Acute abdomen in the medical intensive care unit

Gajić, Ognjen; Urrutia, Luis; Sewani, Hassanali; Schroeder, Darrell R.; Cullinane, Daniel C.; Peters, Steve G.

doi:10.1097/00003246-200206000-00001

Cited by 70 publications

(40 citation statements)

References 10 publications

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“…The clinical data used represent a major strength of the current study. Although some studies regarding the outcome and etiology of acute abdominal pain have been published, these reports come from some single-center studies (van Geloven et al 2000;Gajic et al 2002;Gardner et al 2010). One of the benefits of the national database is that it enables evaluation of a large number of hospitals, and our investigation involved a nationally representative sample of patients with acute abdominal pain in a community setting (Murata et al , 2012.…”

Section: Discussionmentioning

confidence: 99%

Age-Related Differences in Outcomes and Etiologies of Acute Abdominal Pain Based on a National Administrative Database

Murata

Okamoto

Mayumi

et al. 2014

Tohoku J. Exp. Med.

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Acute abdominal pain is one of the most frequent causes of admission to emergency departments. However, there is a shortage of detail information showing the difference of outcomes or etiology of acute abdominal pain according to age. We therefore conducted an epidemiological analysis to reveal the difference between age on outcomes and etiology of acute abdominal pain using an administrative database associated with the Diagnosis Procedure Combination (DPC) system. We obtained discharge data relating to 12,209 patients with acute abdominal pain from 931 DPC participation hospitals between 2009 and 2011 in Japan. We compared length of hospital stay (LOS), in-hospital mortality, and etiology of acute abdominal pain between age categories. Patients were divided into five age groups as follows: < 20 (n = 1,106), 20-39 (n = 3,353), 40-59 (n = 2,925), 60-79 (n = 3,144), and ≥ 80 years (n = 1,681). Longer LOS and higher in-hospital mortality were observed in patients aged ≥ 80 years (p < 0.001). Regarding etiologies of acute abdominal pain, intestinal infection or acute appendicitis were more frequent in patients aged < 20 or 20-39 years, while ileus or cholelithiasis were more frequent in patients aged 60-79 or ≥ 80 years in both male and female patients (p < 0.001). This study demonstrated the significant differences between age with regard to the patient outcomes and etiology of acute abdominal pain. The current findings highlight the importance of improving the quality of medical care for patients with acute abdominal pain.

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Section: Discussionmentioning

confidence: 99%

Age-Related Differences in Outcomes and Etiologies of Acute Abdominal Pain Based on a National Administrative Database

Murata

Okamoto

Mayumi

et al. 2014

Tohoku J. Exp. Med.

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“…Acute mesenteric ischemia is an often devastating disease that is currently the leading cause of the acute abdomen in medical intensive care unit patients 22 and in hemodialysis patients. 23 As the incidences of cardiac and thromboembolic disease increase worldwide, we may expect the same for mesenteric ischemia.…”

Section: Discussionmentioning

confidence: 99%

Imaging of Acute Mesenteric Ischemia Using Multidetector CT and CT Angiography in a Porcine Model

Rosow

Sahani

Strobel

et al. 2005

Journal of Gastrointestinal Surgery

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Acute mesenteric ischemia, a frequently lethal disease, requires prompt diagnosis and intervention for favorable clinical outcomes. This goal remains elusive due, in part, to lack of a noninvasive and accurate imaging study. Traditional angiography is the diagnostic gold standard but is invasive and costly. Computed tomography (CT) is readily available and noninvasive but has shown variable success in diagnosing this disease. The faster scanning time of multidetector row CT (M.D.CT) greatly facilitates the use of CT angiography (CTA) in the clinical setting. We sought to determine whether M.D.CT-CTA could accurately demonstrate vascular anatomy and capture the earliest stages of mesenteric ischemia in a porcine model. Pigs underwent embolization of branches of the superior mesenteric artery, then imaging by M.D.CT-CTA with three-dimensional reconstruction protocols. After scanning, diseased bowel segments were surgically resected and pathologically examined. Multidetector row CT and CT angiography reliably defined normal and occluded mesenteric vessels in the pig. It detected early changes of ischemia including poor arterial enhancement and venous dilatation, which were seen in all ischemic animals. The radiographic findings-compared with pathologic diagnoses-predicted ischemia, with a positive predictive value of 92%. These results indicate that M.D.CT-CTA holds great promise for the early detection necessary for successful treatment of acute mesenteric ischemia. KeywordsMesenteric ischemia; computed tomography; angiography; animal model Acute mesenteric ischemia, the process of insufficient blood supply to the bowel, carries consequences ranging from a transient, totally reversible insult to a lethal event. The prevalence of mesenteric ischemia is increasing in the United States as the population ages. It is estimated that nearly 1% of patients presenting with acute abdominal pain have ischemic intestinal disease, 1-3 and it may be responsible for 0.1% of all hospital The lethality of the disease is well documented, with some series reporting mortality rates exceeding 60%. [4][5][6][7] A critical factor for survival of acute mesenteric ischemia is early diagnosis and intervention. In cases of superior mesenteric artery (SMA) embolism in which surgery is performed once the bowel is infarcted, the mortality rate nearly doubles from 35% to 68%. 8 The mean duration of ischemia preceding surgery for noninfarcted bowel is 13 hours, compared with 21 hours for those with infarction. 9 Thus, the window of opportunity for intervention is narrow and prompt diagnosis is crucial for patient survival. Nevertheless, this goal remains elusive, due in part to the lack of an accurate diagnostic imaging tool. NIH Public AccessAlthough angiography is considered the standard of reference for the diagnosis of mesenteric ischemia, it is not widely used because it is invasive, time-consuming, and costly. Computed tomography has been historically used with variable success for evaluating small bowel ischemia. It can help dete...

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“…Schmerz, Fieber, Paralyse sowie Belastbarkeit. Auch die Entwicklung von Organversagen sowie neurologischen Veränderungen [7,8] oder pathologisch veränderte Laborparameter (Leukozyten, C-reaktives Protein) können Hinweise für Infektionen sein [9,10]. …”

Section: Introductionunclassified

“…Entscheidend für den klinischen Verlauf ist die rasche Diagnose der Anastomoseninsuffizienz [7,8,9,10]. Somit ist die postoperative Überwachung des Patienten sowie die Kenntnis über die potenziellen Komplikationen Voraussetzung für die adäquate Diagnostik und Therapie.…”

Section: Introductionunclassified

“…Hierzu sollte bei klinischem oder laborchemischem Verdacht auf eine Anastomoseninsuffizienz eine zielgerichtete apparative Diagnostik mittels Sonographie, Schnittbildgebung mit oraler oder rektaler Kontrastdarstellung, Endoskopie oder sogar eine Relaparoskopie oder Relaparotomie erfolgen. Die Verzögerung der Diagnose und damit eine verspätete Therapie der Mediastinitis oder Peritonitis geht mit einer signifikanten Zunahme der Letalität einher [7,8]. …”

Section: Introductionunclassified

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Nahtinsuffizienz intestinaler Anastomosen: Endoskopische und laparoskopische Therapieoptionen

Werner¹,

Sauer

2013

Visc Med

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Hintergrund: Anastomoseninsuffizienzen stellen die schwerwiegendste septische Komplikation nach viszeralchirurgischen Eingriffen dar. Neben der chirurgischen Therapie sind zunehmend endoskopische Behandlungsoptionen möglich. Methode: Literaturübersicht. Ergebnisse: Therapieoptionen von Anastomoseninsuffizienzen sind abhängig von der klinischen Symptomatik, der Art der Anastomose, der Defektgröße, den lokalen Gewebeverhältnissen sowie dem Zeitpunkt der Diagnose. Bei einer Nekrose oder Minderdurchblutung der Viszeralorgane müssen diese operativ reseziert werden. Prinzipiell sind alle operativen Revisionseingriffe auch laparoskopisch durchführbar. Bei erhaltener Gewebeperfusion können die Leckagen lokal übernäht oder endoskopisch verschlossen werden. Die Ergebnisse für die Stenttherapie nach Ösophagus- und Magenresektionen sind für moderne Stents sehr Erfolg versprechend. Im Gegensatz dazu sind die Ergebnisse der endoskopischen Stenttherapie bei Insuffizienz nach kolorektalen Eingriffen enttäuschend; dafür steht hier mit der Schwammtherapie eine vielversprechende endoskopische Alternative zur Verfügung. Schlussfolgerung: Die aktuellen Daten zeigen, dass neue laparoskopische und endoskopische Optionen zur Therapie von Anastomoseninsuffizienzen bestehen, die jedoch noch in prospektiven und randomisierten Studien evaluiert werden müssen.

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Acute abdomen in the medical intensive care unit

Abstract: Delays in surgical evaluation and intervention are critical contributors to mortality rate in patients who develop acute abdominal complications in a medical intensive care unit.

Cited by 70 publications

References 10 publications

Age-Related Differences in Outcomes and Etiologies of Acute Abdominal Pain Based on a National Administrative Database

Age-Related Differences in Outcomes and Etiologies of Acute Abdominal Pain Based on a National Administrative Database

Imaging of Acute Mesenteric Ischemia Using Multidetector CT and CT Angiography in a Porcine Model

Nahtinsuffizienz intestinaler Anastomosen: Endoskopische und laparoskopische Therapieoptionen

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