Survival in Nonocclusive Mesenteric Ischemia

Mitsuyoshi, Akira; Obama, Kazutaka; Shinkura, Nobuhiko; Ito, Takashi; Zaima, Masazumi

doi:10.1097/01.sla.0000263157.59422.76

Cited by 173 publications

(86 citation statements)

References 8 publications

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“…Regardless of the underlying ischemic process, occlusive or non-occlusive, the prognosis of AMI is poor as the overall mortality rate may reach 80% in most published cohorts [3, 16–18]. Leone and colleagues provided reliable prognostic data for AMI in an impressive multicenter series of 780 cases [4].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of non-occlusive acute mesenteric ischemia in the intensive care unit

Bourcier

Oudjit

Goudard

et al. 2016

Ann. Intensive Care

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BackgroundNon-occlusive mesenteric ischemia (NOMI) is a common complication and accounts for a major cause of death in critically ill patients. The diagnosis of NOMI with respect to the eventual indications for surgical treatment is challenging. We addressed the performance of the diagnostic strategy of NOMI in the intensive care unit, with emphasis on contrast-enhanced abdominal CT-scan.MethodsThis was a retrospective monocenter study. Patients with clinically suspected acute mesenteric ischemia were included if a comprehensive diagnostic workup was carried out including surgical and/or endoscopic digestive explorations. Patients with evidence of occlusive mesenteric ischemia were excluded. A definite diagnosis of NOMI only relied on surgical or endoscopic findings. Abdominal CT-scans were reviewed by two radiologists blinded from the final diagnosis.ResultsA diagnosis of NOMI could be definitely confirmed or ruled out through surgical or endoscopic explorations of the digestive tract in 147 patients. With respect to their clinical characteristics, only a history of atrial fibrillation was an independent predictor of NOMI (odds ratio 8.3, 95% confidence interval 2.0–35.2, p = 0.004). Among them, 114 patients (75 with and 39 without NOMI) had previously been subjected to contrast-enhanced abdominal CT-scan. Portal venous gas, pneumatosis intestinalis and, to a lesser extent, abnormal contrast-induced bowel wall enhancement were poorly sensitive, but exhibited good specificities of 95, 85 and 71%, respectively. Nineteen out of 75 patients (25.3%) without any suggestive radiological signs finally exhibited mesenteric ischemia, including ten with intestinal necrosis.ConclusionsThe performance of abdominal CT-scan for the diagnosis of NOMI is limited. Radiological signs of advanced-stage ischemia are good predictors of definite mesenteric ischemia, while their absence should not be considered sufficient to rule out the diagnosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0213-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of non-occlusive acute mesenteric ischemia in the intensive care unit

Bourcier

Oudjit

Goudard

et al. 2016

Ann. Intensive Care

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“…These patients may have non-specific symptoms that can range from abdominal pain and nausea to ileus. Other predisposing factors include trauma, cocaine use, ergot ingestion, digoxin, alpha-adrenergic medications, cardiac failure, myocardial infarction, abdominal surgery, and aortic insufficiency (11-13). …”

Section: Acute Mesenteric Ischemiamentioning

confidence: 99%

Radiological Evaluation of Bowel Ischemia

Dhatt

Behr

Miracle

et al. 2015

Radiologic Clinics of North America

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Intestinal ischemia, which refers to insufficient blood flow to the bowel, is a potentially catastrophic entity that may require emergent intervention or surgery in the acute setting. Although the clinical signs and symptoms of intestinal ischemia are nonspecific, CT findings can be highly suggestive in the correct clinical setting. In this chapter we review the CT diagnosis of arterial, venous, and non-occlusive intestinal ischemia. We discuss the vascular anatomy, pathophysiology of intestinal ischemia, CT techniques for optimal imaging, key and ancillary radiological findings, and differential diagnosis. In the setting of an acute abdomen, rapid evaluation is necessary to identify intraabdominal processes that require emergent surgical intervention (1). While a wide-range of intraabdominal diseases may be present from trauma to inflammation, one of the most feared disorders is mesenteric ischemia, also known as intestinal ischemia, which refers to insufficient blood flow to the bowel (2). Initial imaging evaluation for intestinal ischemia is typically obtained with CT. Close attention to technique and search for key radiologic features with relation to the CT technique is required. Accurate diagnosis depends on understanding the vascular anatomy, epidemiology, and pathophysiology of various forms of mesenteric ischemia and their corresponding radiological findings on MDCT. At imaging, not only is inspection of the bowel itself important, but evaluation of the mesenteric fat, vasculature, and surrounding peritoneal cavity also helps improves accuracy in the diagnosis of bowel ischemia.

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“…In 1977, Boley demonstrated that the selective injection of papaverine into the SMA could relieve mesenteric vasoconstriction [3]. In addition, several reports have suggested the benefit of vasodilator therapy [2], [3], [5], [6], [7], [8] and one study concluded that selective mesenteric angiography with continuous vasodilator infusion was a simple, fast, and effective diagnostic and therapeutic tool to reduce the need for laparotomy [5]. Appropriate dosage levels for this therapy are not well established and in this case a lower dose than optimal was administered.…”

Section: Discussionmentioning

confidence: 99%

Delayed intestinal stenosis of nonocclusive mesenteric ischemia after autologous blood collection: A case report

Arima¹,

Omura²,

Hattori³

et al. 2016

International Journal of Surgery Case Reports

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HighlightsThe following two points are the subject of this case report. First, autologous blood collection can be a risk factor of nonocclusive mesenteric ischemia (NOMI). Second, delayed intestinal stenosis after the recovery from NOMI may require surgical intervention in some cases. As far as the authors know, there is no report about NOMI associated with autologous blood collection. In addition, there are few reports about delayed intestinal stenosis after the recovery from NOMI. In this respect, we believe that this case is worth reporting.

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Survival in Nonocclusive Mesenteric Ischemia

Abstract: Early diagnosis of NOMI is possible using the above criteria and MDCT, and initiation of PGE1 treatment may increase survival in patients with NOMI.

Cited by 173 publications

References 8 publications

Diagnosis of non-occlusive acute mesenteric ischemia in the intensive care unit

Diagnosis of non-occlusive acute mesenteric ischemia in the intensive care unit

Radiological Evaluation of Bowel Ischemia

Delayed intestinal stenosis of nonocclusive mesenteric ischemia after autologous blood collection: A case report

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