Mesenteric ischemia

INTRODUCTION: Clinical practice guidelines have recommended an endovascular-first approach(ENDO) for management of patients with chronic mesenteric ischemia(CMI) while open mesenteric bypass(OMB) is proposed for subjects deemed to be poor ENDO candidates. However, the impact of a previous failed endovascular or open mesenteric reconstruction on subsequent OMB is unknown. Accordingly, this study was designed to examine the results of a remedial OMB(R-OMB) after a failed ENDO or primary OMB(P-OMB) for patients with recurrent CMI...

Cocaine is an indirect-acting sympathomimetic drug that inhibits norepinephrine and dopamine reuptake in the adrenergic presynaptic cleft. Cocaine use has been associated with strokes, angina, arrhythmias, and agitation. Data on gastrointestinal complications such as mesenteric ischemia, bowel necrosis, ulceration, and perforation are scarce. Here, we present a rare case of cocaine-induced esophageal, gastric, and small bowel necrosis that contributes to the limited literature on this subject. Diagnosis of cocaine-induced gastrointestinal complications involves a combination of imaging studies, laboratory assessments, and histopathological examinations...

Intraluminal thrombus formation (ILT) is a recently discovered and highly clinically relevant complication after frozen elephant trunk implantation in cardiovascular surgery. In this phenomenon, a thrombus forms within the lumen of the stent graft component of the frozen elephant trunk prosthesis and puts the patient at risk for downstream embolization with visceral or lower limb ischemia. Incidence of ILT reported in the currently available studies ranges from 6% to 17% of patients after frozen elephant trunk implantation...

The celiacomesenteric trunk (CMT), an exceedingly rare anatomic variant uniting the celiac artery and superior mesenteric artery (SMA), holds significant clinical and surgical implications. Despite its rarity, understanding these implications is crucial for effective management. This report outlines the case of a 99-year-old female presenting with septic shock and abdominal pain, with imaging revealing an incidental CMT. This paper aims to elucidate the surgical implications associated with CMT through a comprehensive case review and literature search...

Background: Owing to the low incidence rate and nonspecific symptoms of acute mesenteric ischemia (AMI), the identification and prediction of irreversible transmural intestinal necrosis (ITIN) and extensive bowel resection (≥100 cm) (EBR) are difficult and critical. This study aimed to investigate the risk factors for ITIN and EBR in patients with AMI. Methods: The clinical data of 254 AMI patients were retrospectively analyzed. Furthermore, the incidence of ITIN and EBR were set as dependent variables, and relevant risk factors were screened using univariate and multivariate logistic regression analyses...

PURPOSE: Contrast enhancement of the adrenal gland defined by computed tomography (CT) was previously analyzed as a prognostic factor for critically ill patients in various diseases. However, no study investigated this quantitative parameter in patients with acute mesenteric ischemia. Therefore, the aim of this study was to evaluate the prognostic value of the contrast enhancement of the adrenal glands in patients with clinically suspected AMI. METHODS: All patients with clinically suspected AMI were retrospectively assessed between 2016 and 2020...

Nonocclusive mesenteric ischemia (NOMI) is a life-threatening disorder. Early diagnosis is challenging because NOMI lacks specific symptoms. A 52-year-old man who received extended cholecystectomy with Roux-en-Y hepaticojejunostomy for gallbladder cancer (GBC) presented to our hospital with nausea and vomiting. Neither tender nor peritoneal irritation sign was present on abdominal examination. Blood test exhibited marked leukocytosis (WBC:19,800/mm3). A contrast-enhanced abdominal computed tomography (CT) scan revealed remarkable wall thickening and lower contrast enhancement effect localized to Roux limb...

A 36-year-old man presented with abdominal pain, vomiting, and diarrhea. On arrival, his vital signs were remarkable for fever (39.3 °C) and tachycardia (127 beats/min, regular). His abdomen was distended, and a blood test showed elevations of inflammatory markers. Contrast-enhanced computed tomography revealed a superior mesenteric artery thrombus, ischemic colitis, ascites, and infarctions in the spleen and right kidney. He was diagnosed with bowel necrosis due to acute mesenteric ischemia (AMI). An emergent laparotomy was performed...

BACKGROUND: Gastro intestinal ischemia (GIisch) is challenging to diagnose in patients after cardiothoracic surgery. Computed tomography angiography (CTA) carries substantial false-negative and false-positive rates. The aim of the study was to evaluate if a combination of readily available variables improves the diagnosis of GIisch after cardiothoracic surgery. METHODS: This retrospective study included patients receiving intensive care after cardiothoracic surgery...

Primary small bowel volvulus (SBV), commonly known as midgut volvulus, is an uncommon condition in which the small intestine rotates around its own mesenteric axis. This case report details the diagnostic and management challenges encountered in a rare presentation of primary SBV in a previously healthy 19-year-old male. Our patient presented with acute abdominal pain, vomiting, and signs of shock, prompting urgent medical attention. He was sent for exploratory laparotomy and underwent extensive resection of the gangrenous bowel...

BACKGROUND: Short bowel syndrome (SBS) in adults is defined as having less than 180 to 200 cm of remaining small bowel. Many literature sources do not provide precise epidemiological data, and challenges in estimating the prevalence of SBS include its multifactorial etiology and varying definitions. The most common pathologies leading to SBS include Crohn disease, mesenteric ischemia, radiation enteritis, post-surgical adhesions, and post-operative complications...

PURPOSE:  To evaluate the efficacy and safety of percutaneous rotational thrombectomy-assisted endovascular revascularization of acute thromboembolic superior mesenteric artery occlusions in acute mesenteric ischemia. MATERIALS AND METHODS:  Fifteen cases of percutaneous rotational thrombectomy- assisted (Rotarex S, BD, USA) revascularization were retrospectively analyzed. The etiology was embolic in 40 % of cases and thrombotic in 60 %...

AIM: To identify factors that can help us to avoid a preoperative incorrect diagnosis of vascular occlusion by evaluating patients who underwent laparotomy with a probable preoperative diagnosis of acute mesenteric ischemia (AMI), but later at laparotomy, were diagnosed to have a different pathology than AMI. MATERIAL AND METHODS: A total of 213 patients who were operated with the diagnosis of AMI were enrolled in this study. Based on their operational, clinical, and pathological findings, they were divided into two groups...

Takayasu arteritis is a chronic, idiopathic, inflammatory disease mainly affecting medium and large vessels with a significant rate of morbidity and mortality. The vessels most frequently affected are the aorta and its branches; branches originating from the aortic arch include right brachiocephalic trunk and its branches, left common carotid artery, left subclavian artery, coronary arteries from the ascending aorta, celiac trunk, right and left renal arteries, superior and inferior mesenteric arteries from the descending aorta, and right and left iliofemoral arteries...

Due to the extensive collateral arterial network, symptomatic chronic mesenteric ischemia is a relatively uncommon condition and is associated with severe atherosclerotic disease of all major visceral arteries. Open surgical repair has been commonly used to restore blood supply to the visceral arteries, and the "roof-top" approach has been advocated as an alternative technique to traditional midline incision, mainly because of the great exposure of the suprarenal aorta that it offers. Roof-top approach, in other words, bilateral subcostal incision, is a totally abdominal approach to the suprarenal aorta, and as the title says, it is like a roof-top on the abdominal wall...

UNLABELLED: Stercoral colitis is a rare but serious condition characterized by inflammation of the colonic mucosa due to impacted and hardened faecal material. The word "stercoral" means "related to faeces". This condition usually develops due to the accumulation of hard stool masses in the colon, which cause localized inflammation and irritation. These faecalomas can exert persistent pressure on the colonic wall, causing damage and inflammation. Stercoral colitis presenting symptoms that mimic acute mesenteric ischemia is a diagnostic challenge for clinicians due to the overlap in clinical manifestations...

Cecal volvulus is a rare, life-threatening form of bowel obstruction caused by the entanglement of the bowel around the mesenteric axis, compromising blood supply and leading to obstruction and ischemia. The diagnosis is challenging due to its highly variable clinical presentation and differential diagnoses, which may delay timely intervention. This is a case report of an 89-year-old woman who presented with a two-day history of lower right quadrant abdominal pain, nausea, and a temporary loss of consciousness...

Inferior mesenteric artery (IMA) aneurysms account for approximately 1% of visceral artery aneurysms and can occur secondary to high flow because of occlusive disease in other mesenteric arteries. We describe the case of a 79-year-old man who presented with a 3.3-cm IMA aneurysm and chronic total occlusions of the celiac artery and superior mesenteric artery (SMA). After an unsuccessful attempt at endovascular SMA recanalization, he underwent an uncomplicated retrograde aorta to SMA bypass and antegrade aorta to IMA bypass...

BACKGROUND: Chronic mesenteric ischemia (CMI) is a debilitating disease with a heavy burden on quality of life. Stenting of the superior mesenteric artery (SMA) is the first option for treatment, but there is a lack of consensus defining precise indications for open revascularization (OR). OBJECTIVES: To describe a series of 4 patients with CMI treated with OR and to present an algorithm for the management of this condition. METHODS: Three patients presented with typical intestinal angina and weight loss...

Molecular oxygen is typically delivered to patients via oxygen inhalation or extracorporeal membrane oxygenation (ECMO), potentially resulting in systemic hyperoxia from liberal oxygen inhalation or localized hyperoxia in the lower body from peripheral venoarterial (VA) ECMO. Consequently, this exposes the gastrointestinal tract to excessive oxygen levels. Hyperoxia can trigger organ damage due to the overproduction of reactive oxygen species and is associated with increased mortality. The gut and gut microbiome play pivotal roles in critical illnesses and even small variations in oxygen levels can have a dramatic influence on the physiology and ecology of gut microbes...