Early catheter-directed thrombolysis without bowel resection in acute mesenteric ischaemia for a symptomatic COVID-19 patient

Introduction Acute mesenteric ischaemia frequently requires extensive bowel resection. Primary anastomosis is unsafe necessitating exteriorisation of proximal small bowel and distal colon. Inevitably, therefore, patients are left with high output stomas with concomitant fluid and nutritional problems. Subjects We present two cases of acute mesenteric ischaemia both of which required extensive bowel resection. In both patients, we re-established intestinal continuity early by fashioning a Bishop–Koop type of reconstruction. Results Both patients had uneventful postoperative recoveries with no stoma-related complication or anastomosis problems. Neither patient required prolonged parenteral therapy. Conclusions Bishop–Koop procedure may be used safely in a selected group of patients, with potential advantages of early restoration of intestinal continuity and easier closure.

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Systematic review and meta-analysis of endovascular treatment for acute mesenteric ischaemia

Vascular ◽

10.1177/1708538116689353 ◽

2017 ◽

Vol 25 (4) ◽

pp. 430-438 ◽

Cited By ~ 6

Author(s):

Marawan El Farargy ◽

Ahmed Abdel Hadi ◽

Mohamed Abou Eisha ◽

Khalid Bashaeb ◽

George A Antoniou

Keyword(s):

Systematic Review ◽

Confidence Interval ◽

Endovascular Treatment ◽

Odds Ratio ◽

Observational Studies ◽

Bowel Resection ◽

Meta Analysis ◽

Mesenteric Ischaemia ◽

Conventional Surgery ◽

Acute Mesenteric Ischaemia

Introduction Acute mesenteric ischaemia is associated with a significant morbidity and mortality. Endovascular techniques have emerged as a viable alternative treatment option to conventional surgery. Our objective was to conduct a systematic review of the literature and perform a meta-analysis of reported outcomes. Methods Our review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards and the protocol was registered in PROSPERO (CRD42016035667). We searched electronic information sources (MEDLINE, EMBASE, CINAHL, CENTRAL) and bibliographic lists of relevant articles to identify studies reporting outcomes of endovascular treatment for acute mesenteric ischaemia of embolic or thrombotic aetiology. We defined 30-day or in-hospital mortality and bowel resection as the primary outcome measures. We used the Newcastle–Ottawa scale to assess the methodological quality of observational studies. We calculated combined overall effect sizes using random effects models; results are reported as the odds ratio and 95% confidence interval. Results We identified 19 observational studies reporting on a total of 3362 patients undergoing endovascular treatment for acute mesenteric ischaemia. The pooled estimate of peri-interventional mortality was 0.245 (95% confidence interval 0.197–0.299), that of the requirement for bowel resection 0.326 (95% confidence interval 0.229–0.439), and the pooled estimate for acute kidney injury was 0.132 (95% confidence interval 0.082–0.204). Eight studies reported comparative outcomes of endovascular versus surgical treatment for acute mesenteric ischaemia (endovascular group, 3187 patients; surgical group, 4998 patients). Endovascular therapy was associated with a significantly lower risk of 30-day mortality (odds ratio 0.45, 95% confidence interval 0.30–0.67, P = 0.0001), bowel resection (odds ratio 0.45, 95% confidence interval 0.34–0.59, P < 0.00001) and acute renal failure (odds ratio 0.58, 95% confidence interval 0.49–0.68, P < 0.00001). No differences were identified in septic complications or the development of short bowel syndrome. Conclusion Endovascular treatment for acute mesenteric ischaemia is associated with a considerable mortality and requirement of bowel resection. However, endovascular therapy confers improved outcomes compared to conventional surgery, as indicated be reduced mortality, risk of bowel resection and acute renal failure. An endovascular-first approach should be considered in patients presenting with acute mesenteric ischaemia.

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Acute mesenteric ischaemia, a highly lethal disease with a devastating outcome

VASA ◽

10.1024/0301-1526.35.2.106 ◽

2006 ◽

Vol 35 (2) ◽

pp. 106-111 ◽

Cited By ~ 19

Author(s):

Safioleas ◽

Moulakakis ◽

Papavassiliou ◽

Kontzoglou ◽

Kostakis

Keyword(s):

Mortality Rate ◽

Superior Mesenteric Artery ◽

Mesenteric Artery ◽

Bowel Resection ◽

Morbidity Rate ◽

Time Interval ◽

Mesenteric Ischaemia ◽

Acute Mesenteric Ischaemia ◽

Artery Embolism ◽

Significant Difference

Background: Acute mesenteric ischaemia remains a serious condition requiring emergency surgical management. The mortality rate still remains high, due to the unspecific and delayed diagnosis and ranges from 59% to 100%. Purpose of our study is to present our experience in the management of the disease. Patients and methods: This is a retrospective study of 61 patients treated surgically for acute mesenteric ischaemia, between 1988 and 2004. All patients underwent a laparotomy. 75% of the patients were operated within the first 24 hours and the rest within 48 hours. Results: Superior mesenteric artery embolism occurred in 36 (59%), thrombosis in 21 (34%) and superior mesenteric vein thrombosis in 4 (7%) cases. In 49 (80%) cases, embolectomy or thrombectomy of the superior mesenteric artery with resection of the necrotic segment of the bowel was performed. Twelve cases (20%) were considered inoperable because of massive bowel necrosis. According to our study mortality and morbidity rate amounts to 75% and 80% respectively. No significant difference in the mortality rate between patients with embolism (75%) and thrombosis (76%) was found. However a significant increase of mortality rate was observed when the surgical intervention became afterwards the first 24-hour period. (72% versus 87%). Patients who underwent embolectomy or thrombectomy with bowel resection presented an improved survival rate compared with patients that underwent only bowel resection. (p = 0.019) Conclusions: Acute mesenteric ischaemia has the characteristics of a highly lethal condition and only early recognition and appropriate treatment can reduce the potential for a devastating outcome. The reduction of time interval from the beginning of symptoms up to the treatment remains the main critical important factor.

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Acute Mesenteric Ischaemia: Minimal Invasive Management by Combined Laparoscopy and Percutaneous Transluminal Angioplasty

The European Journal of Surgery ◽

10.1080/110241500750009221 ◽

2000 ◽

Vol 166 (4) ◽

pp. 345-347 ◽

Cited By ~ 12

Author(s):

Frédéric J. P. Leduc, Sophie R. Pestieau, Ol

Keyword(s):

Percutaneous Transluminal Angioplasty ◽

Transluminal Angioplasty ◽

Minimal Invasive ◽

Mesenteric Ischaemia ◽

Acute Mesenteric Ischaemia ◽

Percutaneous Transluminal ◽

Invasive Management

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Cocaine-induced mesenteric ischaemia requiring small bowel resection

BMJ Case Reports ◽

10.1136/bcr-2020-238593 ◽

2021 ◽

Vol 14 (1) ◽

pp. e238593

Author(s):

Asya Veloso Costa ◽

Asiya Zhunus ◽

Rehana Hafeez ◽

Arsh Gupta

Keyword(s):

Small Bowel ◽

Social History ◽

Bowel Resection ◽

Early Recognition ◽

Small Bowel Resection ◽

Emergency Laparotomy ◽

Mesenteric Ischaemia ◽

Bowel Ischaemia ◽

Systemic Complications ◽

Gastrointestinal Complications

Cocaine use causes profound vasoconstriction leading to various systemic complications. Gastrointestinal complications such as mesenteric ischaemia are difficult to recognise and may result in serious consequences if not treated promptly. We report on the case of a 47-year-old man presenting with mesenteric ischaemia on a background of acute on chronic cocaine consumption, where diagnosis was not evident until second presentation. He underwent an emergency laparotomy with small bowel resection and jejunostomy formation and made a good recovery with eventual reversal surgery. The literature on cocaine-induced bowel ischaemia shows significant variability in presentation and outcome. Laboratory investigations are non-specific, and early recognition is vital. Given the increasing recreational use of cocaine in the UK, it is imperative to have a high clinical index of suspicion for mesenteric ischaemia in patients presenting with non-specific abdominal pain, and to ensure a detailed social history covering recreational drug use is not forgotten.

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