) occuring due to sudden, partial or complete interruption of blood ow in main visceral arteries of the abdomen eventually resulting in intestinal ischemia and/or bowel gangrene is a surgical emergency. It represents 0.1% of hospital admissions and 2% of the revascularization operations for atheromatous lesions. 50% of AMI is caused by embolic phenomenon, 25% by thrombotic episode and rest 25% by both. The most common vessel involved in AMI is superior mesenteric artery. Acute mesenteric embolic ischemia (AMEI) arises typically from a cardiac emboli in patients with atrial brillation or following MI. Patients usually presents with central abdominal pain, out of proportion to the physical ndings initially, later becoming diffuse associated with bloody diarrhoea during the episode. An early diagnosis, an aggressive resuscitation, intravascular or surgical restoration of blood ow and subsequent bowel resection based on bowel viability helps reduce morbidity and mortality.

Transmural Bowel Necrosis From Acute Mesenteric Ischemia and Strangulated Small-Bowel Obstruction: Distinctive CT Features

2020 ◽  
Vol 214 (1) ◽  
pp. 90-95 ◽  
Author(s):  
Paul Calame ◽  
Alexandre Malakhia ◽  
Celia Turco ◽  
Franck Grillet ◽  
Gael Piton ◽  
...  
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Mesenteric Ischemia ◽  
Acute Mesenteric Ischemia ◽  
Bowel Necrosis ◽  
Ct Features

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.

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