Update in management of mesenteric ischemia

Chang, Robert W.; Chang, John B.; Longo, Walter E.

doi:10.3748/wjg.v12.i20.3243

Cited by 113 publications

(97 citation statements)

References 47 publications

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“…6) This was the case of our patient. Due to obesity, peritonitis and poor bowel preparation, we preferred an open approach for intestinal exeresis to minimize the risk of post-operative complications.…”

Section: Discussionsupporting

confidence: 56%

“…The choice is highly important. 6) Nowadays, emergency laparoscopy 7,8) can contribute to resolve significant diagnostic and differential diagnostic questions in the presence of acute abdominal symptomatology. It offers the advantage of being feasible at the bedside (in the Intensive Care Unit or Emergency room) of critical patients who cannot be moved, avoiding useless and risky exploratory laparotomies.…”

Section: Introductionmentioning

confidence: 99%

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Acute Aortic Dissection with Intestinal Ischemia: What to Do First

Meriggi

Alloni

Gramigna

et al. 2011

ATCS

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Purpose: In the case of an acute aortic dissection, a surgical aortic procedure is usually the priority in order to restore the perfusion of vital organs. Afterwards, associated ischemic abdominal visceral lesions can be resected. For particular patients, it could be highly beneficial to perform the abdominal surgery before surgically addressing the aorta. The aim of this paper is to contribute to the therapeutic choice in cases of acute aortic dissection with acute abdomen. Case report: The case is reported of a 38-year-old patient, affected by an acute aortic dissection (Stanford type A) and peritonitis. Suspecting the necessity for a complex combined surgical procedure, the patient underwent emergency diagnostic laparoscopy, which showed an infarctual necrosis of the distal ileum and right colon. Therefore, he immediately underwent a wide right hemicolectomy. Afterwards, an ascending aortic substitution was performed. The patient was discharged on the 15th post-operative day, and he is doing well, 1 year and 3 months after the operation. Conclusion: In the case of an acute aortic dissection with acute abdomen, emergency laparoscopy is a precious surgical technique to identify criteria that can lead to therapeutic decisions, including timing.

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Section: Discussionsupporting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Acute Aortic Dissection with Intestinal Ischemia: What to Do First

Meriggi

Alloni

Gramigna

et al. 2011

ATCS

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“…Mesenteric ischemia is a clinical entity with a mortality rate between 60% and 100% that usually requires surgical resection of the necrotic intestinal segment [1] . Although there have been advancements in the treatment of ischemic injury, an ideal treatment has not been defined, and new options should be considered.…”

Section: Introductionmentioning

confidence: 99%

Ketamine anesthesia reduces intestinal ischemia/reperfusion injury in rats

Cámara¹,

Guzmán²,

Barrera³

et al. 2008

WJG

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showed significantly less injury in rats that received ketamine than in rats that did not (2.35 ± 1.14 vs 4.58 ± 0.50, P < 0.0001). The distance traveled by a marker, expressed as percentage of total intestinal length, in rats that received pentobarbital sodium was 20% ± 2% in comparison with 25.9% ± 1.64% in rats that received ketamine (P = 0.017 INTRODUCTIONMesenteric ischemia is a clinical entity with a mortality rate between 60% and 100% that usually requires surgical resection of the necrotic intestinal segment [1] . Although there have been advancements in the treatment of ischemic injury, an ideal treatment has not been defined, and new options should be considered. A promising strategy is the use of anesthetic and sedative agents that might exert protective effects on the injured tissue. Ketamine is an agent that has been recommended for this purpose in clinical situations of sepsis, renal ischemia, cerebral ischemia and serious burn injuries [2][3][4] . The small intestine is very sensitive to ischemic insult [5] . Reperfusion causes additional damage through the release of free radicals, pro-inflammatory cytokines, leukotrienes and other related products [6] . Intestinal Abstract AIM: To investigate the effects of ketamine anesthesia on the motility alterations and tissue injury caused by ischemia/reperfusion in rats. METHODS: T h i r ty m a l e W i s t a r ra t s w e i g h i n g 200-250 g were used. Ischemia was induced by obstructing blood flow in 25% of the total small intestinal length (ileum) with a vascular clamp for 45 min, after which either 60 min or 24 h of reperfusion was allowed. Rats were either anesthetized with pentobarbital sodium (50 mg/kg) or ketamine (100 mg/kg). Control groups received sham surgery. After 60 min of reperfusion, the intestine was examined for morphological alterations, and after 24 h intestinal basic electrical rhythm (BER) frequency was calculated, and intestinal transit determined in all groups. RESULTS: The intestinal mucosa in rats that were anesthetized with ketamine showed moderate alterations such as epithelial lifting, while ulceration and hemorrhage was observed in rats that received pentobarbital sodium after 60 min of reperfusion. Quantitative analysis of structural damage using the Chiu scale

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“…In extensive small bowel resection, patients have severe diarrhea for a few weeks, but many appear to compensate after a few months. Patients who have had total small intestine resection need lifelong intravenous hyperalimentation (Chang et al 2006). However, with rapid treatment, the mortality rate can be reduced considerably, and p a t i e n t s m a y b e s p a r e d b o w e l r e s e c t i o n (Klempnauer et al 1997).…”

Section: Prognosismentioning

confidence: 99%

Mesenteric Ischemia: Still a Deadly Puzzle for the Medical Community

Stamatakos

Stefanaki

Mastrokalos

et al. 2008

Tohoku J. Exp. Med.

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The main goal of this article is to update etiology, epidemiology, diagnosis, treatment and outcome of the various causes of mesenteric ischemia in order to elucidate its labyrinthine clinical riddle, by reviewing the current English medical literature. Mesenteric ischemia is a quite uncommon disorder, observed in the emergency department. It is a lifethreatening vascular emergency that requires early diagnosis and intervention to restore mesenteric blood flow and to prevent bowel necrosis and patient death. Consequently, it is a vital diagnosis to make because of its high mortality rate and its thorny complications. The underlying causes vary, and the prognosis depends on the specific findings during clinical examination. Vague and nonspecific clinical findings and limitations of diagnostic studies make the diagnosis a significant challenge. The prognosis of acute mesenteric ischemia of any type is grave. The complications following this medical jigsaw puzzle are also severe. Patients in whom the diagnosis is missed until infarction occurs have a mortality rate of 90%. Even with good treatment, up to 50-80% of patients die. Survivors of extensive bowel resection face lifelong disability. Despite the progress in understanding the pathogenesis of mesenteric ischemia and the development of treatment modalities, the entity remains a diagnostic challenge for clinicians. Delay in diagnosis contributes to a high mortality rate. Early diagnosis and adequate treatment can improve the clinical outcome. Even if diagnostic modalities have improved since the first successful attempts to confront effectively this clinical entity, mesenteric ischemia still remains a lethal diagnostic enigma for the medical community.Mesenteric Ischemia; thrombosis; bowel infarction; atherosclerosis; mesenteric venous thrombosis; mesenteric thromboendarterectomy.Tohoku

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Update in management of mesenteric ischemia

Cited by 113 publications

References 47 publications

Acute Aortic Dissection with Intestinal Ischemia: What to Do First

Acute Aortic Dissection with Intestinal Ischemia: What to Do First

Ketamine anesthesia reduces intestinal ischemia/reperfusion injury in rats

Mesenteric Ischemia: Still a Deadly Puzzle for the Medical Community

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