Evaluation of outcome in Mesenteric Ischemia

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

Journal of Anesthesia & Pain Medicine ◽

10.33140/japm/03/04/00004 ◽

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.

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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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Correlation between interleukin-6 and septic shock in children

Paediatrica Indonesiana ◽

10.14238/pi52.6.2012.352-5 ◽

2012 ◽

Vol 52 (6) ◽

pp. 352

Author(s):

Stephanie Yulianto ◽

Ari Runtunuwu ◽

Vivekenanda Pateda ◽

Jose Mandei ◽

Julius Lolombulan

Keyword(s):

Septic Shock ◽

Interleukin 6 ◽

Clinical Signs ◽

Cross Sectional Study ◽

P Value ◽

Cross Sectional ◽

Threatening Condition ◽

Life Threatening ◽

The Mean ◽

Pediatric Sepsis

Background Sepsis is a life􀁆threatening condition and the mostcommon cause of death in intensive care units in developingcountries, such as Indonesia. The first clinical signs of sepsis areusually non􀁆spedfic. More specific signs and laboratory parametersoften occur late and are associated 'With organ dysfunction andhigh mortality rates. Interleukin􀁆6 (IL--6) is a biomarker reported tobe superior to clinical signs and conventional tests for sepsis. IL--6levels may indicate microorganism invasion, as well as progressionof infection into sepsis, severe sepsis, and septic shock.Objective To evaluate a correlation between interleukin (IL)􀁆6and septic shock in childrenMethods This cross􀁆sectional study was conducted in the pediatricintensive care unit of Prof. Dr. R.D. Kandou Hospital, Manado,between June to September 2011. Subjects were children withsepsis or septic shock aged 1 month to 13 years, v.ith diagnosesbased on the International Pediatric Sepsis Consensus ConferenceCriteria 2005. A one􀁆time measurement of IL--6 plasma levelswas done at the time of diagnosis. Data was analyzed by logisticregression test using SPSS version 17 software. A P value of <0.05indicated statistical significance.Results The mean IL--6 plasma level in the septic group was 1.68(95%CI 1.45 to 1.91) pg/mL and that of the septic shock groupwas 2.33 (95%CI 1.79 to 2.86) pg/mL. Our results showed astrong positive correlation between IL􀁆6 plasma levels v.ith theprobability of septic shock in children v.ith sepsis (regressioncoefficient􀁇1.3lO, P􀁇O.024).Conclusion Higher plasma IL--6 levels were associated v.ith ahigher risk of septic shock in children with sepsis. [Paediatrrndones.2012;52:352-5].

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Calciphylaxis: A Cause of Necrotic Ulcers in Renal Failure

Journal of Cutaneous Medicine and Surgery ◽

10.1177/120347549800200414 ◽

1998 ◽

Vol 2 (4) ◽

pp. 242-244 ◽

Cited By ~ 11

Author(s):

Amer N. Kalaaji ◽

Margaret C. Douglass ◽

Marsha Chaffins ◽

Lori Lowe

Keyword(s):

Early Diagnosis ◽

Early Recognition ◽

Clinical Signs ◽

Signs And Symptoms ◽

Threatening Condition ◽

Life Threatening ◽

Clinical Signs And Symptoms ◽

Initiation Of Therapy ◽

Stage Renal Disease ◽

End Stage

Background: Calciphylaxis is a rare and life-threatening condition occurring in patients with end-stage renal disease on dialysis. The diagnosis is frequently delayed or missed and therapy is often unsuccessful. Objective: The clinical and pathological components of calciphylaxis are emphasized in a patient that may facilitate early diagnosis and initiation of therapy. Results: Early recognition of the clinical signs and symptoms of calciphylaxis is crucial. The tissue diagnosis requires large elliptical biopsies because histological findings are segmental and often missed. Conclusion: Early diagnosis and intervention in calciphylaxis is critical. Parathyroidectomy should be considered in all cases.

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Beware of the 3776.24 m peak

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907920982758 ◽

2020 ◽

pp. 102490792098275

Author(s):

Stephanie Dorothy Pui Ming Yu ◽

James Siu Ki Lau ◽

Puisy Yau Ng Chan ◽

Pui Gay Kan

Keyword(s):

Emergency Department ◽

Head Injury ◽

Early Diagnosis ◽

Middle Aged ◽

Radiological Findings ◽

Threatening Condition ◽

Life Threatening ◽

Neurosurgical Intervention

A middle-aged man presented to the emergency department after a seemingly trivial head injury. Recognition of pathognomonic radiological findings allowed early diagnosis of a potentially life-threatening condition. The patient recovered uneventfully after prompt neurosurgical intervention.

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Obstructive Ileus Secondary to Acute Mesenteric Ischaemia: Internal Medicine Perspective

The Indonesian Journal of Gastroenterology Hepatology and Digestive Endoscopy ◽

10.24871/221202174-78 ◽

2021 ◽

Vol 22 (1) ◽

pp. 74-78

Author(s):

M Rosyid Narendra ◽

Herry Purbayu

Keyword(s):

Abdominal Pain ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

Signs And Symptoms ◽

Point Of View ◽

Blood Flows ◽

Threatening Condition ◽

Life Threatening ◽

Obstructive Ileus

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

Orvosi Hetilap ◽

10.1556/oh.2012.29444 ◽

2012 ◽

Vol 153 (36) ◽

pp. 1424-1432 ◽

Cited By ~ 3

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.

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

Thrombosis Research ◽

10.1016/j.thromres.2005.04.025 ◽

2006 ◽

Vol 117 (4) ◽

pp. 463-467 ◽

Cited By ~ 37

Author(s):

Hüseyin Altinyollar ◽

Mustafa Boyabatli ◽

Uğur Berberoğlu

Keyword(s):

Early Diagnosis ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

D Dimer

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

International Surgery ◽

10.9738/intsurg-d-14-00268.1 ◽

2015 ◽

Vol 100 (5) ◽

pp. 962-965 ◽

Cited By ~ 3

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 < 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.

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