Colonic ischemia

Oglat, Ayah; Quigley, Eamonn Martin

doi:10.1097/mog.0000000000000325

Cited by 18 publications

(14 citation statements)

References 58 publications

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“…GIisch is among the most lethal gastrointestinal complications after cardiac surgery (14). Among the mechanisms of GIisch, NOMI has been reported to predominate among ICU patients (3,4,15) in keeping with our data. NOMI is characterized by the triad of low cardiac output and/or hypotension, peripheral-artery and mesenteric atheroma, and extraintestinal organ-function impairments due to hypoperfusion and most often involving the liver and kidney (4).…”

Section: Discussionsupporting

confidence: 90%

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Probabilistic Prediction of Gastrointestinal Ischemia after Cardiothoracic Surgery

Stephan,

Facque,

Salem

et al. 2024

Thorac Cardiovasc Surg

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Background Gastrointestinal ischemia (GIisch) is challenging to diagnose in patients after cardiothoracic surgery. Computed tomography angiography (CTA) carries substantial false-negative and false-positive rates. The aim of the study was to evaluate if a combination of readily available variables improves the diagnosis of GIisch after cardiothoracic surgery. Methods This retrospective study included patients receiving intensive care after cardiothoracic surgery. GIisch was confirmed by surgical and/or endoscopic findings. A GIisch prediction score was developed using the Spiegelhalter-Knill-Jones system in a training cohort then tested in a validation cohort (patients without obvious signs of GIisch on CTA). Results The training cohort comprised 125 consecutive patients with suspected GIisch in 2008 to 2019, including 85 with confirmed GIisch. CTA, performed in 92 patients, had a high false-negative rate of 17/60 (28%) and a lower false-positive rate of 7/32 (22%). The score included cardiopulmonary bypass, negatively associated with GIisch, and six variables positively associated with GIisch: intraoperative mean arterial pressure < 50 mm Hg, aspartate aminotransferase > 15 N, lactate increase in 24 hour > 20%, and 3 CTA findings, namely, bowel dilation, bowel wall thickening, and mesenteric vasoconstriction. The area under the receiver operating characteristic was 0.82 (95% confidence interval [CI], 0.51–0.93) in the training cohort and 0.82 (95% CI, 0.68–0.96) in the validation cohort (n = 34 patients). Reliability of the predicted probabilities was greatest for probabilities ≤ 30% or ≥ 70%. Conclusion In patients receiving intensive care after cardiothoracic surgery, GIisch cannot be ruled out based solely on CTA findings. A scoring system combining CTA findings with other variables may improve the diagnosis of GIisch in this population.

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Section: Discussionsupporting

confidence: 90%

“…The distribution of bowel segments involved in our patients is also in accordance with other studies (4,16). The major site was the colon with typically results from a global reduction in blood flow (15). Ischemia of the colon is usually associated with a rapid perforation (1).…”

Section: Discussionmentioning

confidence: 90%

Probabilistic Prediction of Gastrointestinal Ischemia after Cardiothoracic Surgery

Stephan,

Facque,

Salem

et al. 2024

Thorac Cardiovasc Surg

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“…However, it was later found that intraluminal pressures only reach 8–10 cm H 2 O in simple obstruction and are not high enough to cause transmural ischemia in the gut ( Shikata et al, 1983 ; Summers and Lu, 1991 ). Even in the case of ischemia colitis, ischemic change is typically caused by a global reduction in blood flow to the colon, not by local obstructive lesions ( Oglat and Quigley, 2017 ). Nevertheless, blood supply can be compromised through external compression of the bowel or its mesentery by severe adhesions, torsion, or intussusception.…”

Section: Acute Abdominal Pain In Bowel Obstructionmentioning

confidence: 99%

“…Acid-sensitive ion channels (ASIC), TRPV1, and P2X3 are among many of the chemical receptors in the sensory nerve endings ( Bielefeldt, 2006 ; Brierley and Blackshaw, 2006 ). Reviews on inflammation and ischemia associated abdominal pain can be found elsewhere ( Vermeulen et al, 2014 ; Feuerstadt and Brandt, 2015 ; Oglat and Quigley, 2017 ).…”

Section: Acute Abdominal Pain In Bowel Obstructionmentioning

confidence: 99%

Novel Insights Into the Mechanisms of Abdominal Pain in Obstructive Bowel Disorders

Shi

Lin

Hegde

2018

Front. Integr. Neurosci.

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Obstructive bowel disorders (OBD) are characterized by lumen distention due to mechanical or functional obstruction in the gut. Abdominal pain is one of the main symptoms in OBD. In this article, we aim to critically review the potential mechanisms for acute and chronic pain in bowel obstruction (BO). While clustered contractions and associated increase of intraluminal pressure may account for colicky pain in simple obstruction, ischemia may be involved in acute pain in severe conditions such as closed loop obstruction. Recent preclinical studies discovered that visceral sensitivity is increased in BO, and visceral hypersensitivity may underlie the mechanisms of chronic abdominal pain in BO. Mounting evidence suggests that lumen distension, as a circumferential mechanical stretch, alters gene expression (mechano-transcription) in the distended bowel, and mechano-transcription of nociceptive and inflammatory mediators plays a critical role in the development of visceral hypersensitivity in BO. Mechano-transcription of nerve growth factor (NGF) in gut smooth muscle cells is found to increase voltage-gated Na+ channel (Nav) activity of the primary sensory neurons by up-regulating expression of TTX-resistant Nav1.8, whereas mechanical stretch-induced brain-derived neurotrophic factor (BDNF) reduces Kv currents especially A-type (IA) currents by down-regulating expression of specific IA subtypes such as Kv1.4. The NGF and BDNF mediated changes in gene expression and channel functions in the primary sensory neurons may constitute the main mechanisms of visceral hypersensitivity in OBD. In addition, mechanical stretch-induced COX-2 and other inflammatory mediators in the gut may also contribute to abdominal pain by activating and sensitizing nociceptors.

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“…Ischemic colitis is the most common form of vascular injury to the gastrointestinal tract [1]. The most common reason for colonic ischemia is hypoperfusion as compared to thrombotic and embolic events accounting for most vascular insults to the small bowel [2]. Occurrence is typically segmental with left-sided lesions involving the water-shed regions such as the splenic flexure, descending colon, and sigmoid colon.…”

Section: Introductionmentioning

confidence: 99%

The Colonic Single Stripe Sign: A Case of Ischemic Colitis

Parikh

Satiya

Berger-Saunderson

et al. 2019

Cureus

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Sudden, transient reduction in the blood flow especially in the “watershed” regions of the colon can lead to intestinal ischemia causing a decrease in the delivery of oxygen and nutrients to the intestinal wall. Patients with ischemic colitis often have elevated white blood cell counts, serum lactate, and serum amylase levels. Colonoscopy can confirm the diagnosis of ischemia and the findings include edematous, friable mucosa, erythema with interspersed pale areas, scattered hemorrhagic erosions or linear ulcerations. A single, linear ulcer running along the anti-mesenteric colonic wall, "single-stripe sign"- favors the diagnosis of ischemic colitis. Management of mild and moderate colonic ischemia includes supportive care with bowel rest, gastric suction for associated ileus, fluid-electrolyte balance, and broad-spectrum antibiotics. Patients with severe colonic ischemia may require abdominal exploration and colectomy.

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Colonic ischemia

Abstract: Colonic ischemia is a common cause of lower abdominal pain and hemorrhage among the elderly typically occurring in the aftermath of an event which led to hypoperfusion of the colon. For most affected individuals the ischemia is reversible and clinical course benign.

Cited by 18 publications

References 58 publications

Probabilistic Prediction of Gastrointestinal Ischemia after Cardiothoracic Surgery

Probabilistic Prediction of Gastrointestinal Ischemia after Cardiothoracic Surgery

Novel Insights Into the Mechanisms of Abdominal Pain in Obstructive Bowel Disorders

The Colonic Single Stripe Sign: A Case of Ischemic Colitis

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