Local thrombolytic therapy in acute mesenteric ischemia

Abstract

BackgroundThe aim of the study was to evaluate the local thrombolytic therapy (LTT) in combination with laparoscopy, in management of acute mesenteric ischemia (AMI).MethodsFrom January 2000 to January 2010, patients who were admitted to the hospital with AMI due to acute arterial occlusion were analysed retrospectively. Patients presenting with acute abdomen with a suspicion of AMI were evaluated with computerized tomography angiography (CTA). Patients who had findigs of AMI on CTA, were underwent selective mesenteric angiography and LTT eventhough without peritoneal signs. LTT was carried out before or after laparoscopy or laparotomy, and initiated with recombinant plasminogen activator.ResultsLTT was performed in 13 (17.1%), out of 76 patients. From the remaining patients, 56 underwent necrotic bowel resection and 7 underwent tromboembolectomy. The median age was 62 years (45–87). The median duration of symptoms was 24 h. Four (30.7%) patients presented within 24 h onset of symptoms, whilst 9 (69.3%) patients presented after 24 h onset of symptoms. There were 5 (39.5%) patients, who presented with abdominal pain without peritoneal signs on physical examination and 8 (61.5%) patients, who had peritoneal signs. The mortality rate was 20% (1/5) in the first group who presented without peritoneal signs, whilst it was 62.5% (5/8) in the remaining.ConclusionEarly intervention in AMI is the key to better results. CTA combined with early laparoscopy and LTT may have beneficial effects at this setting.

TLR2 Modulates Antibodies Required for Intestinal Ischemia/Reperfusion-Induced Damage and Inflammation

“…Although the mortality rate for mesenteric ischemia/reperfusion (IR) has decreased in recent years, it remains at 40–60% (1, 2). Cellular damage induced by the lack of blood flow to the intestine (mesenteric ischemia) is significantly enhanced upon return of blood flow (reperfusion) and frequently results in systemic inflammation.…”

Morel-Lavallée lesion in a 12-month-old child: A case report and literature review

“…Morel Lavallée lesions occur mostly in young adults in their 30 s to 40 s probably reflecting the age distribution of trauma [ 12 ]. The condition is infrequently described in children and in 2013, Rha et al published a case report of Morel-Lavallée lesion in a 28-month-old child and reviewed the paediatric cases up to that time [ 12 ]. In 2013 their case was the youngest reported [ 12 ].…”

“…The condition is infrequently described in children and in 2013, Rha et al published a case report of Morel-Lavallée lesion in a 28-month-old child and reviewed the paediatric cases up to that time [ 12 ]. In 2013 their case was the youngest reported [ 12 ]. Since then more cases have been added to the medical literature including in a 20-month-old child [ 13 ].…”

Venous acute disturbance of mesenteric circulation: diagnosis and treatment

“…Ряд авторов предлагают лапароскопию как метод контроля эффективности тромболитической терапии [68,83]. Энтеростомия как вариант завершения исходной лапаротомии предложена K. Liu и соавт.…”