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Acute mesenteric ischaemia

Abigail H M Morbi, Ian M Nordon
PURPOSE: This case highlights the importance of timely diagnosis and management of acute mesenteric ischaemia and illustrates the compensatory mechanisms of the mesenteric vasculature. CASE REPORT: A 53-year-old female presented with fever, abdominal pain, and vomiting. The patient had no risk factors for atherosclerosis and was a non-smoker in sinus rhythm with no history of coagulopathy. She was initially treated for viral gastroenteritis. Due to lack of clinical improvement and a rising C-Reactive Protein (416), a CT scan was performed...
June 21, 2016: Acta Chirurgica Belgica
B M M Reiber, R R Gorter, M Tenhagen, H A Cense, A Demirkiran
BACKGROUND: Acute ischaemia of the small intestine is caused by mesenteric venous thrombosis in 5-15% of patients. The non-specific symptoms frequently lead to a diagnostic delay. CASE DESCRIPTION: A 30-year-old pregnant woman presented at the accident and emergency department with progressive abdominal pain, nausea and vomiting. During admission the patient developed signs of peritonitis. Diagnostic laparoscopy revealed a picture of mesenteric venous thrombosis, and we resected 170 cm ischemic small intestine...
2016: Nederlands Tijdschrift Voor Geneeskunde
Jeffrey Hoek, Jack Helleman, Jan Jansen
BACKGROUND: Acute abdominal pain is a common complaint and one with which many general practitioners and first-line specialists are faced. The differential diagnosis is extensive and appropriate selection of additional diagnostics is therefore very important. CASE DESCRIPTION: We present a 48-year-old male with acute abdominal pain and with no medical history suggesting the cause of this pain. Physical examination revealed no abnormalities other than considerable pain on pressure in the epigastric region...
2016: Nederlands Tijdschrift Voor Geneeskunde
Rıdvan Kulu, Hizir Akyildiz, Alper Akcan, Ahmet Oztürk, Erdogan Sozuer
BACKGROUND: The differential diagnosis in acute mesenteric ischaemia (AMI) is essential and sometimes life-saving. A marker for early diagnosis is lacking. Citrulline is an amino acid mainly synthesized by small bowel enterocytes from glutamine. In this study, we aimed to evaluate the diagnostic and prognostic values of citrulline with those of the D-dimer in patients with AMI. METHODS: The patients were divided into two groups; group 1: patients with acute abdominal findings which were attributed preoperatively to AMI, and group 2: patients with acute abdominal findings which were attributed preoperatively to causes other than AMI...
April 8, 2016: ANZ Journal of Surgery
Raghavendra Nagaraja, Prashantha Rao, Vinay Kumaran, Amitabh Yadav, Sorabh Kapoor, Vibha Varma, Naimish Mehta, Samiran Nundy
In Western countries, acute mesenteric ischaemia is commonly due to arterial occlusion and occurs in patients who are usually in their seventh decade. A venous cause for intestinal gangrene has been reported in only about 10 %. We examined whether this was so in India and compared the clinical features of patients with mesenteric arterial and venous ischaemia and relate these to their ultimate prognosis. We studied retrospectively, the records of all patients admitted or referred to the department with a diagnosis of acute mesenteric ischaemia between January 1997 and October 2012, noting their demographic details and mode of presentation, the results of preoperative imaging and blood investigations, the extent of bowel ischaemia, and the length of bowel that was resected at operation and their outcome...
December 2015: Indian Journal of Surgery
Alexander Robinson, Thomas Woodman, Baris Ozdemir, Ary Phaily
We present a case of embolic acute mesenteric ischaemia (AMI) secondary to an underlying cardiac sarcoma, an exceedingly rare presentation only reported twice before. A 46-year-old man presented to accident and emergency department during the night with severe abdominal pain and vomiting. An urgent CT angiograph demonstrated superior mesenteric artery (SMA) occlusion with ischaemic small bowel. Joint surgical effort from vascular and general surgeons successfully recanalised the SMA and a 20 cm segment of small bowel was resected...
2016: BMJ Case Reports
J V T Tilsed, A Casamassima, H Kurihara, D Mariani, I Martinez, J Pereira, L Ponchietti, A Shamiyeh, F Al-Ayoubi, L A B Barco, M Ceolin, A J G D'Almeida, S Hilario, A L Olavarria, M M Ozmen, L F Pinheiro, M Poeze, G Triantos, F T Fuentes, S U Sierra, K Soreide, H Yanar
PURPOSE: Acute mesenteric ischaemia (AMI) accounts for about 1:1000 acute hospital admissions. Untreated, AMI will cause mesenteric infarction, intestinal necrosis, an overwhelming inflammatory response and death. Early intervention can halt and reverse this process leading to a full recovery, but the diagnosis of AMI is difficult and failure to recognize AMI before intestinal necrosis has developed is responsible for the high mortality of the disease. Early diagnosis and prompt treatment are the goals of modern therapy, but there are no randomized controlled trials to guide treatment and the published literature contains a high ratio of reviews to original data...
April 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Pasquale Paolantonio, Marco Rengo, Riccardo Ferrari, Andrea Laghi
Multidetector CT (MDCT) is an imaging technique that provides otherwise unobtainable information in the diagnostic work-up of patients presenting with acute abdominal pain. A correct working diagnosis depends essentially on understanding the individual patient's clinical data and laboratory findings. In haemodynamically stable patients with acute severe and generalized abdominal pain, MDCT is now the preferred imaging test and gives invaluable diagnostic information, also in unstable patients after stabilization...
2016: British Journal of Radiology
P M Ntuli, E Makambwa
Kounis syndrome is characterised by a group of symptoms that manifest as unstable vasospastic or non-vasospastic angina secondary to a hypersensitivity reaction. It was first described by Kounis and Zavras in 1991 as the concurrence of an allergic response with an anaphylactoid or anaphylactic reaction and coronary artery spasm or even myocardial infarction. Since then, this condition has evolved to include a number of mast cell activation disorders associated with acute coronary syndrome. There are many triggering factors, including reactions to multiple medications, exposure to radiological contrast media, poison ivy, bee stings, shellfish and coronary stents...
October 2015: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Moaize Chechi, Zeyad Alsallami, Luke Armstrong
INTRODUCTION: Mesenteric panniculitis is a rare condition which presents as abdominal pain. It involves benign inflammatory or fibrotic changes affecting the mesentery of the bowel. PRESENTATION OF CASE: An 80 year old man presented with severe abdominal pain of acute onset. He was found to have a high lactate and high blood glucose. He was not a known diabetic. A computed tomography (CT) scan revealed a diagnosis of mesenteric panniculitis, and the patient rapidly responded to steroid treatment...
2015: International Journal of Surgery Case Reports
D N Coakley, F M Shaikh, E G Kavanagh
Chronic mesenteric ischaemia is a rare and potentially fatal condition most commonly due to atherosclerotic stenosis or occlusion of two or more mesenteric arteries. Multivessel revascularisation of both primary mesenteric vessels, the celiac artery and superior mesenteric artery (SMA), is the current mainstay of treatment; however, in a certain cohort of patients, revascularisation one or both vessels may not be possible. Arteries may be technically unreconstructable or the patient may be surgically unfit for the prolonged aortic cross clamping times required...
2015: Case Reports in Vascular Medicine
Savas Yuruker, Murat Derebey, Kagan Karabulut, Ismail Alper Tarim, Selim Nural, Ilhan Karabicak, Necati Ozen
Portomesenteric venous gas is a rare condition most commonly caused by mesenteric ischaemia. Mesenteric ischemia, can be life-threatining and requires immediate surgical intervention with a poor prognosis. During the laparotomy, intestinal necrosis and perforation are most common findings although some patients reveal no surgical pathology. In this report we present a case of portomesenteric venous gas which is secondary to acute intramural intestinal haematoma.
September 2015: JPMA. the Journal of the Pakistan Medical Association
Sven A Lang, Martin Loss, Walter A Wohlgemuth, Hans J Schlitt
BACKGROUND: Acute thrombosis of the portal vein (PV) and/or the mesenteric vein (MV) is a rare but potentially life-threatening disease. A multitude of risk factors for acute portal vein thrombosis (PVT)/mesenteric vein thrombosis (MVT) have been identified, including liver cirrhosis, malignancy, coagulation disorders, intra-abdominal infection/inflammation, and postoperative condition. METHODS: This article analyses the treatment options for acute PVT/MVT. RESULTS: Initially, the clinical management should identify patients with an intra-abdominal focus requiring immediate surgical intervention (e...
December 2014: Viszeralmedizin
Mehmet Toptas, İbrahim Akkoc, Yildiray Savas, Sinan Uzman, Yasar Toptas, Mehmet Mustafa Can
Acute mesenteric ischaemia (AMI) is an emergency condition that requires urgent diagnosis. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been studied as inflammatory biomarkers in atherosclerosis, but data regarding AMI are lacking. The study population included patients with AMI (n = 46) versus age and sex-matched healthy controls (n = 46). Computed multidetector tomographic angiography was performed to diagnose AMI. NLR and PLR were calculated using complete blood count...
March 2016: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
M Rahmanian, J J Nedooshan, S Rafat, R Rafie, M Rafiei, R N Moghadam
Arterial thrombosis or emboli have rarely been reported in Cushing syndrome (CS). Here we describe the first case of mesenteric ischaemia secondary to ventricular emboli in a patient with CS. Laboratory evaluation showed increased fibrinogen and factor VIII. Previous studies showed that venous thromboembolism (VTE) increases in CS. This case for the first time described arterial system thrombosis and emboli in a patient with adrenocorticotropin (ACTH)-dependent CS.
October 2015: Acta Clinica Belgica
James G McGarry, Sinead H McEvoy, David P Brophy
INTRODUCTION: Acute mesenteric ischaemia (AMI) continues to have a high mortality, ranging from 60 to 80%. PRESENTATION OF CASE: A 78-year-old male presented with a 20-hour history of abdominal pain, secondary to a superior mesenteric artery (SMA) thromboembolic occlusion diagnosed on computed tomography (CT) angiography. Following confirmation of bowel viability at laparotomy, endovascular intervention using combined thrombolysis, angioplasty and thromboaspiration was performed...
March 2015: Annals of Medicine and Surgery
Chit Saing, Kathir G Yoganathan
We report a case of an HIV-positive man on antiretroviral therapy (ART) who developed abdominal pain due to acute-on-chronic intestinal ischaemia secondary to superior mesenteric vein thrombosis (SMVT) requiring emergency surgery. He was found to have persistently low levels of protein C on thrombophilia screening. To the best of our knowledge, the association linking SMVT to protein C deficiency in an HIV-infected patient has never been reported in the literature.
2015: BMJ Case Reports
E McCarthy, M Little, J Briggs, J Sutcliffe, C R Tapping, R Patel, M J Bratby, R Uberoi
This review focuses on the radiology of mesenteric ischaemia. Covering the acute and chronic presentations, both of which result from impaired vascularisation of the gastrointestinal tract, we evaluate the role of radiographs, ultrasound, CT, MRI, and catheter angiography in the diagnosis of these conditions. Looking to the future, we also assess some of the emerging imaging techniques. Across medicine and surgery there has been a significant shift towards minimally invasive interventions. Although percutaneous revascularisation of chronic mesenteric ischaemia has been performed for some time, there has been a developing trend for the use of such techniques in acute mesenteric ischaemia...
July 2015: Clinical Radiology
O Ait-Mokhtar, G Bayet, S Benamara, J Brunet, F X Hager, J Sainsous
We report a case of a 73 year-old man admitted for acute mesenteric ischaemia. Eight years before, he had a first mesenteric ischaemic event treated by left colectomy and angioplasty of both main coeliac artery (MCA) and superior mesenteric artery (SMA); the patient was discharged on lifelong clopidogrel and aspirin. One month before his admission for the index event, he had a major haematuria; clopidogrel was stopped first, then aspirin because of recurrent haematuria. Five days after withdrawal of both antiplatelet drugs, the patient presented with acute mesenteric ischaemia...
June 2015: Heart, Lung & Circulation
Panoraia Paraskeva, Jacob A Akoh
INTRODUCTION: The increasing frequency of use of CT in patients with acute abdomen is likely to improve the diagnosis of rarely occurring conditions/causes such as superior mesenteric vein thrombosis (MVT). Despite its severe consequences, MVT often presents with nonspecific clinical features. PRESENTATION OF CASE: AD, a 64-year-old man was an emergency admission with vague abdominal discomfort of two weeks duration, acute upper abdominal pain, loose stools, fresh rectal bleeding and vomiting...
2015: International Journal of Surgery Case Reports
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