Mesenteric ischemia: a radiologic perspective

Sinha, Dimpi; Kale, Sudhir; Kundaragi, Nischal G; Sharma, Sukrity

doi:10.1007/s00261-020-02867-y

Cited by 13 publications

(8 citation statements)

References 42 publications

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“…PI is a frequent finding in abdominal CT, but its presence is rather unspecific [1][2][3] and the prognostic value of this sign on CT is not yet clearly defined. Our study evaluated predictors of short-term mortality in patients in whom there was a clinical suspicion of mesenteric ischemia and in whom PI was found in CT.…”

Section: Discussionmentioning

confidence: 99%

“…The high utilization rate of CT imaging in patients with suspected mesenteric ischemia and, along with this, the frequent finding of PI causes a dilemma, since the presence of PI alone is not helpful in guiding further treatment [1][2][3][4]. Greenstein et al [16] and Wayne et al [17] proposed management algorithms for patients with PI having the aim to divide patients into those requiring surgery and those who do not.…”

Section: Discussionmentioning

confidence: 99%

“…CT typically demonstrates a low density linear and/or bubbly pattern of gas within the bowel wall, which can be readily diagnosed with CT due to its high spatial resolution and multiplanar reformation capabilities [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

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Pneumatosis intestinalis in abdominal CT: predictors of short-term mortality in patients with clinical suspicion of mesenteric ischemia

et al. 2022

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Purpose Pneumatosis intestinalis (PI) in the bowel wall demonstrated in computed tomography (CT) of the abdomen is unspecific and its prognostic relevance remains poorly understood. The purpose of this study was to identify predictors of short-term mortality in patients with suspected mesenteric ischemia who were referred to abdominal CT and showed PI. Methods In this retrospective, IRB-approved, single-centre study, CT scans and electronic medical records of 540 patients who were referred to abdominal CT with clinical suspicion of mesenteric ischemia were analysed. 109/540 (20%) patients (median age 66 years, 39 females) showed PI. CT findings were correlated with surgical and pathology reports (if available), with clinical and laboratory findings, and with patient history. Short-term outcome was defined as survival within 30 days after CT. Results PI was found in the stomach (n = 6), small bowel (n = 65), and colon (n = 85). Further gas was found in mesenteric (n = 54), portal (n = 19) and intrahepatic veins (n = 36). Multivariate analysis revealed that PI in the colon [odds ratio (OR) 2.86], elevated blood AST levels (OR 3.00), and presence of perfusion inhomogeneities in other abdominal organs (OR 3.38) were independent predictors of short-term mortality. Surgery had a positive effect on mortality (88% lower likelihood of mortality), similar to the presence of abdominal pain (65% lower likelihood). Conclusions Our study suggests that in patients referred for abdominal CT with clinical suspicion of mesenteric ischemia, location of PI in the colon, elevation of blood AST, and presence of perfusion inhomogeneities in parenchymatous organs are predictors of short-term mortality. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pneumatosis intestinalis in abdominal CT: predictors of short-term mortality in patients with clinical suspicion of mesenteric ischemia

et al. 2022

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“…Since early intervention is crucial for the prognosis of MI, MI needs to be diagnosed early, which can be challenging[ 5 ]. When MI is suspected to exist, it can usually be diagnosed on the basis of gastrointestinal signs and symptoms combined with ischemic changes such as exudate and thickening of the intestinal wall on abdominal and bowel CT scans or direct vascular computed tomography angiography (CTA) scans in response to vascular blood flow[ 6 , 7 ]. It is also important to note that other diseases such as appendicitis, gastroduodenal perforation, and acute pancreatitis still need to be ruled out when MI is complicated by acute abdominal conditions such as vomiting of coffee-like contents, bloody stools, or signs of peritoneal irritation.…”

Section: Discussionmentioning

confidence: 99%

Concealed mesenteric ischemia after total knee arthroplasty: A case report

Zhang

et al. 2021

WJCC

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BACKGROUND In critical care medicine, mesenteric ischemia (MI) is a life-threatening disease that can be present in both critically ill patients and those undergoing major surgery. For the first time, we report a case of concealed MI with a long course after knee arthroplasty. CASE SUMMARY A male patient underwent left total knee arthroplasty for gouty arthritis and developed a persistent fever and persistently high levels of serum infection markers after surgery. He was considered to have a periprosthetic site infection and treated with antibiotics and colchicine, periprosthetic debridement was performed, and the spacer was replaced, but no improvement was seen. At 54 d after arthroplasty, the patient developed gastrointestinal symptoms of nausea and vomiting, abdominal distention, and subsequently, cloudiness of consciousness, and hypotensive shock. Finally, the patient was diagnosed with ascending colonic mesentery ischemia with necrosis after laparotomy, which improved after right hemicolectomy. CONCLUSION Concealed MI without gastrointestinal symptoms after major surgery is rare and easily misdiagnosed. Orthopedic surgeons need to be aware of this complication.

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“…When splanchnic vasoconstriction lasts more than 30 min, it is irreversible even after total reestablishment of the arterial blood flow [36]. NOMI patients usually present with sudden-onset abdominal pain, abdominal The prognosis of patients with NOMI is unfavorable because their symptoms are usually masked by sedatives and/or analgesics [37].…”

Section: Non-occlusive Mesenteric Ischemiamentioning

confidence: 99%

Understanding CT imaging findings based on the underlying pathophysiology in patients with small bowel ischemia

et al. 2022

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Because acute small bowel ischemia has a high mortality rate, it requires rapid intervention to avoid unfavorable outcomes. Computed tomography (CT) examination is important for the diagnosis of bowel ischemia. Acute small bowel ischemia can be the result of small bowel obstruction or mesenteric ischemia, including mesenteric arterial occlusion, mesenteric venous thrombosis, and non-occlusive mesenteric ischemia. The clinical significance of each CT finding is unique and depends on the underlying pathophysiology. This review describes the definition and mechanism(s) of bowel ischemia, reviews CT findings suggesting bowel ischemia, details factors involved in the development of small bowel ischemia, and presents CT findings with respect to the different factors based on the underlying pathophysiology. Such knowledge is needed for accurate treatment decisions.

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Mesenteric ischemia: a radiologic perspective

Cited by 13 publications

References 42 publications

Pneumatosis intestinalis in abdominal CT: predictors of short-term mortality in patients with clinical suspicion of mesenteric ischemia

Pneumatosis intestinalis in abdominal CT: predictors of short-term mortality in patients with clinical suspicion of mesenteric ischemia

Concealed mesenteric ischemia after total knee arthroplasty: A case report

Understanding CT imaging findings based on the underlying pathophysiology in patients with small bowel ischemia

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