Mesenteric Ischemia
Stephen M. Cohn, Alan Lisbon, Stephen Heard in 50 Landmark Papers, 2021
Acute mesenteric ischemia (AMI) is a challenging and potentially fatal condition that requires a high index of suspicion, early diagnosis, and prompt restoration of blood flow to avoid fulminant bowel necrosis and death. Delays in diagnoses have been associated with a mortality of up to 80% (Mamode et al., 1999; Clair and Beach, 2016). Intestinal ischemia is broadly categorized according to the segment of bowel to which blood flow is compromised and the acuity of onset. The presentation management strategies and outcomes of these entities varies widely; accurate diagnosis is thus paramount (Lim et al., 2019). Whereas, colonic ischemic (ischemic colitis) is limited to the colon, mesenteric ischemia primarily affects the small bowel. And while patients with chronic mesenteric ischemia exhibit episodic or recurrent intestinal angina and “food fear” and can be managed in a less urgent manner, acute mesenteric ischemia requires immediate intervention.
Radiology of Infectious Diseases and Their Potential Mimics in the Critical Care Unit
Cheston B. Cunha, Burke A. Cunha in Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Ischemic colitis results from compromise to the colonic blood supply, either by global changes in circulation or by local changes in mesenteric vasculature. As such, findings occur in a territorial distribution, typically in watershed areas, particularly the splenic flexure (superior mesenteric artery/inferior mesenteric artery junction) and the rectosigmoid junction (inferior mesenteric artery/hypogastric artery junction). It is the most common form of gastrointestinal ischemia, is usually transient and self-limited, and the cause is often somewhat elusive and multifactorial. Most of the patients affected are elderly, with non-specific abdominal pain, and occasionally bloody diarrhea. It is associated with cardiovascular disease, numerous medications, coagulopathic states, and hypovolemia. Again, bowel wall thickening, mucosal irregularity, and pericolic inflammatory changes may be seen on CT. Specific, but uncommon, findings for bowel ischemia include pneumatosis (in the correct clinical context), which may be difficult to distinguish from intraluminal gas in some patients, and the absence of submucosal enhancement in the region of infarction [3,61].
Mesenteric and renal angiography
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
The principal indication for mesenteric angiography is evaluation of intestinal ischemia when the CT scan is not conclusive and the level of clinical suspicion is high.[4] Classically, patients with acute intestinal ischemia present with sudden or recent onset of pain and little or no findings on abdominal physical exam. These patients often have a history of coronary artery disease, peripheral arterial disease, atrial fibrillation, or other cardiovascular risk factors (Table 24.1). Acute intestinal ischemia should also be suspected in patients with severe abdominal pain following endovascular procedures that involve catheter traversal in the abdominal aorta. The decision to perform angiography on patients with suspected acute intestinal ischemia needs to be individualized. For instance, patients presenting with acute abdominal pain due to suspected arterial occlusion with intestinal infarction should be referred for immediate laparotomy instead of angiography. Alternatively, patients with nonocclusive disease may benefit from a strategy that incorporates initial angiography.
Fully automatic d -lactate assay using a modified commercially available method
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2021
Rikke Wehner Rasmussen, David Straarup, Ole Thorlacius-Ussing, Aase Handberg, Peter Astrup Christensen
Intestinal ischemia refers to reversible impaired blood perfusion to an intestinal segment. Intestinal infarction is the fast-evolving and irreversible endpoint of the ischemic process. Obstructive intestinal ischemia is caused by intravascular (primary intestinal) or extravascular (secondary intestinal) ischemia. Primary intestinal ischemia is a diagnostic obstacle due to a blurred history, vague symptoms and unspecific paraclinical findings and causes detrimental outcomes. Early diagnosis and treatment within 6 h reduce mortality [1,2]. The diagnostic tools at hand in the clinical setting are computed tomography (CT) scan and biochemical parameters, however, both have shortcomings. The unclear clinical presentation often results in unspecific CT examinations. Standard biochemical parameters have failed to show significant sensitivity and specificity to diagnose intestinal ischemia. Together, the result is time-consuming diagnostic procedures and unacceptable time delay before diagnosis and treatment as discussed by Carver et al. [1] and Klar et al. [2].
In the Experimental Model of Acute Mesenteric Ischemia, The Correlation of Blood Diagnostic Parameters with the Duration of Ischemia and their Effects on Choice of Treatment
Published in Journal of Investigative Surgery, 2019
Mikail Cakir, Dogan Yildirim, Fatma Sarac, Turgut Donmez, Semih Mirapoglu, Adnan Hut, Fazilet Erozgen, Omer Faruk Ozer, Melih Ozgun Gecer, Leyla Zeynep Tigrel, Oguzhan Tas
The most important factors determining intestinal injury are the level of mesenteric artery obstruction, the rate of collateral flow, and the duration of ischemia. Intestinal ischemia can be seen in a wide range of clinical and pathological conditions. Pathological findings can range from mild changes to total necrosis and gangrene. Also, biomarker levels are affected by the amount of ischemic bowel, the length was not measured because the experiment was based on total ligation of SMA for each group. It was seen that similar length ischemic segments were detected by the eye with varying degrees of color changes according to time passed. In experimental studies, structural changes in the mucosa begin within 10 min of SMA occlusion.4 Although necrosis and edema in the submucosa can be regenerated, perforation or peritonitis can occur if the necrosis reaches the muscular and serosal layers.4 Therefore, early diagnosis, vascular imaging methods, vascular surgery, and intensive care support can improve the prognosis of mesenteric ischemia.
The Diagnostic Value of ischemia-modified albumin (IMA) and signal peptide-CUB-EGF domain-containing protein-1 (SCUBE-1) in an Experimental Model of Strangulated Mechanical Bowel Obstruction
Published in Journal of Investigative Surgery, 2022
Arif Burak Cekic, Ozgen Gonenc Cekic, Ali Aygun, Sinan Pasli, Serap Yaman Ozer, Suleyman Caner Karahan, Suleyman Turedi, Sami Acar, Ozgur Tatli, Esin Yulug
The classic findings of strangulated MBO include abdominal pain, fever, leukocytosis, tachycardia, nausea-vomiting, a palpable painful mass, abdominal distension, absence of intestinal sounds, findings of peritoneal irritation, and acidosis.6 Surgical treatment is applied following early diagnosis in cases presenting with symptoms of strangulated MBO and peritonitis findings. However, the decision-making process is much more difficult in patients presenting without classic examination findings. Although various imaging methods and biochemical parameters showing intestinal ischemia are employed, there is no definitive recommended method for early and accurate diagnosis.7,8