Contrast-Enhanced CT for the Diagnosis of Acute Mesenteric Ischemia

Garzelli, Lorenzo; Nuzzo, Alexandre; Copin, P.; Calame, Paul; Corcos, Olivier; Vilgrain, Valérie; Ronot, Maxime

doi:10.2214/ajr.19.22625

Cited by 45 publications

(80 citation statements)

References 85 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In group 1, the most common specific cause of bowel ischaemia was non-occlusive mesenteric ischaemia (7/15, 47%). The high ability of enhanced CT to detect bowel ischaemia in PI patients was verified, as previously demonstrated, 7,22 in light of our finding that among 41 patients undergoing enhanced CT on admission, all nine patients showing bowel wall attenuation had ischaemia. Meanwhile, in PI patients undergoing non-enhanced CT on admission (n = 23), abdominal pain, elevated CRP, WBC and NLR, and the presence of ascites and/or free air were still more likely to be associated with bowel ischaemia (Table S1).…”

Section: Categorization Of Patients' Characteristics On the Basis Of The Presence Of Bowel Ischaemiasupporting

confidence: 84%

Clinical characteristics of patients with pneumatosis intestinalis

Fujii

Yamashita

Tashiro

et al. 2021

ANZ Journal of Surgery

View full text Add to dashboard Cite

Background: Several theories explaining the development of pneumatosis intestinalis (PI) have been reported, but a substantial portion of cases have been idiopathic. Additionally, predictors of bowel ischaemia in PI have not been fully investigated, while PI with bowel ischaemia has deteriorated overall outcomes of PI. Methods: Sixty-four patients diagnosed with PI (2009-2019) were allocated to two groups: with (group 1; n = 15 (23%)) and without (group 2; n = 49 (77%)) bowel ischaemia. Fourteen patients underwent emergency surgery, and bowel ischaemia was identified in nine (64%). Six patients in group 1 were diagnosed with bowel ischaemia, and were treated palliatively. On medical charts, we determined underlying conditions of PI, compared the characteristics and outcomes between the groups, and identified the predictors of bowel ischaemia. Results: Group 1 patients more commonly showed abdominal pain, lower base excess, higher C-reactive protein concentrations, higher white blood cell counts and higher neutrophil-to-lymphocyte ratios, and more frequent comorbid ascites, free air and hepatic portal vein gas. Of nine bowel ischaemia surgery patients, three (33%) died; all because of anastomotic leak. All except three patients in group 2, who presented with aspiration pneumonia, responded to treatment. Only one patient had an unknown cause (1/64, 1.6%), and various underlying conditions in secondary PI were confirmed. Conclusion: Idiopathic PI may be identified rarely using current imaging and knowledge, but outcomes in PI patients with bowel ischaemia remain unsatisfactory. Earlier identification of bowel ischaemia by various specialists in accordance with predictors of bowel ischaemia could improve overall outcomes in PI patients.

show abstract

Section: Categorization Of Patients' Characteristics On the Basis Of The Presence Of Bowel Ischaemiasupporting

confidence: 84%

Clinical characteristics of patients with pneumatosis intestinalis

Fujii

Yamashita

Tashiro

et al. 2021

ANZ Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…A multiphase phase CT is the modality of choice;classically this is a dual phase examination, with arterial and portal venous phases. The addition of an unenhanced scan is beneficial as unenhanced bowel hyperdensity is highly specific of ischaemia[361] and improves sensitivity, diagnostic confidence and interobserver agreement[362]. Findings on CT depend on the underlying cause of AMI, whether it is arterial, venous or NOMI; however, reduced bowel wall enhancement has high sensitivity[363], with appreciable inter-reader agreement of CT features of AMI[364].Intravenous contrast increases diagnostic accuracy.…”

mentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

et al. 2021

View full text Add to dashboard Cite

Aim There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence‐based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. Methods Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology‐based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence‐based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. Results All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. Conclusion These guidelines provide an up to date and evidence‐based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.

show abstract

“…A split bolus technique allows a single-phase acquisition by dividing the contrast dose with a timed delay. [3] It has the advantage of lower radiation doses. Speci c signs of bowel ischemia include lack of bowel wall enhancement, pneumatosis intestinalis, gas in the portal vein, and pneumoperitoneum.…”

Section: Discussionmentioning

confidence: 99%

Post-traumatic hollow viscus perforation with mesenteric and bowel ischemia

Prasad

2021

Preprint

View full text Add to dashboard Cite

BackgroundHollow viscus perforation and acute mesenteric ischemia are life-threatening conditions that must be recognized and managed appropriately. Computed tomography (CT) helps to visualize the bowel wall directly, as well as in the timely diagnosis of secondary signs of bowel ischemia.Case PresentationA young male presented with blunt trauma to the upper abdomen. A supine radiograph was suspicious of pneumoperitoneum and CT was performed to rule out perforation. The above finding was confirmed on CT, in addition, lack of enhancement of a segment of colon and non-occlusive mesenteric ischemia was evident. He was managed with exploratory laparotomy and repair of the perforation with partial colectomy.ConclusionsThe radiologist should be familiar with signs of pneumoperitoneum on supine radiographs for detection of hollow viscus perforation. These must be viewed with an index of high suspicion in symptomatic patients, post-trauma, and, further cross-sectional imaging may still be required.

show abstract

Contrast-Enhanced CT for the Diagnosis of Acute Mesenteric Ischemia

Cited by 45 publications

References 85 publications

Clinical characteristics of patients with pneumatosis intestinalis

Clinical characteristics of patients with pneumatosis intestinalis

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

Post-traumatic hollow viscus perforation with mesenteric and bowel ischemia

Contact Info

Product

Resources

About