An unusual case of mesenteric ischaemia.
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ABSTRACT:
SUBMITTER: Ayres LRO
PROVIDER: S-EPMC5369707 | biostudies-other | 2014 Jan
REPOSITORIES: biostudies-other
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Project description:Acute Mesenteric Ischemia (AMI) is a rare life-threatening entity caused by sudden interruption of the blood supply to a segment of the bowel due to impairment of mesenteric arterial blood flow or venous drainage. Clinical presentation varies according to the time course of vascular occlusion. Contrast-enhanced Computed Tomography (CT) of the abdomen represents the main diagnostic test for AMI diagnosis, enabling fast and excellent evaluation of the intestine, mesenteric vasculature, and other ancillary characteristics of AMI. Typical CT findings of AMI include paralytic ileus, decreased or absent bowel wall contrast-enhancement, pneumatosis intestinalis, and porto-mesenteric venous gas. We hereby report a case of an 89-year-old man presenting with AMI due to Superior Mesenteric Artery (SMA) thrombotic occlusion following endovascular stenting superficial femoral arteries. Typical findings were observed on abdominal CT imaging, yet associated with the presence of gas exclusively in the SMA district, without any involvement of the porto-mesenteric venous system. Different imaging features and pitfalls can help radiologists to accurately diagnose AMI, especially when irreversible bowel damage is about to occur. Therefore, radiologists and emergency physicians should be aware of the unusual association between gas in the SMA arterial district and AMI, even in the absence of porto-mesenteric venous system involvement, in order to urge prompt surgical consultation when observed.
| S-EPMC9130093 | biostudies-literature
Project description:Wilkie's Syndrome is a very rare disease caused by reduction of aorto-mesenteric space with consequent duodenum compression. It can combine with left renal vein stenosis which, when symptomatic, is known as "Nutcracker Syndrome". We describe a clinical onset case with epigastric pain without vomiting in a normal weight patient. 28-year-old woman who came to our observation for intense epigastric pain after a weight loss of 14 kg in 4 months. Multidetector Computed Tomography and Ultrasound revealed gastric and duodenal overdistension with hydro-air levels, severe duodenum stenosis, and left renal vein compression. Wilkie's Syndrome is common in anorexic individuals suffering from recurrent postprandial vomiting, onset with severe epigastric pain, without vomiting, is quite unusual. High-calorie diet must be first therapeutic approach, in case of failure treatment of first choice should be endovascular stenting and, only in selected cases, surgical treatment should be used because it is very invasive and burdened with numerous complications. Failure to diagnose this disease can expose patients to serious health risks.
| S-EPMC8358285 | biostudies-literature
Project description:Background: Acute mesenteric ischaemia (AMI) is a surgical emergency which has an associated high mortality. The mainstay of active treatment includes early surgical intervention, with resection of non-viable bowel, and revascularisation of the ischaemic bowel where possible. Due to the physiological insult of AMI however, perioperative care often involves critical care and the use of vasoactive agents to optimise end organ perfusion. A number of these vasoactive agents are currently available with varied mechanism of action and effects on splanchnic blood flow. However, specific guidance on which is the optimal vasoactive drug to use in these settings is limited. This systematic review aimed to evaluate the current evidence comparing vasoactive drugs in AMI. Methods: A systematic search of Ovid Medline, Ovid Embase, Cochrane CENTRAL and the Cochrane Database of Systematic Review was performed on the 5th of November 2020 to identify randomised clinical trials comparing different vasoactive agents in AMI on outcomes including mortality. The search was performed through the Royal College of Surgeons of England (RCSEng) search support library. Results were analysed using the Rayyan platform, and independently screened by four investigators. Results: 614 distinct papers were identified. After screening, there were no randomised clinical trials meeting the inclusion criteria. Conclusions: This review identifies a gap in literature, and therefore recommends an investigation into current practice and clinician preference in relation to vasoactive agents in AMI. Multicentre randomised controlled trials comparing these medications on clinical outcomes will therefore be required to address this question.
| S-EPMC8459625 | biostudies-literature
Project description:The current study presents a mesenteric mesenchymal tumor case, with unusual features in diagnostic imaging and histology. A 16-year-old male was admitted to the hospital with abdominal pain. Computed tomography (CT) revealed an abdominal mass, 2 cm in diameter. The results of contrast-enhanced CT, magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography indicated no specific features suggestive of its histology. Two arteries branching from the superior mesenteric artery were observed feeding the hypervascular tumor. After endoscopic and other laboratory findings revealed no additional lesions, the lesion was diagnosed as a primary mesenteric tumor. As the possibility of malignancy and future bleeding from this tumor could not be ruled out, a resection of the tumor was performed. During the surgery, the tumor, which was well circumscribed and hypervascular, was located in the mesentery of the jejunum. The resected tumor did not exhibit typical histological characteristics, and was labeled as 'myxoid smooth muscle neoplasm of uncertain biologic potential'. At 2 years after surgery, the patient remained well without evidence of recurrence. As primary mesenteric tumors are rare, particularly in young patients, it is considered important that this type of unusual tumor be included in the differential diagnosis for mesenteric tumors.
| S-EPMC5543262 | biostudies-other
Project description:ObjectiveTo estimate the incidence of acute mesenteric ischaemia (AMI), proportions of its different forms and short-term and long-term mortality.DesignSystematic review and meta-analysis.Data sourcesMEDLINE (Ovid), Web of Science, Scopus and Cochrane Library were searched until 26 July 2022.Eligibility criteriaStudies reporting data on the incidence and outcomes of AMI in adult populations.Data extraction and synthesisData extraction and quality assessment with modified Newcastle-Ottawa scale were performed using predeveloped standard forms. The outcomes were the incidence of AMI and its different forms in the general population and in patients admitted to hospital, and the mortality of AMI in its different forms.ResultsFrom 3064 records, 335 full texts were reviewed and 163 included in the quantitative analysis. The mean incidence of AMI was 6.2 (95% CI 1.9 to 12.9) per 100 000 person years. On average 5.0 (95% CI 3.3 to 7.1) of 10 000 hospital admissions were due to AMI. Occlusive arterial AMI was the most common form constituting 68.6% (95% CI 63.7 to 73.2) of all AMI cases, with similar proportions of embolism and thrombosis.Overall short-term mortality (in-hospital or within 30 days) of AMI was 59.6% (95% CI 55.5 to 63.6), being 68.7% (95% CI 60.8 to 74.9) in patients treated before the year 2000 and 55.0% (95% CI 45.5 to 64.1) in patients treated from 2000 onwards (p<0.05). The mid/long-term mortality of AMI was 68.2% (95% CI 60.7 to 74.9). Mortality due to mesenteric venous thrombosis was 24.6% (95% CI 17.0 to 32.9) and of non-occlusive mesenteric ischaemia 58.4% (95% CI 48.6 to 67.7). The short-term mortality of revascularised occlusive arterial AMI was 33.9% (95% CI 30.7 to 37.4).ConclusionsIn adult patients, AMI is a rarely diagnosed condition with high mortality, although with improvement of treatment results over the last decades. Two thirds of AMI cases are of occlusive arterial origin with potential for better survival if revascularised.Prospero registration numberCRD42021247148.
| S-EPMC9608543 | biostudies-literature
Project description:BackgroundThe mesenteric artery calcium score (MACS) identifies patients with possible chronic mesenteric ischaemia (CMI) using standard computed tomography (CT) imaging. The MACS does not necessitate a dedicated computed tomography angiography (CTA) which is required for evaluation of mesenteric artery patency. This study aimed to test the use of a symptom and MACS based score chart to facilitate the selection of patients with a low probability of CMI, in whom further diagnostic workup can be omitted, and to validate the CTA-based score chart proposed by van Dijk et al. which guides treatment decisions in patients with suspected CMI.MethodsThis retrospective study included consecutive patients with suspected CMI. The Agatston definition was used to calculate the MACS. Multivariable logistic regression analysis was used to create a MACS score chart, which was applied in all patients to determine its discriminative ability. The score chart by van Dijk et al. was validated in this independent external patient series.ResultsHundred-ninety-two patients were included, of whom 49 had CMI. The MACS score chart composed of the variables weight loss, postprandial abdominal pain, history of cardiovascular disease, and MACS, showed an excellent discriminative ability (area under the curve [AUC] 0.87). CMI risks were 2.1% in the low-risk group (0-4 points) and 39.1% in the increased risk group (5-10 points); sensitivity (97.8%) and negative predictive value (NPV; 97.9%) were high. The CTA-based score chart by van Dijk et al. showed an excellent discriminative ability (AUC 0.89).ConclusionThe MACS score chart shows promise for early risk stratification of patients with suspected CMI based on a near-perfect NPV. It is complementary to the CTA-based score chart by van Dijk et al., which showed excellent external validity and is well suited to guide subsequent (invasive) treatment decisions in patients with suspected CMI.
| S-EPMC8259376 | biostudies-literature
Project description:BackgroundThe aim of this multicentre prospective observational study was to identify the incidence, patient characteristics, diagnostic pathway, management and outcome of acute mesenteric ischaemia (AMI).MethodsAll adult patients with clinical suspicion of AMI admitted or transferred to 32 participating hospitals from 06.06.2022 to 05.04.2023 were included. Participants who were subsequently shown not to have AMI or had localized intestinal gangrene due to strangulating bowel obstruction had only baseline and outcome data collected.ResultsAMI occurred in 0.038% of adult admissions in participating acute care hospitals worldwide. From a total of 705 included patients, 418 patients had confirmed AMI. In 69% AMI was the primary reason for admission, while in 31% AMI occurred after having been admitted with another diagnosis. Median time from onset of symptoms to hospital admission in patients admitted due to AMI was 24 h (interquartile range 9-48h) and time from admission to diagnosis was 6h (1-12 h). Occlusive arterial AMI was diagnosed in 231 (55.3%), venous in 73 (17.5%), non-occlusive (NOMI) in 55 (13.2%), other type in 11 (2.6%) and the subtype could not be classified in 48 (11.5%) patients. Surgery was the initial management in 242 (58%) patients, of which 59 (24.4%) underwent revascularization. Endovascular revascularization alone was carried out in 54 (13%), conservative treatment in 76 (18%) and palliative care in 46 (11%) patients. From patients with occlusive arterial AMI, revascularization was undertaken in 104 (45%), with 40 (38%) of them in one site admitting selected patients. Overall in-hospital and 90-day mortality of AMI was 49% and 53.3%, respectively, and among subtypes was lowest for venous AMI (13.7% and 16.4%) and highest for NOMI (72.7% and 74.5%). There was a high variability between participating sites for most variables studied.ConclusionsThe overall incidence of AMI and AMI subtypes varies worldwide, and case ascertainment is challenging. Pre-hospital delay in presentation was greater than delays after arriving at hospital. Surgery without revascularization was the most common management approach. Nearly half of the patients with AMI died during their index hospitalization. Together, these findings suggest a need for greater awareness of AMI, and better guidance in diagnosis and management.Trial registrationNCT05218863 (registered 19.01.2022).
| S-EPMC10807222 | biostudies-literature
Project description:To investigate CT findings in patients with pathologically proven mesenteric ischaemia post-cardiopulmonary bypass surgery and compare them with the control group of patients without ischaemia.68 patients were identified by a search of local surgical and pathological databases; these patients met the inclusion criteria of a laparotomy within 1 month of a procedure requiring cardiopulmonary bypass and a CT abdomen/pelvis within 1 week of the pathological diagnosis. Two radiologists independently reviewed the studies, evaluating 17 separate findings relating to the bowel, the vasculature or other structures; consensus was subsequently reached. The diagnostic value of CT findings was assessed using logistic regression.52 of 68 patients had pathologically proven ischaemia. Portal venous gas, mesenteric venous gas and small bowel faeces sign all had specificities of >0.94 for ischaemia but low sensitivity (<0.27). Differential mural enhancement had high sensitivity (0.92) but poor specificity (0.50). The combination of pneumatosis, bowel loop dilatation and differential mural enhancement predicted bowel ischaemia with a probability of 98%. The hardest signs to interpret based on poor interreader kappa agreement were bowel wall thinning, mesenteric stranding and differential mural enhancement.A combination of CT signs was predictive of ischaemic bowel; however, the more specific findings lacked sensitivity. If clinical suspicion is high for bowel ischaemia, prompt surgical intervention is warranted, regardless of CT findings.Arterial occlusion was uncommon and venous occlusion was not present, which is supportive of a predominantly non-occlusive aetiology for ischaemia in this patient group.
| S-EPMC3798331 | biostudies-other
Project description:We report the case of a 15-year-old female patient suffering from progressive anorexia, weight loss and recurrent abdominal pain, initially diagnosed as anorexia nervosa. She eventually presented with severe malnutrition and acute bowel obstruction, revealing a mass of the transverse colon. A well-differentiated Lieberkühn adenocarcinoma was established by histology. The patient underwent transverse and right colectomy and was treated with adjuvant chemotherapy. Colorectal cancer (CRC) is predominantly a disease of older adults and is extremely rare in children and adolescents. Seldom suspected, it is more likely to be diagnosed at an advanced stage, with unfavourable tumour histology and poor outcome. Young patients diagnosed with CRC should receive genetic counselling regardless of their family history or tumour type. This reports' take-home message is that recurrent and persistent digestive symptoms in the young should alert physicians and lead to further investigations.
| S-EPMC5990079 | biostudies-literature
Project description:BackgroundAcute mesenteric ischaemia (AMI) is a disease with different pathophysiological mechanisms, leading to a life-threatening condition that is difficult to diagnose based solely on clinical signs. Despite widely acknowledged need for biomarkers in diagnosis of AMI, a broad systematic review on all studied biomarkers in different types of AMI is currently lacking. The aim of this study was to estimate the diagnostic accuracy of all potential biomarkers of AMI studied in humans.MethodsA systematic literature search in PubMed, The Cochrane Library, Web of Science and Scopus was conducted in December 2022. Studies assessing potential biomarkers of AMI in (at least 10) adult patients and reporting their diagnostic accuracy were included. Meta-analyses of biomarkers' sensitivity, specificity, and positive and negative likelihood ratios were conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study quality was assessed with the QUADAS-2 tool.ResultsSeventy-five studies including a total of 9914 patients assessed 18 different biomarkers in serum/plasma and one in urine (each reported in at least two studies), which were included in meta-analyses. None of the biomarkers reached a conclusive level for accurate prediction. The best predictive value overall (all studies with any type and stage of AMI pooled) was observed for Ischaemia-modified albumin (2 studies, sensitivity 94.7 and specificity 90.5), interleukin-6 (n = 4, 96.3 and 82.6), procalcitonin (n = 6, 80.1 and 86.7), and intestinal fatty acid-binding protein (I-FABP) measured in serum (n = 16, 73.9 and 90.5) or in urine (n = 4, 87.9 and 78.9). In assessment of transmural mesenteric ischaemia, urinary I-FABP (n = 2, 92.3 and 85.2) and D-dimer (n = 3, 87.6 and 83.6) showed moderate predictive value. Overall risk of bias was high, mainly because of selected study populations and unclear timings of the biomarker measurements after onset of symptoms. Combinations of biomarkers were rarely studied, not allowing meta-analyses.ConclusionsNone of the studied biomarkers had sufficient sensitivity and specificity to diagnose AMI, although some biomarkers showed moderate predictive accuracy. Future studies should focus on timing of measurements of biomarkers, distinguishing between early stage and transmural necrosis, and between different types of AMI. Additionally, studies on combinations of biomarkers are warranted. PROSPERO registration: CRD42022379341.
| S-EPMC10474684 | biostudies-literature