Clinical Factors and Outcomes in Patients with Acute Mesenteric Ischemia in the Emergency Department

Huang, Her Hsiung; Chang, Ya Ju; Yen, David Hung Tsang; Kao, Wei Fong; Chen, Jen Dar; Wang, Lee Min; Huang, Ching-Kuei; Lee, Chen Hsen

doi:10.1016/s1726-4901(09)70165-0

Cited by 75 publications

(40 citation statements)

References 17 publications

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“…This results in “food fear”, early satiety, and weight loss. In the acute setting however, the clinical symptoms are similar to those found in patients with the arterial embolic disease (5). …”

Section: Acute Mesenteric Ischemiamentioning

confidence: 53%

“…The mean age of patients with acute mesenteric arterial occlusive ischemia (embolic and thrombosis) is 70 years of age. However, patients younger than 50 years of age may also form occlusive emboli in the setting of atrial fibrillation (5). Arterial emboli from a cardiac (6) or septic source are the most common cause of acute mesenteric ischemia and comprise 40-50% of the cases.…”

Section: Acute Mesenteric Ischemiamentioning

confidence: 99%

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Radiological Evaluation of Bowel Ischemia

Dhatt

Behr

Miracle

et al. 2015

Radiologic Clinics of North America

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Intestinal ischemia, which refers to insufficient blood flow to the bowel, is a potentially catastrophic entity that may require emergent intervention or surgery in the acute setting. Although the clinical signs and symptoms of intestinal ischemia are nonspecific, CT findings can be highly suggestive in the correct clinical setting. In this chapter we review the CT diagnosis of arterial, venous, and non-occlusive intestinal ischemia. We discuss the vascular anatomy, pathophysiology of intestinal ischemia, CT techniques for optimal imaging, key and ancillary radiological findings, and differential diagnosis. In the setting of an acute abdomen, rapid evaluation is necessary to identify intraabdominal processes that require emergent surgical intervention (1). While a wide-range of intraabdominal diseases may be present from trauma to inflammation, one of the most feared disorders is mesenteric ischemia, also known as intestinal ischemia, which refers to insufficient blood flow to the bowel (2). Initial imaging evaluation for intestinal ischemia is typically obtained with CT. Close attention to technique and search for key radiologic features with relation to the CT technique is required. Accurate diagnosis depends on understanding the vascular anatomy, epidemiology, and pathophysiology of various forms of mesenteric ischemia and their corresponding radiological findings on MDCT. At imaging, not only is inspection of the bowel itself important, but evaluation of the mesenteric fat, vasculature, and surrounding peritoneal cavity also helps improves accuracy in the diagnosis of bowel ischemia.

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Section: Acute Mesenteric Ischemiamentioning

confidence: 53%

Section: Acute Mesenteric Ischemiamentioning

confidence: 99%

Radiological Evaluation of Bowel Ischemia

Dhatt

Behr

Miracle

et al. 2015

Radiologic Clinics of North America

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show abstract

“…A high index of suspicion in the elderly patient with pain out of proportion to clinical signs and an untreated cardiac arrhythmia is not an adequate baseline. In many studies up to 20 % of patients had no pain recorded [ 2 , 6 , 7 , 17 – 24 ] and in one study 65 % of patients were intubated at the time of referral [ 25 ]. Moreover, many patients have peritonitis at presentation.…”

Section: Introductionmentioning

confidence: 99%

ESTES guidelines: acute mesenteric ischaemia

Tilsed

Casamassima

Kurihara

et al. 2016

Eur J Trauma Emerg Surg

287

283

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PurposeAcute mesenteric ischaemia (AMI) accounts for about 1:1000 acute hospital admissions. Untreated, AMI will cause mesenteric infarction, intestinal necrosis, an overwhelming inflammatory response and death. Early intervention can halt and reverse this process leading to a full recovery, but the diagnosis of AMI is difficult and failure to recognize AMI before intestinal necrosis has developed is responsible for the high mortality of the disease. Early diagnosis and prompt treatment are the goals of modern therapy, but there are no randomized controlled trials to guide treatment and the published literature contains a high ratio of reviews to original data. Much of that data comes from case reports and often small, retrospective series with no clearly defined treatment criteria.MethodsA study group of the European Society for Trauma and Emergency Surgery (ESTES) was formed in 2013 with the aim of developing guidelines for the management of AMI. A comprehensive literature search was performed using the Medical Subject Heading (MeSH) thesaurus keywords “mesenteric ischaemia”, “bowel ischaemia” and “bowel infarction”. The bibliographies of relevant articles were screened for additional publications. After an initial systematic review of the literature by the whole group, a steering group formulated questions using a modified Delphi process. The evidence was then reviewed to answer these questions, and recommendations formulated and agreed by the whole group.ResultsThe resultant recommendations are presented in this paper.ConclusionsThe aim of these guidelines is to provide recommendations for practice that will lead to improved outcomes for patients.

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“…15,16 Analyzing the consequences of AMI -such as perforation, peritonitis, or sepsis -showed no statistical impact on the evolution of patients included in our study due to the few existing cases, other authors reporting important associations between AMI complications and negative evolution of patients. 17 As a summary, it can be said that early diagnosis is indispensable for an effective treatment, being the only way to keep mortality rates low. [18][19][20]…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With in-Hospital Death in Patients with Acute Mesenteric Artery Ischemia

Élthes¹,

Cozlea

Török³

2018

Journal of Cardiovascular Emergencies

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Objective: The aim of the study was to assess the factors associated with increased mortality in patients with acute mesenteric ischemia, emphasizing the importance of an early diagnosis and a prompt surgical intervention in order to avoid lesion progression. Materials and method: A retrospective analytical study was conducted on a study population of 50 male and female patients with acute ischemia of the mesenteric arteries, aged between 36-92 years. Demographic and pathological history characteristics were assessed, together with presented symptoms, laboratory and CT findings, as well as surgical outcome and time-related aspects between presentation in the emergency department and time of surgery, as well as the hospitalization period until discharge or death. Results: Muscular defense (OR = 23.05) and shock (OR = 13.24) as symptoms were strongly associated with a poor prognosis, while elevated values of lactate dehydrogenase (p = 0.0440) and creatine kinase (p = 0.0025) were associated with higher death rates. The time elapsed during investigations in the emergency room was significantly higher in patients who deceased (p = 0.0023), similarly to the total time from the onset of symptoms to the beginning of surgery (p = 0.0032). Surgical outcomes showed that patients with segmental ischemia of the small bowel had significantly higher chances of survival (p <0.0001). Conclusion: Increased mortality rates in patients presenting in the emergency department for acute mesenteric ischemia were observed in patients with occlusion of the superior mesenteric artery, with higher levels of CK and LDH, as well as with longer periods of stay in the emergency department for diagnostic procedures until the commencement of the surgical intervention. Therefore, proper investigations in a timely manner followed by a specific and prompt surgical intervention may avoid unfavorable evolution of patients towards death.

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Clinical Factors and Outcomes in Patients with Acute Mesenteric Ischemia in the Emergency Department

Cited by 75 publications

References 17 publications

Radiological Evaluation of Bowel Ischemia

Radiological Evaluation of Bowel Ischemia

ESTES guidelines: acute mesenteric ischaemia

Factors Associated With in-Hospital Death in Patients with Acute Mesenteric Artery Ischemia

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