Advances in the diagnosis of non-occlusive mesenteric ischemia and challenges in intra-abdominal sepsis patients: a narrative review

Zhou, C.; Liu, Xiaosun; Shou, Chunhui; Yang, Weili; Yu, Jian

doi:10.7717/peerj.15307

Cited by 6 publications

(3 citation statements)

References 62 publications

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“…AMI can also be caused by nonocclusive aetiology. Non-occlusive mesenteric ischaemia is due to vasoconstriction of the mesenteric vessels without an intraluminal clot [ 75 ]. It accounts for approximately 20% of cases, and it has been observed in critically unwell patients in an intensive care setting [ 75 ].…”

Section: Discussionmentioning

confidence: 99%

Scoping Review of Clinical Presentations and Outcomes in Patients with Concomitant COVID-19 Infection and Acute Mesenteric Ischaemia

Cai,

Zhao,

Mallappa

2024

Viruses

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Objectives: COVID-19 infection confers an increased risk of coagulation dysfunction (1) predisposing to thromboembolism in many anatomical sites including the gastrointestinal tract (GIT) (2). This study investigates the clinical presentation and outcome in patients presenting with concurrent COVID-19 infection and gastrointestinal tract ischaemia. Furthermore, differentiation and comparisons are drawn between those with arterial and venous aetiology for mesenteric ischaemia. Methods: A systematic search was undertaken on EMBASE, PubMed, and MEDLINE. Two independent reviewers screened titles, abstracts, and full-text articles according to the inclusion criteria and extracted relevant data. Data analyses were conducted using Excel®. Results: Forty-one studies were included in the data analyses, yielding 44 patients. Twenty-six patients had mesenteric arterial occlusion, sixteen patients had mesenteric venous occlusion, and two patients had both arterial and venous mesenteric occlusion. All patients had concurrent COVID-19 infection. The survival rate in patients with arterial aetiology was 38.5% in contrast to 68.8% in patients with venous aetiology. Twelve patients (29.3%) experienced respiratory symptoms in the community before the onset of gastrointestinal symptoms, and five (12.2%) developed gastrointestinal symptoms during their inpatient stay for COVID-19 pneumonitis. Conclusions: Acute mesenteric ischaemia presents a clinical challenge to diagnose due to its non-specific symptoms. Concurrent COVID-19 infection with its predominant respiratory symptoms adds a further challenge in recognising the non-specific symptoms of mesenteric ischaemia. Our study draws attention to the increased thromboembolic risk posed by COVID-19 infection and the need for a high index of suspicion to aid prompt diagnosis and management of acute mesenteric ischaemia, even in the post-pandemic era.

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Section: Discussionmentioning

confidence: 99%

Scoping Review of Clinical Presentations and Outcomes in Patients with Concomitant COVID-19 Infection and Acute Mesenteric Ischaemia

Cai,

Zhao,

Mallappa

2024

Viruses

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“…Additionally, it is difficult to interpret inflammatory markers in patients with NOMI who usually have an active inflammatory state due to their severe underlying illness and its treatment (e.g. ICU patients) [ 98 , 99 ]. Of note, there was no study assessing IL-6 in NOMI.…”

Section: Discussionmentioning

confidence: 99%

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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“…Ранняя диагностика ОННМК, необходимая для улучшения прогноза лечения, остается сложной задачей, особенно у пациентов реанимационных отделений с угнетением уровня бодрствования и абдоминальным сепсисом [29].…”

Section: Introductionunclassified

Acute non-occlusive mesenteric ischemia in patients with various types of comorbidities and postoperative complications: clinical case and observation.

Rogal,

Lebedev,

Yartsev

et al. 2023

jour

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Aim. To enhance the outcomes of treating patients with acute non-occlusive mesenteric ischemia (focal) following colostomy, aiming to gain a better understanding of the prevalent risk factors for complications and exploring ways of their reduction.Materials and methods. A clinical case detailing the treatment of a patient with acute non-occlusive mesenteric ischemia amidst abdominal sepsis and stoma necrosis, compounded by inflammatory disease of the spinal cord membranes, is presented. Additionally, the clinical observation of a patient experiencing postoperative complications, including coronavirus infection and bilateral hydrothorax, is provided.Results. In a patient presenting severe coronary pathology alongside a nuanced clinical manifestation of mesenteric ischemia in the delayed phase, a surgical intervention involving intestinal tract resection and subsequent stoma removal was conducted. Regrettably, stoma necrosis ensued, necessitating reconstructive surgery. The patient’s initial critical state, compounded by the requirement for repeated surgical intervention, precipitated a swift progression of multiple organ failure, culminating in mortality. Conversely, another patient, postoperatively diagnosed with coronavirus infection and bilateral hydrothorax, exhibited amelioration in clinical status following administered treatment, ultimately warranting hospital discharge.Conclusions. Early diagnosis and timely surgical intervention contribute to improving the prognosis of treatment. Early postoperative complications and repeated surgical interventions significantly worsen the prognosis.

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Advances in the diagnosis of non-occlusive mesenteric ischemia and challenges in intra-abdominal sepsis patients: a narrative review

Cited by 6 publications

References 62 publications

Scoping Review of Clinical Presentations and Outcomes in Patients with Concomitant COVID-19 Infection and Acute Mesenteric Ischaemia

Scoping Review of Clinical Presentations and Outcomes in Patients with Concomitant COVID-19 Infection and Acute Mesenteric Ischaemia

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

Acute non-occlusive mesenteric ischemia in patients with various types of comorbidities and postoperative complications: clinical case and observation.

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