Pathophysiology of Mesenteric Ischemia

Patel, Amit; Kaleya, Ronald; Sammartano, Robert J.

doi:10.1016/s0039-6109(16)45626-4

Cited by 102 publications

(54 citation statements)

References 20 publications

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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%

“…The resulting cellular hypoxia activates a variety of vascular and inflammatory mediator systems (e.g., eicosanoids, leukotrienes, PAF, reactive oxygen species, the complement system, cytokines, and adhesion molecules) that trigger adhesion, migration, and activation of WBC and increase vascular leakage with fluid and protein efflux from blood vessels culminating in severe local inflammatory response and SIR (4,11,21,29,39). Although reinstitution of blood flow to ischemic tissues is critical to their salvage, the reperfusion of ischemic splanchnic organs may paradoxically enhance the vascular and tissue inflammatory response initiated by the ischemia and even aggravate (at least temporarily) some of the manifestations of the ischemic damage (4,21,29,39).…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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“…However, when the necrosis reaches the muscular layer in transmural necrosis, more complications develop such as perforation or peritonitis. [1,2] In our experimental study, at 2nd hour, there were mucosal necrosis in all segments, yet submucosa and muscularis propria were found intact. However, beyond the 4th hour, major histopathological findings were transmural tissue necrosis and mucosal necrosis in wide areas, and intact mucosa were very scant.…”

Section: Figmentioning

confidence: 49%

“…An early diagnosis in bowel ischemia prevents the necrosis, while the elimination of the obstruction relieves the patient free of the risk for peritonitis that is triggered by the perforation of the intestinal wall. [1][2][3] The key is not to delay laparotomy unnecessarily. So that it is of great importance to find a specific and rapidly elevating marker.…”

mentioning

confidence: 99%

Correlation Of Biochemical Markers With Histopathological Findings In Experimental Strangulated Hernia

Peker¹,

Yıldız²,

Zeybek³

et al. 2009

TUTFD

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Objectives: This study was planned to evaluate whether possible changes in the hematological parameters and the biochemical markers can be used to detect obstruction-induced (strangulated) intestinal ischemia. Materials and Methods:Forty rats divided into five groups underwent the following procedures: Group 1 rats were treated with only laparotomy (sham-operated controls). To the strangulated hernia groups surgical induction of strangulated intestinal obstruction was performed. Tissue and blood samples were taken at 30 minutes (group 2), 2nd hour (group 3), 4th hour (group 4) and 6th hour (group 5) respectively, and then LDH, CPK, ALP, AST, ALT, D-dimer levels and blood cells counts were measured and histopathological examination was done.Results: Focal mucosal necrosis accompanied was confirmed by histological findings in the strangulated intestinal ischemia group after second hour. Serum D-dimer, ALT, ALP, CPK levels and neutrophil count became elevated at second hour, which was statistically significant. Conclusion:In patients with hernia, after reduction of the intestinal hernia, raised levels of serum D-dimer, ALT, ALP, CPK levels and neutrophil count may indicate the presence of a bowel ischemia. However, more comprehensive clinical studies are required to evaluate the potential survival benefit by using the laboratory tests as a marker and/or a useful diagnostic tool of the need for laparotomy.

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“…Moreover both tests require detorsion of the bowel and reperfusion of the bowel. Reperfusion of ischemic or gangrenous bowel can produce metabolic acidosis, intestinal bacterial and toxin translocation and possible irreversible septic shock (Patel A 1992, Zimmerman BJ 1992. Reperfusion of ischemic intestine results in extensive microvascular and parenchymal cell injury by release of proteases and physical disruption of the endothelial barrier resulting in eventual cell death (Zimmerman BJ 1992).…”

Section: General Considerations In Management Of Ischemic Gutmentioning

confidence: 99%

Gangrene of Large Bowel Due to Volvulus-Etiopathogenesis, Management and Outcome

Machado¹

2011

Gangrene - Current Concepts and Management Options

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Pathophysiology of Mesenteric Ischemia

Cited by 102 publications

References 20 publications

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

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

Correlation Of Biochemical Markers With Histopathological Findings In Experimental Strangulated Hernia

Gangrene of Large Bowel Due to Volvulus-Etiopathogenesis, Management and Outcome

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