Diagnosis of non-occlusive acute mesenteric ischemia in the intensive care unit

Abstract

BackgroundNon-occlusive mesenteric ischemia (NOMI) is a common complication and accounts for a major cause of death in critically ill patients. The diagnosis of NOMI with respect to the eventual indications for surgical treatment is challenging. We addressed the performance of the diagnostic strategy of NOMI in the intensive care unit, with emphasis on contrast-enhanced abdominal CT-scan.MethodsThis was a retrospective monocenter study. Patients with clinically suspected acute mesenteric ischemia were included if a comprehensive diagnostic workup was carried out including surgical and/or endoscopic digestive explorations. Patients with evidence of occlusive mesenteric ischemia were excluded. A definite diagnosis of NOMI only relied on surgical or endoscopic findings. Abdominal CT-scans were reviewed by two radiologists blinded from the final diagnosis.ResultsA diagnosis of NOMI could be definitely confirmed or ruled out through surgical or endoscopic explorations of the digestive tract in 147 patients. With respect to their clinical characteristics, only a history of atrial fibrillation was an independent predictor of NOMI (odds ratio 8.3, 95% confidence interval 2.0–35.2, p = 0.004). Among them, 114 patients (75 with and 39 without NOMI) had previously been subjected to contrast-enhanced abdominal CT-scan. Portal venous gas, pneumatosis intestinalis and, to a lesser extent, abnormal contrast-induced bowel wall enhancement were poorly sensitive, but exhibited good specificities of 95, 85 and 71%, respectively. Nineteen out of 75 patients (25.3%) without any suggestive radiological signs finally exhibited mesenteric ischemia, including ten with intestinal necrosis.ConclusionsThe performance of abdominal CT-scan for the diagnosis of NOMI is limited. Radiological signs of advanced-stage ischemia are good predictors of definite mesenteric ischemia, while their absence should not be considered sufficient to rule out the diagnosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0213-x) contains supplementary material, which is available to authorized users.

A strategy for improving the prognosis of non‐occlusive mesenteric ischemia (NOMI): a single‐center observational study

“…First, we found that CT findings of intestinal pneumatosis could be a potential prognostic factor for survival outcome in patients with NOMI. The reports to date have indicated that CT findings are important for diagnosing NOMI, but few reports have stated that CT findings are a prognostic factor . We suggest that intestinal pneumatosis is an early CT finding of irreversible NOMI and we know the general condition of the patient can deteriorate after the time through our cases.…”

Role of Serum Lactic Acid Level in Diagnosing Mesenteric Bowel Ischemia With the Aid of the Ct Angiogram.

“…(Table 10) Pearson correlation showed non-significant positive correlation between lactic acid and age. Discussion: -AMI consists of two varied pathophysiological existence diagnostic & treatment , while the treatment consist of instrumental arterial reperfusion and resection of necrotic bowel segments, still the diagnosis had several challenges & difficulties due to the fact that patients could be admitted to the ER without specific symptoms of abdominal pain , (2,10) In two thirds of the cases the cause of intestinal ischemia were "arterial embolism or thrombosis with blood flow impairment in the superior mesenteric artery (SMA) distribution affecting all or portions of the small bowel and right colon" which increase CT-scandisparity ,…”

Cholesterol Crystal Embolism as the Reason of Acute Non-Occlusive Mesenteric Ischemia After Infrarenal Aortic Aneurism Repair

“…Больная М., 69 лет, с диагнозом: АИСА диаметром 5 см (рис. 4,5). Выполнены резекция аневризмы с внутримешковым бифуркационным протезированием до подвздошных артерий и имплантация НБА в протез.…”

“…На 3-и сутки в связи с развитием перитонита, обусловленного некрозом терминального отдела подвздошной и восходящей ободочной кишки без [1,9,10]. По данным литературы, ОННМК после резекции АИСА встречается в 0,2-1 % случаев [10,16], является трудно диагностируемым, смертельно опасным осложнением с плохим прогнозом и летальностью, достигающей в ряде наблюдений 100 % [3,4].…”

“…5. МСКТ-ангиография больной М., 69 лет начала, хирургическое лечение, что делает особенно актуальной раннюю диагностику этого осложнения, позволяющую в срок выполнить резекцию пораженного участка кишки до развития перитонита и перфорации [4,17]. Имеются данные, что задержка в выполнении экстренной операции на сутки увеличивает летальность на 20 % [17].…”