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Acute mesenteric ischemia

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https://www.readbyqxmd.com/read/28439845/a-systematic-review-of-the-clinical-presentation-diagnosis-and-treatment-of-small-bowel-obstruction
#1
REVIEW
Srinivas R Rami Reddy, Mitchell S Cappell
PURPOSE OF REVIEW: This study aimed to systematically review small bowel obstruction (SBO), focusing on recent changes in diagnosis/therapy. RECENT FINDINGS: SBO incidence is about 350,000/annum in the USA. Etiologies include adhesions (65%), hernias (10%), neoplasms (5%), Crohn's disease (5%), and other (15%). Bowel dilatation occurs proximal to obstruction primarily from swallowed air and secondarily from intraluminal fluid accumulation. Dilatation increases mural tension, decreases mucosal perfusion, causes bacterial proliferation, and decreases mural tensile strength that increases bowel perforation risks...
June 2017: Current Gastroenterology Reports
https://www.readbyqxmd.com/read/28425094/fatal-acute-hemorrhagic-bowel-infarction-caused-by-mesenteric-venous-thrombosis-and-literature-review
#2
Supawon Srettabunjong
Acute mesenteric venous thrombosis (MVT) is a rare, but life-threatening medical phenomenon. MVT is normally characterized by insidious onset, with nonspecific signs and symptoms. A high index of clinical suspicion is required for diagnosis, and emergency surgery is necessary to optimize the chances of patient survival, especially in the people aged more than 70 years. Surprisingly, based on my review of the literature, no fatal acute MVT case has been reported in the forensic literature. All reported such cases have been documented in medical literature, and most of them have been associated with underlying risk factors for venous thrombosis, such as hypercoagulable state, certain cancers, and stasis of the blood flow...
April 20, 2017: Journal of Forensic Sciences
https://www.readbyqxmd.com/read/28395790/serological-markers-for-human-intestinal-ischemia-a-systematic-review
#3
REVIEW
Joep P M Derikx, Dirk H S M Schellekens, Stefan Acosta
Early and accurate diagnosis of intestinal ischemia is important in order to provide rapid and correct treatment and reduce morbidity and mortality rates. Clinical signs and symptoms are often unspecific. This systemic review sums up literature regarding human plasma biomarkers for acute mesenteric ischemia reported during the last ten years. Classic, general markers, including lactate, white cell count, base excess, show poor diagnostic accuracy for intestinal ischemia. Preliminary results for ischemia-modified albumin are promising, which is also true for the inflammatory marker procalcitonin...
February 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28395786/vascular-imaging-of-the-mesenteric-vasculature
#4
REVIEW
Louisa J D van Dijk, André S van Petersen, Adriaan Moelker
Imaging of the mesenteric vasculature is crucial in diagnosing vascular disease of the gastro-intestinal tract such as acute or chronic mesenteric ischemia caused by arterial stenosis, embolism or thrombosis, mesenteric vein thrombosis and mesenteric aneurysm or dissection. The reference standard for imaging of the mesenteric vasculature is digital subtraction angiography. However, modalities as duplex ultrasonography, computed tomography angiography and magnetic resonance angiography are developing rapidly and may provide accurate imaging non-invasively...
February 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28395785/acute-mesenteric-ischemia-part-ii-vascular-and-endovascular-surgical-approaches
#5
REVIEW
Jussi M Kärkkäinen, Stefan Acosta
The modern treatment of acute mesenteric ischemia (AMI) requires seamless collaboration of gastrointestinal surgeons, vascular surgeons, and interventional radiologists. The treatment strategy is straightforward aiming at rapid restoration of blood flow to the intestine. Bowel resection is performed on demand. The first thing to consider is the patient's clinical condition at presentation, whether there are signs of peritonitis or not, and whether the patient is hemodynamically stable or not. Second, there are four etiologies of AMI that need to be distinguished as they differ in treatment: superior mesenteric artery embolism, mesenteric arterial occlusive disease, mesenteric venous thrombosis, and non-occlusive mesenteric ischemia...
February 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28395784/acute-mesenteric-ischemia-part-i-incidence-etiologies-and-how-to-improve-early-diagnosis
#6
REVIEW
Jussi M Kärkkäinen, Stefan Acosta
Acute mesenteric ischemia (AMI) is generally thought to be a rare disease, but in fact, it is more common cause of acute abdomen than appendicitis or ruptured abdominal aortic aneurysm in patients over 75 years of age. In occlusive AMI, surgical treatment without revascularization is associated with as high as 80% overall mortality. It has been shown that early diagnosis with contrast-enhanced computed tomography and revascularization can reduce the overall mortality in AMI by up to 50%. However, only a minority of patients with AMI are being treated actively with revascularization in the United States, and the situation is very likely similar in Europe as well...
February 2017: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/28392914/the-use-of-super-selective-mesenteric-embolisation-as-a-first-line-management-of-acute-lower-gastrointestinal-bleeding
#7
Bryan Soh, Steven Chan
INTRODUCTION: In this study, we aim to assess the efficacy and safety of digital subtraction angiography (DSA) and super-selective mesenteric artery embolisation in managing lower gastrointestinal bleeding (LGIB) at a multi-centre health service in Melbourne (Australia). METHOD: A retrospective case series of patients with LGIB treated with superselective embolisation in our area health service. Patients with confirmed active LGIB, on either radionuclide scintigraphy (RS) or contrast-enhanced multi-detector CT angiography (CE-MDCT), were referred for DSA, and subsequently endovascular intervention...
May 2017: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/28376703/symptomatic-delayed-aortic-dissection-after-superior-mesenteric-artery-stenting-for-chronic-mesenteric-ischemia
#8
Cindy Huynh, Robert Schwartz
Chronic mesenteric ischemia most commonly occurs secondary to atherosclerotic disease of the mesenteric arteries. Patients are often older than 60 years and can present with postprandial abdominal pain, nausea, diarrhea, and significant weight loss. Symptomatic disease has traditionally been managed with open surgical repair, but endovascular strategies, such as percutaneous angioplasty and stenting, have emerged as the mainstays of therapy. Complications from stenting include plaque embolization, thrombosis, perforation, or dissection of the mesenteric arteries...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28362714/iloprost-prostaglandin-e1-and-papaverine-relax-human-mesenteric-arteries-with-similar-potency
#9
Christoph Mahlke, Jens-Peter Kühn, Birger Mensel, André Schreiber, Annett Juretzko, Antje Steinbach, Olaf Grisk
OBJECTIVE: Non-occlusive mesenteric ischemia (NOMI) is accompanied by mesenteric artery spasms that are at least in part due to endothelin system activation. Acute treatment includes intra-arterial infusion of vasodilators such as iloprost, prostaglandin E1 (PGE1) and papaverine. Their effectiveness is not well characterized in human mesenteric arteries. We directly compared their potency to relax isolated human mesenteric arteries. To explore the potential of Rock inhibition to treat mesenteric artery spasms, we tested if endothelin-1 (ET-1)-induced mesenteric artery constrictions depend rho kinase (Rock)...
March 30, 2017: Shock
https://www.readbyqxmd.com/read/28359796/trends-in-treatment-and-mortality-for-mesenteric-ischemia-in-the-united-states-from-2000-to-2012
#10
Sara L Zettervall, Ruby C Lo, Peter A Soden, Sarah E Deery, Klaas H Ultee, Duane S Pinto, Mark C Wyers, Marc L Schermerhorn
BACKGROUND: It is unknown whether increased endovascular treatment of chronic mesenteric ischemia has led to decreases in open surgery, acute mesenteric ischemia, or overall mortality. The present study evaluates the trends in endovascular and open treatment over time for chronic and acute mesenteric ischemia. METHODS: We identified patients with chronic or acute mesenteric ischemia in the Nationwide Inpatient Sample and Center for Disease Control and Prevention database from 2000 to 2012...
March 28, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28355983/mesenteric-inflammatory-veno-occlusive-disease-of-the-spleen-metasynchronous-with-two-arterial-thrombotic-events-in-systemic-lupus-erythematosus
#11
D Allali, G Puppa, C Chizzolini
Vasculitides, particularly those affecting small vessels, are known to complicate systemic lupus erythematosus (SLE); however, isolated venulitis of the mesenteric bed has rarely been reported. Here we relate the case of a 46-year-old woman with SLE who presented with acute abdominal pain due to artery thrombosis and extended splenic ischemia requiring splenectomy. The histological examination revealed diffuse venulitis in the absence of arterial vasculitis consistent with the definition of mesenteric inflammatory veno-occlusive disease (MIVOD)...
January 1, 2017: Lupus
https://www.readbyqxmd.com/read/28348948/microscopic-polyangiitis-atypical-presentation-with-extensive-small-bowel-necrosis-diffuse-alveolar-hemorrhage-and-renal-failure
#12
Justin M Segraves, Vivek N Iyer
Microscopic polyangiitis is an uncommon systemic vasculitis of varying severity that is associated with myeloperoxidase (MPO) and perinuclear antineutrophil cytoplasmic (p-ANCA) antibodies. The most commonly affected organs are the lungs and kidneys. We report on a very unusual case of microscopic polyangiitis presenting with severe mesenteric ischemia in addition to diffuse alveolar hemorrhage and acute renal failure. The patient was initially diagnosed with acute pancreatitis at an outside facility given his severe abdominal pain and elevated pancreatic enzymes...
2017: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/28341511/open-and-endovascular-abdominal-aortic-injury-repair-outcomes-in-polytrauma-patients
#13
Anand Dayama, Aksim Rivera, Odunayo Olorunfemi, Ahmed Mahmoud, Catherine A Fontecha, John McNelis
INTRODUCTION: The management of patients with abdominal aortic injury (AAI) remains challenging. Open repair of AAI is still the standard of care although it is associated with high mortality. In past few years, endovascular surgery has evolved as a less invasive alternative to open surgery in emergency settings. The objective of this study was to compare outcomes after open repair versus endovascular repair of AAI in polytrauma patients. METHODS: The National Trauma Data Bank, from 2008 to 2012, was queried to identify trauma patients undergoing open and endovascular repair of AAI using International Classification of Diseases, ninth Edition, and Clinical Modification codes...
March 21, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28331640/a-case-of-hepatic-portal-venous-gas-hypothesis-of-a-transient-direct-communication-between-a-penetrating-antral-gastric-ulcer-and-mesenteric-varices
#14
Hassan M Ghoz, Shamlan M Sheikh, Kanika Khandelwal, Joseph Fiore, Nicholas James, Joel Weinstock
Hepatic portal venous gas (HPVG) is a rare radiological sign that usually signifies an acute intra-abdominal process, most commonly bowel ischemia and sepsis. Few reports described an association with underlying gastric pathologies. We report a 60-year-old patient who presented with melena and chills and was discovered to have a gastric ulcer that appeared to have penetrated into a mesenteric varix. This, in turn, likely caused development of HPVG associated with fungemia. Treatment with a proton pump inhibitor and bowel rest was sufficient to resolve symptoms and the HPVG...
2017: Case Reports in Gastrointestinal Medicine
https://www.readbyqxmd.com/read/28330439/impact-of-preoperative-anemia-and-postoperative-hemoglobin-drop-on-the-incidence-of-acute-kidney-injury-and-in-hospital-mortality-in-patients-with-type-b-acute-aortic-syndromes-undergoing-thoracic-endovascular-aortic-repair
#15
Riccardo Gorla, Konstantinos Tsagakis, Michael Horacek, Amir-Abbas Mahabadi, Philipp Kahlert, Heinz Jakob, Eduardo Bossone, Raimund Erbel, Rolf Alexander Jánosi
BACKGROUND: The impact of preoperative anemia and postoperative hemoglobin (Hb) drop on the incidence of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR) for type B acute aortic syndromes (AAS) as well as their prognostic value is unknown. METHODS: This retrospective study included 144 patients with type B AAS undergoing TEVAR at our center. Preoperative anemia was classified as no/mild (Hb ≥ 12.0 g/dL in men; ≥11.3 g/dL in women), moderate (Hb 10...
April 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28323233/iloprost-use-in-patients-with-persistent-intestinal-ischemia-unsuitable-for-revascularization
#16
Alexandre Nuzzo, Damien Soudan, Lore Billiauws, Julie Bataille, Léon Maggiori, Maxime Ronot, Jeanick Stocco, Yoram Bouhnik, Yves Castier, Olivier Corcos
INTRODUCTION: Persistent or chronic intestinal ischemic injury (i3) can lead to severe malnutrition and acute mesenteric ischemia. Although recommended, revascularization of splanchnic arteries is sometimes unrealizable. MATERIAL AND METHODS: We report a case series of iloprost use in consecutive stable patients with persistent i3 unsuitable for revascularization followed in a tertiary care center. The feasibility of revascularization was discussed and ruled out by a multidisciplinary team, and informed consent was obtained prior to consideration of a vasoactive therapy...
March 16, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28321558/a-novel-scoring-system-for-diagnosing-acute-mesenteric-ischemia-in-the-emergency-ward
#17
Zhen Wang, Jun-Qiang Chen, Jin-Lu Liu, Lei Tian
BACKGROUND: Early diagnosis of acute mesenteric ischemia (AMI) based on clinical judgment has been proved to be too difficult. Therefore, it is important for identifying clinical parameters that can differentiate AMI from other acute abdomen upon presentation. METHODS: We analyzed a database of 106 consecutive patients admitted to the emergency ward for suspected AMI in whom diagnosis of AMI was confirmed by laparotomy, CT angiography or mesenteric angiography. The patients' demographics, previous history, clinical signs, results of laboratory investigations and ultrasonography were collected...
March 20, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28271679/the-diagnostic-value-of-scube1-in-acute-appendicitis
#18
E Sonmez, A Dursun, B Gulen, H Metin, O F Ozer
BACKGROUND: SCUBE1 has recently been studied as a diagnostic biomarker for acute coronary syndrome, ischemic stroke, and acute mesenteric ischemia. The aim of this study is to evaluate the value of SCUBE1 and routine parameters used in patients diagnosed with acute appendicitis. METHODS: Of the 150 patients admitted to the emergency department whose initial diagnosis were acute appendicitis (AA), 103 patients were excluded from the study for various reasons. Forty-seven patients with a definitive diagnose of AA and 43 volunteers were enrolled in the study...
March 1, 2017: Clinical Laboratory
https://www.readbyqxmd.com/read/28266590/predictive-factors-of-intestinal-necrosis-in-acute-mesenteric-ischemia-prospective-study-from-an-intestinal-stroke-center
#19
Alexandre Nuzzo, Leon Maggiori, Maxime Ronot, Aymeric Becq, Aurelie Plessier, Nathalie Gault, Francisca Joly, Yves Castier, Valerie Vilgrain, Catherine Paugam, Yves Panis, Yoram Bouhnik, Dominique Cazals-Hatem, Olivier Corcos
OBJECTIVES: To identify predictive factors for irreversible transmural intestinal necrosis (ITIN) in acute mesenteric ischemia (AMI) and establish a risk score for ITIN. METHODS: This single-center prospective cohort study was performed between 2009 and 2015 in patients with AMI. The primary outcome was the occurrence of ITIN, confirmed by specimen analysis in patients who underwent surgery. Patients who recovered from AMI with no need for intestinal resection were considered not to have ITIN...
April 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28261615/can-the-preoperative-serum-lactate-level-predict-the-extent-of-bowel-ischemia-in-patients-presenting-to-the-emergency-department-with-acute-mesenteric-ischemia
#20
Peter C Ambe, Kai Kang, Marios Papadakis, Hubert Zirngibl
Purpose. Early recognition of acute mesenteric ischemia (AMI) can be challenging. Extensive bowel necrosis secondary to AMI is associated with high rates of mortality. The aim of this study was to investigate the association between preoperative serum lactate level and the extent of bowel ischemia in patients with AMI. Methods. Data of patients with abdominal pain and elevated serum lactate undergoing emergency laparotomy for suspected AMI within 24 hours of presentation was retrospectively abstracted. The length of the ischemic bowel segment was compared with the preoperative serum lactate level...
2017: BioMed Research International
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