Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence

Abstract

Acute mesenteric ischemia (AMI) is a severe condition associated with poor prognosis, ultimately leading to death due to multiorgan failure. Several mechanisms may lead to AMI, and non-occlusive mesenteric ischemia (NOMI) represents a particular form of AMI. NOMI is prevalent in intensive care units in critically ill patients. In NOMI management, promptness and accuracy of diagnosis are paramount to achieve decisive treatment, but the last decades have been marked by failure to improve NOMI prognosis, due to lack of tools to detect this condition. While real-life diagnostic management relies on a combination of physical examination, several biomarkers, imaging, and endoscopy to detect the possibility of several grades of NOMI, research studies only focus on a few elements at a time. In the era of artificial intelligence (AI), which can aggregate thousands of variables in complex longitudinal models, the prospect of achieving accurate diagnosis through machine-learning-based algorithms may be sought. In the following work, we bring you a state-of-the-art literature review regarding NOMI, its presentation, its mechanics, and the pitfalls of routine work-up diagnostic exams including biomarkers, imaging, and endoscopy, we raise the perspectives of new biomarker exams, and finally we discuss what AI may add to the field, after summarizing what this technique encompasses.

Artificial intelligence model validation before its application in clinical diagnosis assistance

“…After studying the interesting article “Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence” by Bourcier et al [ 1 ], who analyzed the current state of artificial intelligence (AI) in assisting clinical diagnosis and its possible application in diagnosing nonocclusive mesenteric ischemia, we are in full agreement with the AI techniques that the authors mention. However, a greater emphasis on the evaluation process for AI models could yield better results; when a rigorous testing stage is lacking, these models show poor performance upon transfer from the laboratory to real practice.…”

Methamphetamine-Induced Bowel Ischemia in a 50-Year-Old Male

“…Right-sided colonic involvement has been associated with an increased need for surgical intervention and greater mortality. Early detection of bowel ischemia is critical for patient outcomes, and computed tomography is a frequently used modality for diagnosis [ 13 , 14 ]. A study by Nakamura et al found that pneumatosis intestinalis on CT imaging may represent a harbinger of irreversible bowel ischemia necessitating early exploratory laparotomy for definitive diagnosis [ 15 ].…”

An Autopsy Case of Nonocclusive Mesenteric Ischemia with Bilateral Renal Artery Vasoconstriction

“…An important issue arises from the clinical course of our patient. The actual pathophysiology of NOMI remains unknown [ 3 ]; however, NOMI may occur simultaneously with renal vasoconstriction, which indicates a shared mechanism between these 2 conditions.…”

“…Nonocclusive mesenteric ischemia (NOMI) is a mesenteric circulatory disorder defined as diffuse intestinal ischemia in the presence of a patent arterial trunk [ 1 ]. Patients with NOMI account for 20–30% of patients with acute mesenteric ischemia, and NOMI has a mortality rate of 50–80% [ 2 , 3 ]. Elderly patients with NOMI should undergo multidisciplinary disease management, and surgery should always be pursued [ 4 , 5 ].…”