Mesenteric Ischemia

Williams, Lester F.

doi:10.1016/s0039-6109(16)44481-6

Cited by 81 publications

(21 citation statements)

References 41 publications

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“…Older patients (≥70 years of age), as in the present case, have a 3.8-fold increased risk of mortality compared to those less than 70 years old (3). Some of these elderly patients as well as the present case have atypical presentations, and sometimes they are confused and unable to articulate their complaints, thus making them tend to seek medical attention late in the course of the disease (22). Risk factors for MVT can be divided into three main groups: direct injury, local venous congestion or stasis, and thrombophilia (17).…”

Section: Discussionmentioning

confidence: 75%

Fatal Acute Hemorrhagic Bowel Infarction Caused by Mesenteric Venous Thrombosis

Srettabunjong

2017

Journal of Forensic Sciences

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Acute mesenteric venous thrombosis (MVT) is a rare, but life-threatening medical phenomenon. MVT is normally characterized by insidious onset, with nonspecific signs and symptoms. A high index of clinical suspicion is required for diagnosis, and emergency surgery is necessary to optimize the chances of patient survival, especially in the people aged more than 70 years. Surprisingly, based on my review of the literature, no fatal acute MVT case has been reported in the forensic literature. All reported such cases have been documented in medical literature, and most of them have been associated with underlying risk factors for venous thrombosis, such as hypercoagulable state, certain cancers, and stasis of the blood flow. Here, I report the case of a sudden unexpected death due to extensive intestinal ischemia and infarction with massive abdominal hemorrhage caused by acute MVT in a 72-year-old man without known underlying risk factors.KEYWORDS: forensic science, forensic pathology, embolism, intestinal gangrene, vascular occlusion, medico-legal death, sudden unexpected death, thrombosis Mesenteric ischemia (MI) arises from a highly complex heterogeneous group of disorders that result in insufficient blood supply to the intestine, causing extensive irreversible bowel infarction and eventual death. Although a rarely occurring event, MI is a lifethreatening condition that is well understood among physicians who treat patients with acute abdominal disorders. A highly lethal condition that is difficult to diagnose, only one-third of patients with acute mesenteric ischemia (AMI) were correctly identified before surgical intervention or death (1,2). AMI requires emergency surgical treatment, with mortality rates that range from 60% to 80% (3,4). Avoiding delay in diagnosis and treatment remains the greatest challenge to reducing the high mortality rate associated with this condition (5). Surprisingly, based on my review of the literature, no such case has been reported in the forensic literature. All reported such cases have been documented in the medical literature, and most of them have been associated with underlying risk factors for venous thrombosis, such as hypercoagulable state, certain cancers, and stasis of the blood flow. Here, I report the case of a sudden unexpected death due to AMI with massive abdominal hemorrhage caused by acute mesenteric venous thrombosis in a 72-year-old man without known underlying risk factors. Case ReportA 72-year-old man was found dead lying on a sofa in his house by his wife and son who had returned home in the evening. According to information obtained from the deceased's relatives, the deceased was diagnosed with hypertension 5 years earlier and he irregularly complied with his prescribed antihypertensive therapy. Approximately 3 days before his death, he complained of intermittent abdominal discomfort and pain. He was not able to eat food as usual, and he had occasional nausea, vomiting, and diarrhea. He as well as his family, had no significant previous medical histo...

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Section: Discussionmentioning

confidence: 75%

Fatal Acute Hemorrhagic Bowel Infarction Caused by Mesenteric Venous Thrombosis

Srettabunjong

2017

Journal of Forensic Sciences

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“…Splanchnic ischemia is a common clinical entity that may be caused by mechanical obliteration of flow in blood vessels (occlusive ischemia) or by critical secondary reduction in splanchnic organ blood flow (nonocclusive ischemia) (8,11,14,29,35). Occlusion of a large vessel (e.g., the SMA) may be due to emboli, thrombosis, or pressure by a tumor, an aneurysm, or surgical ligation.…”

Section: Discussionmentioning

confidence: 99%

“…In both groups the morbidity and mortality related to these processes are high. In adults, occlusive and nonocclusive conditions may reduce splanchnic blood flow (8,35 …”

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confidence: 99%

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Effects of hyperoxia on local and remote microcirculatory inflammatory response after splanchnic ischemia and reperfusion

Waisman¹,

Brod²,

Wolff³

et al. 2003

American Journal of Physiology-Heart and Circulatory Physiology

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. Effects of hyperoxia on local and remote microcirculatory inflammatory response after splanchnic ischemia and reperfusion. Am J Physiol Heart Circ Physiol 285: H643-H652, 2003. First published April 24, 2003 10.1152/ajpheart.00900.2002-Splanchnic ischemia-reperfusion (I/R) causes tissue hypoxia that triggers local and systemic microcirculatory inflammatory responses. We evaluated the effects of hyperoxia in I/R induced by 40-min superior mesenteric artery (SMA) occlusion and 120-min reperfusion in four groups of rats: 1) control (anesthesia only), 2) sham operated (all surgical procedures without vascular occlusion; air ventilation), 3) SMA I/R and air, 4) SMA I/R and 100% oxygen ventilation started 10 min before reperfusion. Leukocyte rolling and adhesion in mesenteric microvessels, pulmonary microvascular blood flow velocity (BFV), and macromolecular (FITC-albumin) flux into lungs were monitored by intravital videomicroscopy. We also determined pulmonary leukocyte infiltration. SMA I/R caused marked decreases in mean arterial blood pressure (MABP) and blood flow to the splanchnic and hindquarters vascular beds and pulmonary BFV and shear rates, followed by extensive increase in leukocyte rolling and adhesion and plugging of Ͼ50% of the mesenteric microvasculature. SMA I/R also caused marked increase in pulmonary sequestration of leukocytes and macromolecular leak with concomitant decrease in circulating leukocytes. Inhalation of 100% oxygen maintained MABP at significantly higher values (P Ͻ 0.001) but did not change regional blood flows. Oxygen therapy attenuated the increase in mesenteric leukocyte rolling and adherence (P Ͻ 0.0001) and maintained microvascular patency at values not significantly different from sham-operated animals. Hyperoxia also attenuated the decrease in pulmonary capillary BFV and shear rates, reduced leukocyte infiltration in the lungs (P Ͻ 0.001), and prevented the increase in pulmonary macromolecular leak (P Ͻ 0.001), maintaining it at values not different from sham-operated animals. The data suggest that beneficial effects of normobaric hyperoxia in splanchnic I/R are mediated by attenuation of both local and remote inflammatory microvascular responses. reperfusion injury; acute lung injury; reoxygenation injury; intravital videomicroscopy; multiorgan failure; systemic inflammatory response syndrome HYPOPERFUSION AND ISCHEMIA of the bowel is a common, important pathological process that affects adults and infants. In both groups the morbidity and mortality related to these processes are high. In adults, occlusive and nonocclusive conditions may reduce splanchnic blood flow (8,35

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“…The coils Figure 2. Diagram of setup for experiment 1. Through a midline laparotomy, a loop of ileum is isolated and the segmental mesenteric artery is dissected and encircled with a monofilament snare that is exteriorized.…”

Section: Methodsmentioning

confidence: 99%

Noninvasive Diagnosis of Mesenteric Ischemia Using a SQUID Magnetometer

Richards

Cl²,

Allos³

et al. 1995

Annals of Surgery

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ObjectiveThe authors assessed the ability of a Superconducting Quantum Interference Device (SQUID) magnetometer to noninvasively detect mesenteric ischemia in a rabbit model. Summary Background DataSuperconducting Quantum Interference Device magnetometers have been used to detect magnetic fields created by the basic electrical rhythm (BER) and to detect changes in BER of exteriorized bowel of anesthetized rabbits during mesenteric ischemia. MethodsThe BER of rabbit ileum was noninvasively measured transabdominally using a SQUID magnetometer and compared with the electrical activity recorded with surgically implanted serosal electrodes before, during, and after snare occlusion of the superior mesenteric artery. ResultsTransabdominal SQUID recording of BER frequency was highly correlated to the measurements obtained with electrodes (R = 0.91). Basic electrical rhythm frequency decreased from 16.4 0.8 to 8.3 ± 0.3 cpm (p < 0.001) after 25 minutes of ischemia. Reperfusion of ischemic bowel resulted in recovery of BER frequency to 14.3 ± 0.4 cpm 10 minutes after blood flow was restored. ConclusionsA SQUID magnetometer is capable of noninvasively detecting mesenteric ischemia reliably and at an early stage by detecting a significant drop in BER frequency. These positive findings have encouraged the authors to continue development of clinically useful, noninvasive, detection of intestinal magnetic fields using SQUID magnetometers. 696

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Mesenteric Ischemia

Cited by 81 publications

References 41 publications

Fatal Acute Hemorrhagic Bowel Infarction Caused by Mesenteric Venous Thrombosis

Fatal Acute Hemorrhagic Bowel Infarction Caused by Mesenteric Venous Thrombosis

Effects of hyperoxia on local and remote microcirculatory inflammatory response after splanchnic ischemia and reperfusion

Noninvasive Diagnosis of Mesenteric Ischemia Using a SQUID Magnetometer

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