Acute Mesenteric Ischemia

Oldenburg, W. Andrew; Lau, Louis; Rodenberg, Thomas J.; Edmonds, Hope J.; Burger, Charles D.

doi:10.1001/archinte.164.10.1054

Cited by 648 publications

(690 citation statements)

References 48 publications

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“…[45][46][47][48][49] The clinical picture in the early stages is unspecific and similar to other abdominal syndromes (peritonitis, occlusion). Pain can be acute, sudden (arterial embolism or thrombosis) or slowly progressing (ischemia by non occlusal causes or venous mesenteric thrombosis), associated with nausea, vomiting and change in bowel habits.…”

Section: Vascular Abdominal Syndromementioning

confidence: 99%

Abdominal pain: a synthesis of recommendations for its correct management

Tirotta

Marchetti²,

Lillo

et al. 2015

Ital J Med

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Abdominal pain represents one of the most important diagnostic challenges for any physician and its correct interpretation and management require a proper systematic approach and sometimes an urgent action. Moreover the guidelines that can be referred to for indications about the most adequate management procedures are few and often focused only on radiologic management. Consequently, the approach to abdominal pain is often empirical. Therefore, we propose a review of the literature on the diagnosis of abdominal pain, which may contribute to improve the diagnosis and treatment of this complex condition through a systematic review of the evidences available in this field. As to our methodology, we conducted an extensive search in the main guideline databases (SIGN, ICSI, NICE, National Guideline Cleringhouse, CMA Infobase, NZ Guidelines Group, National System Guidelines, Clinical Practice Guidelines Portal, eGuidelines), using as key words abdominal pain and abdominalgia. The guidelines were assessed according to the 2010 Italian version of the AGREE (Appraisal of Guidelines, Research and Evaluation II) methodology. Afterwards we formulated our main recommendations associated with the corresponding levels of evidence and focused our attention on some grey areas, which we investigated with further research using Medline and the main systematic review databases (Cochrane database). The four main grey areas investigated were: hospital admission criteria, prognostic stratification, need for analgesic treatment and possibility of attributing abdominalgia to an abdominal pain syndrome. We then formulated our consesus-based recommendations on the grey areas. Abdominal pain management remains a complex issue for internists. As with other diagnostic challenges, it would be advisable to develop additional guidelines based on a multidisciplinary approach and not only focused on radiological management.

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Section: Vascular Abdominal Syndromementioning

confidence: 99%

Abdominal pain: a synthesis of recommendations for its correct management

Tirotta

Marchetti²,

Lillo

et al. 2015

Ital J Med

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“…However, despite the great technological development applied to medicine in recent years, especially in image examination and in life support advances, mortality rates in cases of acute mesenteric ischemia remain high, around 60 to 80%, according to several authors 31,32,33,34,35,36 experience, needing yet researches about more accurate techniques on fast and efficient assessment of mesenteric ischemia.…”

Section: Introductionmentioning

confidence: 99%

Infrared imaging contribution for intestinal ischemia detection in wound healing

Malafaia

Brioschi²,

Aoki

et al. 2008

Acta Cir. Bras.

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Purpose: To study thermal variations obtained through infrared image in rats, and to evaluate the relationship between intestinal ischemic time and histopathological findings. Methods: Thirty Wistar rats were operated after distribution in 5 groups with different times of ischemia. Thermograms were obtained by using a infrared camera. The surgical technique has been standardized for all groups: abdominal cavity opening by a 5cm length incision in the midline, abdominal wall plans section and cavity exposure, and exteriorization of the intestine. In group I (control), it was proceeded only laparotomy without superior mesenteric artery ligature. After first thermogram done, incision was closed with continuing suture. In each rat in groups II, III, IV and V, the superior mesenteric artery was located at its origin on abdominal aorta, dissected and occluded with a vascular microclamp, subjecting the intestine to ischemia in variable times. Results: Rats submitted to a 30 minutes ischemia presented reactive hyperemia, thermal differential of 1.8°C and normal pathological examination. The 1 hour ischemia produced reactive hyperemia with ischemic areas, thermal differential of 1.0°C and injuries at villosities' tips. However, the 90 minutes ischemia had not shown reactive hyperemia with large ischemic areas, thermal differential of -1.0°C and injury in the upper third of the villosities. The 2 hours ischemia demonstrated a severe ischemia, thermal differential of -2.0°C and injury throughout the all villosities' extension. Conclusion: It has been possible studying thermal variations through infrared image in rats, showing correlation between thermal response in thermograms, ischemic time and histopathological findings. Key words: Spectrophotometry, Infrared. Tissue Survival. Ischemia. Wound Healing. Rats. RESUMOObjetivo: Estudar as variações térmicas obtidas por meio da imagem infravermelha em ratos, e avaliar sua correlação com o tempo de isquemia intestinal e os achados histopatológicos. Métodos: Trinta ratos Wistar foram operados após distribuição em cinco grupos com diferentes tempos de isquemia. Os termogramas foram obtidos utilizando-se uma câmera infravermelha. A técnica operatória foi padronizada para todos os grupos, abertura da cavidade abdominal por uma incisão na linha média de 5 cm de comprimento com secção de todos os planos da parede abdominal e exposição da cavidade e as alças intestinais exteriorizadas. No grupo I (controle) foi feito apenas laparotomia sem ligadura da artéria mesentérica superior. Após realizado o primeiro termograma, foi fechada a incisão com sutura contínua. Em cada rato dos grupos II, III, IV e V a artéria mesentérica superior foi localizada em sua origem na aorta abdominal, dissecada com e ocluída por um microclampe vascular submetendo o intestino à isquemia em tempos variáveis. Resultados: Os ratos submetidos à isquemia de 30 minutos apresentaram hiperemia reativa, diferencial térmico de 1,8°C e exame anatomopatológico normal. A isquemia de 1 hora produziu hiperemia reati...

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“…Mesenteric ischemia is a relatively rare disorder; however nonspecific clinical findings and limitations of diagnostic studies make the diagnosis a significant challenge. Despite recent advances in diagnosis and treatment, mortality rates continue to remain high (Chang and Stein 2003;Oldenburg et al 2004;Ujiki 2005).…”

mentioning

confidence: 99%

Mesenteric Ischemia: Still a Deadly Puzzle for the Medical Community

Stamatakos

Stefanaki

Mastrokalos

et al. 2008

Tohoku J. Exp. Med.

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The main goal of this article is to update etiology, epidemiology, diagnosis, treatment and outcome of the various causes of mesenteric ischemia in order to elucidate its labyrinthine clinical riddle, by reviewing the current English medical literature. Mesenteric ischemia is a quite uncommon disorder, observed in the emergency department. It is a lifethreatening vascular emergency that requires early diagnosis and intervention to restore mesenteric blood flow and to prevent bowel necrosis and patient death. Consequently, it is a vital diagnosis to make because of its high mortality rate and its thorny complications. The underlying causes vary, and the prognosis depends on the specific findings during clinical examination. Vague and nonspecific clinical findings and limitations of diagnostic studies make the diagnosis a significant challenge. The prognosis of acute mesenteric ischemia of any type is grave. The complications following this medical jigsaw puzzle are also severe. Patients in whom the diagnosis is missed until infarction occurs have a mortality rate of 90%. Even with good treatment, up to 50-80% of patients die. Survivors of extensive bowel resection face lifelong disability. Despite the progress in understanding the pathogenesis of mesenteric ischemia and the development of treatment modalities, the entity remains a diagnostic challenge for clinicians. Delay in diagnosis contributes to a high mortality rate. Early diagnosis and adequate treatment can improve the clinical outcome. Even if diagnostic modalities have improved since the first successful attempts to confront effectively this clinical entity, mesenteric ischemia still remains a lethal diagnostic enigma for the medical community.Mesenteric Ischemia; thrombosis; bowel infarction; atherosclerosis; mesenteric venous thrombosis; mesenteric thromboendarterectomy.Tohoku

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Acute Mesenteric Ischemia

Cited by 648 publications

References 48 publications

Abdominal pain: a synthesis of recommendations for its correct management

Abdominal pain: a synthesis of recommendations for its correct management

Infrared imaging contribution for intestinal ischemia detection in wound healing

Mesenteric Ischemia: Still a Deadly Puzzle for the Medical Community

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