Acute Mesenteric Infarction: The Chameleon of Acute Abdomen Evaluating the Quality of the Diagnostic Parameters in Acute Mesenteric Ischemia

Grotelueschen, Rainer; Miller, Verena; Heidelmann, Lena M; Melling, Nathaniel; Ghadban, Tarik; Grupp, Katharina; Reeh, Matthias; Welte, Maria-Noemi; Uzunoğlu, Faik G.; Izbicki, Jakob R.; Bachmann, Kai

doi:10.1159/000512779

Cited by 4 publications

(2 citation statements)

References 35 publications

(53 reference statements)

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“…They also reported that the odds ratios were 7.57 and 5.04 in predicting intestinal necrosis when the neutrophil-lymphocyte ratio was >11.05 and the platelet-lymphocyte ratio was >156.26. However, other studies did not find that WBC or CRP were risk factors associated with intestinal necrosis [18‒20]. In AMI cases, intestinal hypoxia leads to increased anaerobic glycolysis and lactate metabolites, which eventually leads to metabolic acidosis.…”

Section: Discussionmentioning

confidence: 99%

“…In AMI cases, intestinal hypoxia leads to increased anaerobic glycolysis and lactate metabolites, which eventually leads to metabolic acidosis. Therefore, many studies have reported that pH and lactate are risk factors associated with intestinal necrosis [ 16 , 17 , 19 , 21 ]. The guidelines suggest that laparotomy should be performed in patients with peritonitis due to the high possibility of bowel necrosis [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

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Mesenteric Vein Thrombosis following Sleeve Gastrectomy: A Case Report and Review of the Literature

Ma,

Zhao,

Zhang

et al. 2024

Obes Facts

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Introduction: Acute mesenteric ischemia (AMI) is a rare but lethal disease. Mesenteric venous thrombosis (VAMI) is a subtype of AMI. Morbid obesity is usually accompanied by hypertension, hyperlipidemia or diabetes mellitus, which are risk factors associated with AMI. Case presentation: We present a 28-year-old man with mesenteric venous thrombosis post laparoscopic sleeve gastrectomy (LSG). He was first misdiagnosed with intestinal obstruction. Superior mesenteric vein thrombosis was confirmed after computed tomography angiography (CTA). Laparotomy, resection of necrotic small bowel and ostomy were performed immediately. Conclusion: Patients with morbidly obese accompanied by hypertension, hyperlipidemia or diabetes mellitus have a high risk of AMI. Abdominal pain with sudden onset should be considered as AMI. Anticoagulation therapy post sleeve gastrectomy might help to reduce the incidence of AMI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mesenteric Vein Thrombosis following Sleeve Gastrectomy: A Case Report and Review of the Literature

Ma,

Zhao,

Zhang

et al. 2024

Obes Facts

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Factors that may affect the outcome of acute occlusive mesenteric ischemia. A single-center study

Zhang,

Ma,

Zhao

et al. 2024

BMC Surg

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Background Acute mesenteric ischemia is a rare but lethal disease. Acute occlusive mesenteric ischemia consists of mesenteric artery embolism, mesenteric artery thrombosis, and mesenteric vein thrombosis. This study aimed to investigate the factors that may affect the outcome of acute occlusive mesenteric ischemia. Methods Data from acute occlusive mesenteric ischemia patients admitted between May 2016 and May 2022 were reviewed retrospectively. Patients were divided into 2 groups according to whether complications(Clavien‒Dindo ≥ 2) occurred within 6 months of the first admission. Demographics, symptoms, signs, laboratory results, computed tomography angiography features, management and outcomes were analyzed. Results 59 patients were enrolled in this study. Complications(Clavien‒Dindo ≥ 2) occurred within 6 months of the first admission in 17 patients. Transmural intestinal necrosis, peritonitis, white blood cell count, percentage of neutrophils, percentage of lymphocytes, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, creatine kinase isoenzyme, cardiac troponin I, laparoscopic exploration rate, open embolectomy rate, enterostomy rate, length of necrotic small bowel, length of healthy small bowel, surgical time and intraoperative blood loss differed significantly between groups. Creatine kinase isoenzyme (OR = 1.415, 95% CI: 1.060–1.888) and surgical time (OR = 1.014, 95% CI: 1.001–1.026) were independent risk factors associated with complications(Clavien‒Dindo ≥ 2). Conclusions Our analysis suggests that acute occlusive mesenteric ischemia patients with a creatine kinase isoenzyme level greater than 2.22 ng/mL or a surgical time longer than 156 min are more likely to experience complications’(Clavien‒Dindo ≥ 2) occurrence within 6 months of the first admission.

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Diagnostic accuracy of biomarkers to detect acute mesenteric ischaemia in adult patients: a systematic review and meta-analysis

Reintam Blaser,

Starkopf,

Björck

et al. 2023

World J Emerg Surg

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Background Acute mesenteric ischaemia (AMI) is a disease with different pathophysiological mechanisms, leading to a life-threatening condition that is difficult to diagnose based solely on clinical signs. Despite widely acknowledged need for biomarkers in diagnosis of AMI, a broad systematic review on all studied biomarkers in different types of AMI is currently lacking. The aim of this study was to estimate the diagnostic accuracy of all potential biomarkers of AMI studied in humans. Methods A systematic literature search in PubMed, The Cochrane Library, Web of Science and Scopus was conducted in December 2022. Studies assessing potential biomarkers of AMI in (at least 10) adult patients and reporting their diagnostic accuracy were included. Meta-analyses of biomarkers’ sensitivity, specificity, and positive and negative likelihood ratios were conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study quality was assessed with the QUADAS-2 tool. Results Seventy-five studies including a total of 9914 patients assessed 18 different biomarkers in serum/plasma and one in urine (each reported in at least two studies), which were included in meta-analyses. None of the biomarkers reached a conclusive level for accurate prediction. The best predictive value overall (all studies with any type and stage of AMI pooled) was observed for Ischaemia-modified albumin (2 studies, sensitivity 94.7 and specificity 90.5), interleukin-6 (n = 4, 96.3 and 82.6), procalcitonin (n = 6, 80.1 and 86.7), and intestinal fatty acid-binding protein (I-FABP) measured in serum (n = 16, 73.9 and 90.5) or in urine (n = 4, 87.9 and 78.9). In assessment of transmural mesenteric ischaemia, urinary I-FABP (n = 2, 92.3 and 85.2) and D-dimer (n = 3, 87.6 and 83.6) showed moderate predictive value. Overall risk of bias was high, mainly because of selected study populations and unclear timings of the biomarker measurements after onset of symptoms. Combinations of biomarkers were rarely studied, not allowing meta-analyses. Conclusions None of the studied biomarkers had sufficient sensitivity and specificity to diagnose AMI, although some biomarkers showed moderate predictive accuracy. Future studies should focus on timing of measurements of biomarkers, distinguishing between early stage and transmural necrosis, and between different types of AMI. Additionally, studies on combinations of biomarkers are warranted. PROSPERO registration: CRD42022379341.

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Acute Mesenteric Infarction: The Chameleon of Acute Abdomen Evaluating the Quality of the Diagnostic Parameters in Acute Mesenteric Ischemia

Cited by 4 publications

References 35 publications

Mesenteric Vein Thrombosis following Sleeve Gastrectomy: A Case Report and Review of the Literature

Mesenteric Vein Thrombosis following Sleeve Gastrectomy: A Case Report and Review of the Literature

Factors that may affect the outcome of acute occlusive mesenteric ischemia. A single-center study

Diagnostic accuracy of biomarkers to detect acute mesenteric ischaemia in adult patients: a systematic review and meta-analysis

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