Non-occlusive Mesenteric Ischemia after Splenic Metastasectomy for Small-Cell Lung Cancer

Yamane, Hiromichi; Fukuda, N.; Nishino, Ken; Yoshida, Kazuhiro; Ochi, Nobuaki; Yamagishi, Tomoko; Honda, Yoshihiro; Kawamoto, Hirofumi; Monobe, Yasumasa; Mimura, Hidefumi; Naomoto, Yoshio; Takigawa, Nagio

doi:10.2169/internalmedicine.54.3545

Cited by 8 publications

(6 citation statements)

References 13 publications

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“…3,4 Case reports and small retrospective case series described the occurrence of NOMI especially after cardiac surgery 5 –10 and heart failure 6,11 but also in a variety of other acute critical illnesses. 11 –24…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Analysis of Nonocclusive Mesenteric Ischemia in Medical and Surgical ICU Patients: Clinical Data on Demography, Clinical Signs, and Survival

Stahl

Busch

Maschke

et al. 2019

J Intensive Care Med

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Background: To analyze demography, clinical signs, and survival of intensive care patients diagnosed with nonocclusive mesenteric ischemia (NOMI) and to evaluate the effect of a local intra-arterial prostaglandin therapy. Methods: Retrospective observational study screening 455 intensive care patients with acute arterial mesenteric perfusion disorder in a tertiary care hospital within the past 8 years. Lastly, 32 patients with NOMI were enrolled, of which 11 received local intra-arterial prostaglandin therapy. The diagnosis of NOMI was based on the clinical presentation and established biphasic computed tomography criteria. Clinical and biochemical data were obtained 24 hours before, at the time, and 24 hours after diagnosis. Results: Patients were 60.5 (49.3-73) years old and had multiple comorbidities. Most of them were diagnosed with septic shock requiring high doses of norepinephrine (NE: 0.382 [0.249-0.627] μg/kg/min). The Sequential Organ Failure Assessment (SOFA) score was 18 (16-20). A decrease in oxygenation (Pao2/Fio2), pH, and bicarbonate and an increase in international normalized ratio, lactate, bilirubin, leucocyte count, and NE dose were early indicators of NOMI. Median SOFA score significantly increased in the last 24 hours before diagnosis of NOMI (16 vs 18, P < .0001). Overall, 28-day mortality was 75% (81% nonintervention vs 64% intervention cohort; P = .579). Median SOFA scores 24 hours after intervention increased by +5% in the nonintervention group and decreased by 5.5% in the intervention group ( P = .0059). Conclusions: Our data suggest that NOMI is a detrimental disease associated with progressive organ failure and a high mortality. Local intra-arterial prostaglandin application might hold promise as a rescue treatment strategy. These data encourage future randomized controlled trials are desirable.

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Section: Introductionmentioning

confidence: 99%

A Retrospective Analysis of Nonocclusive Mesenteric Ischemia in Medical and Surgical ICU Patients: Clinical Data on Demography, Clinical Signs, and Survival

Stahl

Busch

Maschke

et al. 2019

J Intensive Care Med

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“…2 Multiple case reports and small case series described the occurrence of NOMI after cardiac surgery, [3][4][5][6][7][8] heart failure, 4,9 and a variety of heterogeneous acute critical illnesses. [9][10][11][12][13][14][15][16][17][18][19][20][21][22] Risk factors for NOMI appear to be older age as well as cardiovascular and/or chronic kidney disease (CKD) and it occurs especially in situations after major surgery, sepsis, and shock requiring vasopressor therapy. 23,24 Nonocclusive mesenteric ischemia is often only diagnosed in advanced stages of extensive intestinal necrosis, 24 leading to a devastating mortality rate up to 90% that has not changed over the past decades.…”

Section: Introductionmentioning

confidence: 99%

Nonocclusive Mesenteric Ischemia and Interventional Local Vasodilatory Therapy: A Meta-Analysis and Systematic Review of the Literature

Stahl

Rittgerodt

Busch

et al. 2019

J Intensive Care Med

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Background: Intensive care patients with nonocclusive mesenteric ischemia (NOMI) show mortality rates of 70% to 90%. Besides emergency surgery, different interventional local vasodilatory treatment (LVT) attempts have been described. We performed a systematic review and a meta-analysis to evaluate feasibility, efficacy, and tolerability of LVT in patients with life-threatening NOMI. Methods: Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed until February 2019. Measured outcomes included immediate technical success rates (as indicated by mesenteric vasodilation on angiography or clinical improvement) and adverse events (AEs). Therapeutic efficacy was measured by the assessment of overall mortality. Results: Twelve studies (335 patients, 245 received LVT) from 1977 to 2018 were included. All studies were retrospective (4 comparative and 8 noncomparative). Different intra-arterial vasodilators (4× papaverine, 6× prostaglandin E1, 1× tolazoline/heparin, 1× tolazoline + iloprost) were reported. Initial technical success rate was 75.9% (95% confidence interval [CI], 55.1%-89%, P = .017) with an AE rate of 2.9% (95% CI: 1.3%-6.6%; P = .983). Overall mortality in LVT patients was 40.3% (95% CI: 28.7%-53%, P = .134). In 4 studies, outcomes were compared between patients receiving LVT to those who received standard of care (odds ratio for death in LVT patients was 0.261 [95% CI: 0.095-0.712, P = .009]). Conclusions: Local vasodilatory treatment appears to be safe in patients with NOMI and might have the potential to at least partially reverse mesenteric vasoconstriction features in control angiographies. However, with no randomized and prospective studies available yet, the overall quality of published studies has to be considered as low; therefore, it is not possible to draw generalizable conclusions from the present data concerning clinical end points. Its application might hold promise as a rescue treatment strategy and deserves further evaluation in randomized controlled trials.

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“…1,2) Solitary splenic metastasis is extremely rare and only 31 cases have been reported previously. [3][4][5] The spleen is relatively resistant to metastatic seeding. Immune cells that play a role in immune surveillance are present in high density in the spleen, help to eliminate the cancer cells before they proliferate, and because of high concentration of antiangiogenic factors, the spleen creates an environment that is not advantageous to the growth of metastatic cancer cells.…”

Section: Discussionmentioning

confidence: 99%

Solitary Splenic Metastasis of Lung Cancer Presenting as Benign Cystic Disease

Matsuoka

Yamada

Matsuoka

et al. 2021

ATCS

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Solitary splenic metastasis from primary lung cancer is extremely rare. Here, we demonstrated a solitary splenic metastasis of primary lung cancer that was difficult to distinguish from benign cystic disease. A 69-year-old-female was diagnosed as middle lobe lung cancer. Although preoperative abdominal computed tomography (CT) demonstrated a low-density splenic nodule, fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed no fluorodeoxyglucose uptake in the splenic nodule. Therefore, the nodule was diagnosed as benign cystic disease and middle lobe lobectomy was performed. Postoperative pathologic examination demonstrated papillary-predominant adenocarcinoma with mucin, and the tumor was diagnosed as primary lung cancer. However, the splenic nodule continued to increase postoperatively. Splenectomy was undergone 30 months after the pulmonary resection and the splenic tumor was diagnosed as the splenic metastasis of lung cancer. In the 24 months since the splenectomy, no recurrence has been observed in the absence of treatment. Splenectomy was an effective treatment for solitary splenic metastasis of lung cancer in this case. FDG uptake in the splenic tumor was not evident due to marked mucus production.

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Non-occlusive Mesenteric Ischemia after Splenic Metastasectomy for Small-Cell Lung Cancer

Cited by 8 publications

References 13 publications

A Retrospective Analysis of Nonocclusive Mesenteric Ischemia in Medical and Surgical ICU Patients: Clinical Data on Demography, Clinical Signs, and Survival

A Retrospective Analysis of Nonocclusive Mesenteric Ischemia in Medical and Surgical ICU Patients: Clinical Data on Demography, Clinical Signs, and Survival

Nonocclusive Mesenteric Ischemia and Interventional Local Vasodilatory Therapy: A Meta-Analysis and Systematic Review of the Literature

Solitary Splenic Metastasis of Lung Cancer Presenting as Benign Cystic Disease

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