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Furusawa K, Yoshimitsu M, Matsukawa H, Oi K, Yunoki K, Tamura A. Precise diagnosis of acute mesenteric ischemia using indocyanine green imaging prevents small bowel resection: A case report. Int J Surg Case Rep 2022; 97:107463. [PMID: 35961148 PMCID: PMC9403293 DOI: 10.1016/j.ijscr.2022.107463] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kohei Furusawa
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima-shi, Hiroshima-ken 730-8518, Japan.
| | - Masanori Yoshimitsu
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima-shi, Hiroshima-ken 730-8518, Japan
| | - Hiroyoshi Matsukawa
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima-shi, Hiroshima-ken 730-8518, Japan
| | - Kuniomi Oi
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima-shi, Hiroshima-ken 730-8518, Japan
| | - Keiji Yunoki
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima-shi, Hiroshima-ken 730-8518, Japan
| | - Akihisa Tamura
- Department of Radiology, Hiroshima City Hiroshima Citizens Hospital, 7-33, Moto-machi, Naka-ku, Hiroshima-shi, Hiroshima-ken 730-8518, Japan
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Complicaciones trombóticas secundarias a infección por COVID-19 en el embarazo: Reporte de un caso. ACTA COLOMBIANA DE CUIDADO INTENSIVO 2022. [PMCID: PMC9420718 DOI: 10.1016/j.acci.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La enfermedad secundaria a la infección por el coronavirus 2019 (COVID-19) se asocia a una alta tasa de transmisión y virulencia, por lo cual se ha extendido alrededor del mundo. Se asocia con una importante morbimortalidad relacionada, principalmente con SDRA y sepsis. En las pacientes gestantes, cada vez es más relevante la mayor vulnerabilidad para enfermedad grave secundaria a la infección, como consecuencia de los cambios fisiológicos del embarazo, con una tasa de mortalidad materna del 25%; adicionalmente, existe mayor evidencia acerca de las complicaciones isquémicas y trombóticas que se dan como consecuencia del estado inflamatorio difuso y de hipercoagulabilidad relacionada con la infección y las adaptaciones fisiológicas propias de la gestación. A continuación, se describe un caso de una mujer en tercer trimestre de embarazo que cursa con una disfunción orgánica múltiple debido a COVID-19, requiriendo manejo en Unidad de Cuidado Intensivo (UCI) obstétrico, aunque se logró dar egreso a la paciente luego de un cuadro de evolución tórpida, es importante su análisis como ejemplo claro de las múltiples complicaciones que se pueden presentar en la infección por SARS-CoV-2 durante la gestación. Por todo lo anterior, la infección por COVID-19 en mujeres embarazadas requiere una estrategia de manejo por un equipo multidisciplinario que permita el reconocimiento y manejo oportuno.
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Siebert M, Lucas N, Gelli M, Sourrouille I, Benhaïm L, Faron M, Micol JB, Ducreux M, Stoclin A, Honoré C. Acute Abdominal Complications in Deeply Neutropenic Onco-Hematology Patients: A Retrospective Series of 105 Cases. World J Surg 2022; 46:2389-2398. [PMID: 35816234 DOI: 10.1007/s00268-022-06653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Acute abdominal complications (AAC) in patients with deep neutropenia (DN) is challenging to manage because of the expected influence of AAC on oncological prognosis and higher surgical complication rate in a period of DN. In practice, these parameters are difficult to appreciate. This study reported our experience in managing these patients. METHODS All consecutive patients treated in our tertiary care cancer center between 2010 and 2020 who developed AAC in the context of a DN were retrospectively analyzed. AAC was defined as an infection (intra-abdominal, perineal, or cutaneous), bowel obstruction, or intra-abdominal hemorrhage. FINDINGS Among 105 patients, 18 (17%) required emergent surgery (group 1), 34 patients had a complication requiring surgical oversight (group 2), and 53 patients had a non-surgical etiology (group 3). Fifteen patients underwent surgery in the group 1, three in group 2, and one in group 3. Overall, 28 patients died during hospitalization. Mortality was statistically different between the groups (p = 0·01), with a higher rate in group 1 (n = 9/18, 50%) than in group 2 (n = 11/34, 32%) and group 3 (n = 8/53, 15%). All groups together had a median overall survival (OS) of 14 months and disease-free survival (DFS) of 10 months. OS was not comparable between the groups, and the median length of survival in group 1 was 6 months versus 8 months in group 2 and 23 months in group 3. In group 1, five patients (5/18, 28%) did not relapse at the end of the follow-up compared to 13 in group 2 (13/34, 38%) and 25 in group 3 (25/53, 47%). After discharge, OS and DFS were similar between the groups. INTERPRETATION The advent of an AAC necessitating surgery in the context of DN is a deadly event associated with a 50% mortality; nonetheless, in case of unpostponable emergencies, surgery can provide long-term survival in selected patients.
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Affiliation(s)
- Matthieu Siebert
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, 94805, Villejuif, France.
| | - Nolwenn Lucas
- Department of Intensive Care, Gustave Roussy Cancer Campus, Villejuif, France
| | - Maximiliano Gelli
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, 94805, Villejuif, France
| | - Isabelle Sourrouille
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, 94805, Villejuif, France
| | - Léonor Benhaïm
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, 94805, Villejuif, France
| | - Matthieu Faron
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, 94805, Villejuif, France
| | | | - Michel Ducreux
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Annabelle Stoclin
- Department of Intensive Care, Gustave Roussy Cancer Campus, Villejuif, France
| | - Charles Honoré
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, 94805, Villejuif, France
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Liao JN, Chan YH, Kuo L, Tsai CT, Lim SS, Chao TF. Risk of Ischemic Bowel Disease in Patients With Atrial Fibrillation Receiving Warfarin or Non-vitamin K Antagonist Oral Anticoagulants. Front Cardiovasc Med 2022; 9:874460. [PMID: 35865380 PMCID: PMC9294170 DOI: 10.3389/fcvm.2022.874460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/14/2022] [Indexed: 01/01/2023] Open
Abstract
BackgroundAlthough atrial fibrillation (AF) is a risk factor for ischemic bowel disease, data regarding the incidence of ischemic bowel disease in patients with anticoagulated AF were limited.MethodsThe present study used the Taiwan NHIRD and included newly diagnosed patients with AF aged ≥ 20 years without ischemic bowel disease from 2012 to 2018. A total of 69,549 patients taking warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) constituted the final study group. We aimed to study the incidence of ischemic bowel disease in patients with AF receiving warfarin or NOACs. Secondary endpoints were also analyzed, including ischemic stroke, systemic embolism, myocardial infarction, mortality, intracranial hemorrhage (ICH), major bleeding, and composite adverse events (ischemic bowel disease or ICH or major bleeding).ResultsThere were 43,787 patients taking NOACs and 25,762 patients taking warfarin. The overall incidence rate of ischemic bowel disease was 0.036% per year and increased with the CHA2DS2-VASc scores [0.013% for patients with a CHA2DS2-VASc score of 0 (men) or 1 (women), 0.022% for those with a CHA2DS2-VASc score of 1 (men) or 2 (women), and 0.039% for those with a CHA2DS2-VASc score ≥ 2 (men) or ≥ 3 (women)]. The risk of ischemic bowel disease was similar between NOAC and warfarin groups (0.036%/year vs. 0.037%/year; adjusted hazard ratio 0.802, p = 0.430), whereas the NOAC group had a significantly lower risk of secondary endpoints compared to the warfarin group.ConclusionWe reported the incidence of ischemic bowel disease in patients with anticoagulated AF from a nationwide cohort database and observed a positive correlation between the increase of CHA2DS2-VASc scores and the incidence rate. Moreover, NOAC was as effective as warfarin for the risk of ischemic bowel disease.
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Affiliation(s)
- Jo-Nan Liao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Hsin Chan
- The Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Microscopy Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ling Kuo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chuan-Tsai Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Su-Shen Lim
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Tze-Fan Chao,
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Giulio F, Ruggiero S, Vicini S, Bellini D, Rengo M, Carbone I. Unusual computed tomography findings of gas in the superior mesenteric artery system with no signs of porto-mesenteric venous gas in a case of acute mesenteric ischemia. Radiol Case Rep 2022; 17:2568-2572. [PMID: 35634014 PMCID: PMC9130093 DOI: 10.1016/j.radcr.2022.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 11/24/2022] Open
Abstract
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.
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106
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Otto CC, Czigany Z, Heise D, Bruners P, Kotelis D, Lang SA, Ulmer TF, Neumann UP, Klink C, Bednarsch J. Prognostic Factors for Mortality in Acute Mesenteric Ischemia. J Clin Med 2022; 11:jcm11133619. [PMID: 35806904 PMCID: PMC9267588 DOI: 10.3390/jcm11133619] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/07/2022] [Accepted: 06/20/2022] [Indexed: 12/23/2022] Open
Abstract
Postoperative mortality in patients undergoing surgical and/or interventional treatment for acute mesenteric ischemia (AMI) has remained an unsolved problem in recent decades. Here, we investigated clinical predictors of postoperative mortality in a large European cohort of patients undergoing treatment for AMI. In total, 179 patients who underwent surgical and/or interventional treatment for AMI between 2009 and 2021 at our institution were included in this analysis. Associations between postoperative mortality and various clinical variables were assessed using univariate and multivariable binary logistic regression analysis. Most of the patients were diagnosed with arterial ischemia (AI; n = 104), while venous ischemia (VI; n = 21) and non-occlusive mesenteric ischemia (NOMI; n = 54) were present in a subset of patients. Overall inhouse mortality was 55.9% (100/179). Multivariable analyses identified leukocytes (HR = 1.08; p = 0.008), lactate (HR = 1.25; p = 0.01), bilirubin (HR = 2.05; p = 0.045), creatinine (HR = 1.48; p = 0.039), etiology (AI, VI or NOMI; p = 0.038) and portomesenteric vein gas (PMVG; HR = 23.02; p = 0.012) as independent predictors of postoperative mortality. In a subanalysis excluding patients with fatal prognosis at the first surgical exploration (n = 24), leukocytes (HR = 1.09; p = 0.004), lactate (HR = 1.27; p = 0.003), etiology (AI, VI or NOMI; p = 0.006), PMVG (HR = 17.02; p = 0.018) and intraoperative FFP transfusion (HR = 4.4; p = 0.025) were determined as independent predictors of postoperative mortality. Further, the risk of fatal outcome changed disproportionally with increased preoperative lactate values. The clinical outcome of patients with AMI was determined using a combination of pre- and intraoperative clinical and radiological characteristics. Serum lactate appears to be of major clinical importance as the risk of fatal outcome increases significantly with higher lactate values.
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Affiliation(s)
- Carlos Constantin Otto
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (C.C.O.); (Z.C.); (D.H.); (S.A.L.); (T.F.U.); (U.P.N.); (C.K.)
| | - Zoltan Czigany
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (C.C.O.); (Z.C.); (D.H.); (S.A.L.); (T.F.U.); (U.P.N.); (C.K.)
| | - Daniel Heise
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (C.C.O.); (Z.C.); (D.H.); (S.A.L.); (T.F.U.); (U.P.N.); (C.K.)
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, 52074 Aachen, Germany;
| | - Drosos Kotelis
- Department of Vascular Surgery, University Hospital RWTH Aachen, 52074 Aachen, Germany;
- Department of Vascular Surgery, University Hospital Bern, 3010 Bern, Switzerland
| | - Sven Arke Lang
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (C.C.O.); (Z.C.); (D.H.); (S.A.L.); (T.F.U.); (U.P.N.); (C.K.)
| | - Tom Florian Ulmer
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (C.C.O.); (Z.C.); (D.H.); (S.A.L.); (T.F.U.); (U.P.N.); (C.K.)
| | - Ulf Peter Neumann
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (C.C.O.); (Z.C.); (D.H.); (S.A.L.); (T.F.U.); (U.P.N.); (C.K.)
- Department of Surgery, Maastricht University Medical Center (MUMC), 6229 HX Maastricht, The Netherlands
| | - Christian Klink
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (C.C.O.); (Z.C.); (D.H.); (S.A.L.); (T.F.U.); (U.P.N.); (C.K.)
- Department of Surgery, Diakonissen-Stiftungs-Krankenhaus Speyer, 67346 Speyer, Germany
| | - Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, 52074 Aachen, Germany; (C.C.O.); (Z.C.); (D.H.); (S.A.L.); (T.F.U.); (U.P.N.); (C.K.)
- Correspondence: ; Tel.: +49-241-80-89501
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de la Garza MA, Hegge SR, Bakker J. Inguinal Hernia in Nonhuman Primates: From Asymptomatic to Life-Threatening Events. Vet Sci 2022; 9:vetsci9060280. [PMID: 35737332 PMCID: PMC9228773 DOI: 10.3390/vetsci9060280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/24/2022] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
In this study, a review of available data and literature on the epidemiology and anamnesis of inguinal hernias in nonhuman primates, as well as on their clinical evaluation and surgical management, was conducted. Inguinal hernias are assumed to be relatively common in male nonhuman primates. Clinical signs are usually limited to a visible or palpable mass in the groin region without pain or systemic illness. Most hernias contain omentum. Careful monitoring is an acceptable treatment option for those animals. Size, the danger of incarceration, and the presence of strangulation are important factors when considering surgical repair. A strangulated inguinal hernia is an emergency, requiring prompt surgery to avoid tissue necrosis and death. Imaging techniques, as well as computed tomography (CT), ultrasonography, and magnetic resonance imaging (MRI), provide information about the anatomical characteristics of the suspected region, allowing for a diagnosis and treatment. An inguinal hernia repair can be performed with either open surgery or laparoscopic surgery. The hernia repair can be achieved by mesh or suture. Decisions regarding which repair technique to use depend on the surgeon′s skill level and preference. Complication and recurrence rates are generally low. The most common postsurgical complication is a recurrence of the hernia. Contraceptive measures are not indicated in breeders, as there is no known hereditary component, and the presence of hernia does not appear to affect fertility, nor does it predispose to occurrence, recurrence, or incarceration.
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Affiliation(s)
| | | | - Jaco Bakker
- Animal Science Department (ASD), Biomedical Primate Research Centre (BPRC), 2288 GJ Rijswijk, The Netherlands
- Correspondence: ; Tel.: +31-15-284 2579
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Salem R, Hameed W, Ravikumar R, Bharathkumar M, Devachandran J, Samraj K. Management of Mesenteric Venous Ischaemia: A Case Series With Newer Approaches. Cureus 2022; 14:e25704. [PMID: 35832762 PMCID: PMC9272985 DOI: 10.7759/cureus.25704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/05/2022] Open
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Giordano G, La Mirata E, Politi V, Veroux M, Meli GA, Evola G, Palmucci S, Basile A, Basile G. Left Paraduodenal Hernia in a Young Patient with Recurrent Abdominal Pain: A Case Report and Short Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2022; 23:e935413. [PMID: 35660720 PMCID: PMC9175513 DOI: 10.12659/ajcr.935413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/30/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Internal hernias are a rare cause of small bowel obstruction in patients, which usually have a long history of mild abdominal symptoms, sometimes leading to emergency surgery due to acute abdominal pain. Occasionally, it takes a long time to make the correct diagnosis because of symptoms vagueness and transience of typical imaging findings; at times, a definitive diagnosis is possible only through surgery, especially in cases of acute presentations in a low-resource setting where high-performance diagnostic equipment may be unavailable. CASE REPORT We report the case of a young male patient with a long history of mild abdominal symptoms and some episodes of acute abdominal pain. Following one of these episodes, several diagnostic examinations were performed and he was diagnosed with left paraduodenal hernia after typical signs were found on imaging exams, both CT and MRI; the patient underwent laparotomy with reduction of intestinal loops in the peritoneal cavity and suturing of the sac and was eventually discharged with no further symptoms whatsoever. CONCLUSIONS Among internal hernias, left paraduodenal hernias account for the major part and are characterized by the protrusion of bowel loops through the fossa of Landzert; herniated loops produce a sac-like appearance (typical imaging sign on both CT and MRI) and may cause partial displacement of other organs and blood vessels. Internal hernias should always be considered as a rare differential diagnosis in the workup of a patient with abdominal pain or intestinal obstruction: knowledge of both typical imaging features and specific surgical techniques are mandatory so that these patients may be properly cared for.
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Affiliation(s)
- Gabriele Giordano
- Department of Medical-Surgical Sciences and Advanced Technologies “G.F. Ingrassia” – Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Elena La Mirata
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Valentina Politi
- UOC MCAU (Urgent Surgery), University Teaching Hospital Policlinico “G. Rodolico-San Marco”, University of Catania, Catania, Italy
| | - Massimiliano Veroux
- Organ Transplantation Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Gaetano Alfio Meli
- Department of Medical-Surgical Sciences and Advanced Technologies “G.F. Ingrassia” – Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Giuseppe Evola
- Department of General and Emergency Surgery, Garibaldi Hospital, Catania, Italy
| | - Stefano Palmucci
- Department of Medical-Surgical Sciences and Advanced Technologies “G.F. Ingrassia” – Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Antonio Basile
- Department of Medical-Surgical Sciences and Advanced Technologies “G.F. Ingrassia” – Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Catania, Italy
| | - Guido Basile
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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Damage-control surgery in patients with nontraumatic abdominal emergencies: A systematic review and meta-analysis. J Trauma Acute Care Surg 2022; 92:1075-1085. [PMID: 34882591 DOI: 10.1097/ta.0000000000003488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND After the successful implementation in trauma, damage-control surgery (DCS) is being increasingly used in patients with nontraumatic emergencies. However, the role of DCS in the nontrauma setting is not well defined. The aim of this study was to investigate the effect of DCS on mortality in patients with nontraumatic abdominal emergencies. METHODS Systematic literature search was done using PubMed. Original articles addressing nontrauma DCS were included. Two meta-analyses were performed, comparing (1) mortality in patients undergoing nontrauma DCS versus conventional surgery (CS) and (2) the observed versus expected mortality rate in the DCS group. Expected mortality was derived from Acute Physiology And Chronic Health Evaluation, Simplified Acute Physiology Score, and Portsmouth Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity scores. RESULTS A total of five nonrandomized prospective and 16 retrospective studies were included. Nontrauma DCS was performed in 1,238 and nontrauma CS in 936 patients. Frequent indications for surgery in the DCS group were (weighted proportions) hollow viscus perforation (28.5%), mesenteric ischemia (26.5%), anastomotic leak and postoperative peritonitis (19.6%), nontraumatic hemorrhage (18.4%), abdominal compartment syndrome (17.8%), bowel obstruction (15.5%), and pancreatitis (12.9%). In meta-analysis 1, including eight studies, mortality was not significantly different between the nontrauma DCS and CS group (risk difference, 0.09; 95% confidence interval, -0.06 to 0.24). Meta-analysis 2, including 14 studies, revealed a significantly lower observed than expected mortality rate in patients undergoing nontrauma DCS (risk difference, -0.18; 95% confidence interval, -0.29 to -0.06). CONCLUSION This meta-analysis revealed no significantly different mortality in patients undergoing nontrauma DCS versus CS. However, observed mortality was significantly lower than the expected mortality rate in the DCS group, suggesting a benefit of the DCS approach. Based on these two findings, the effect of DCS on mortality in patients with nontraumatic abdominal emergencies remains unclear. Further prospective investigation into this topic is warranted. LEVEL OF EVIDENCE Systematic review and meta-analysis, level III.
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111
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Mak AK, Andraska EA, Reitz KM, Chaer R, Eslami MH, Avgerinos E. A single institutional experience with suction thrombectomy in acute mesenteric ischemia. ANNALS OF VASCULAR SURGERY. BRIEF REPORTS AND INNOVATIONS 2022; 2:100070. [PMID: 36733720 PMCID: PMC9890405 DOI: 10.1016/j.avsurg.2022.100070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Acute mesenteric ischemia (AMI) is typically treated by open surgery or hybrid techniques. Catheter-based aspiration thrombectomy represents another minimally invasive alternative with a potential additional safety benefit of minimizing the bleeding risk associated with thrombolytics. In this institutional case series, we present five clinical cases of aspiration thrombectomy for high-risk AMI using the Penumbra aspiration system. All patients underwent technically successful endovascular thrombectomy as demonstrated by intraoperative angiography results. However, bowel necrosis and sepsis adversely affected postoperative outcomes. Lack of intraoperative bowel assessment is a limitation of endovascular methods, highlighting the importance of patient selection.
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Affiliation(s)
- Allison K Mak
- University of Pittsburgh School of Medicine, United States
| | - Elizabeth A Andraska
- Department of Surgery, Division of Vascular Surgery, UPMC Heart and Vascular Institute, UPMC Presbyterian Hospital, Room E362.4, South Tower, 200 Lothrop Street, Pittsburgh, PA 15213-2582, United States
| | - Katherine M Reitz
- Department of Surgery, Division of Vascular Surgery, UPMC Heart and Vascular Institute, UPMC Presbyterian Hospital, Room E362.4, South Tower, 200 Lothrop Street, Pittsburgh, PA 15213-2582, United States
| | - Rabih Chaer
- Department of Surgery, Division of Vascular Surgery, UPMC Heart and Vascular Institute, UPMC Presbyterian Hospital, Room E362.4, South Tower, 200 Lothrop Street, Pittsburgh, PA 15213-2582, United States
| | - Mohammed H Eslami
- Department of Surgery, Division of Vascular Surgery, UPMC Heart and Vascular Institute, UPMC Presbyterian Hospital, Room E362.4, South Tower, 200 Lothrop Street, Pittsburgh, PA 15213-2582, United States
| | - Efthymios Avgerinos
- Department of Surgery, Division of Vascular Surgery, UPMC Heart and Vascular Institute, UPMC Presbyterian Hospital, Room E362.4, South Tower, 200 Lothrop Street, Pittsburgh, PA 15213-2582, United States
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Yang JS, Xu ZY, Chen FX, Wang MR, Cong RC, Fan XL, He BS, Xing W. Role of clinical data and multidetector computed tomography findings in acute superior mesenteric artery embolism. World J Clin Cases 2022; 10:4020-4032. [PMID: 35665105 PMCID: PMC9131226 DOI: 10.12998/wjcc.v10.i13.4020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/25/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Superior mesenteric artery embolism (SMAE) has acute onset and fast progression, which seriously threatens the life of patients. Multidetector computed tomography (MDCT) is one of the most important diagnostic methods for SMAE, which plays an important role in the diagnosis and prognosis of SMAE.
AIM To evaluate the value of combined clinical data and MDCT findings in the diagnosis of acute SMAE and predict the risk factors for SMAE-related death.
METHODS Data from 53 SMAE patients who received abdominal MDCT multi-phase enhancement and superior mesenteric artery digital subtraction angiography examinations were collected. Univariate cox regression and multivariate cox model were used to analyze the correlation between death risk and clinical and computed tomography features in SMAE patients.
RESULTS Univariate Cox regression model showed that intestinal wall thinning, intestinal wall pneumatosis, blood lactate > 2.1 mmol/L and blood pH < 7.35 increased the risk of death in patients with SMAE. After adjusting for age, sex, embolic involvement length and embolic distribution region, multivariate Cox regression model I showed that blood lactate > 2.1 mmol/L (HR = 5.26, 95%CI: 1.04-26.69, P = 0.045) and intestinal wall thinning (HR = 9.40, 95%CI: 1.05-83.46, P = 0.044) were significantly increases the risk of death in patients with SMAE.
CONCLUSION For patients with SAME, increased blood lactate and intestinal wall thinning are the risk factors for death; hence, close monitoring may reduce the mortality rate. Clinical observation combined with MDCT signs can significantly improve SMAE diagnosis.
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Affiliation(s)
- Ju-Shun Yang
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu Province, China
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Zhen-Yu Xu
- Department of Ultrasonography, The Second People's Hospital of Nantong, Nantong 226002, Jiangsu Province, China
| | - Fei-Xiang Chen
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Mei-Rong Wang
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Ruo-Chen Cong
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Xiao-Le Fan
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Bo-Sheng He
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Wei Xing
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu Province, China
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Miao SL, Ye XN, Lin TT, Qiu YH, Huang JY, Zheng XW, Chen FF. The psoas muscle density as a predictor of postoperative complications and 30-day mortality for acute mesenteric ischemia patients. Abdom Radiol (NY) 2022; 47:1644-1653. [PMID: 32892241 DOI: 10.1007/s00261-020-02714-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/09/2020] [Accepted: 08/21/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Low muscle mass and quality is associated with poor surgical outcomes. Psoas muscle density (PMD)is a validated surrogate for muscle quality that can be easily measured from a clinical computed tomography (CT) scan. The objective of this study was to investigate the association between PMD and short-term postoperative outcomes in patients with acute mesenteric ischemia (AMI). METHODS From April 2006 and September 2019, the clinical data of all patients who underwent surgical intervention with a preoperative diagnosis of AMI and had preoperative non-contrast CT images available were retrospectively reviewed. PMD was measured by CT at the third lumbar vertebra. The lowest quartile of PMD for men and women in all patients was used as sex-specific cut-off values for low PMD. Univariate and multivariate analyses evaluating risk factors of postoperative complications and 30-day mortality were performed. RESULTS The cohort consisted of 88 patients with a mean age of 58.8 ± 16.2 years, of whom 21 (23.9%) patients had low PMD based on the diagnostic cut-off values (40.5 HU for men and 28.4 HU for women), 35 (39.8%) patients developed complications within 30 days of the operation, and 10 (11.3%) patients died within 30 days of surgery. Low PMD patients had a higher risk of postoperative complications and 30-day mortality than patients without low PMD patients. In a multivariate analysis, low PMD and low psoas muscle area (PMA) were independent predictors of postoperative complications. However, only low PMD remained an independent risk factor for 30-day mortality. CONCLUSIONS Preoperative assessment of the PMD on CT can be a practical method for identifying AMI patients at risk for postoperative complications and 30-day mortality.
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Affiliation(s)
- Shou-Liang Miao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325015, Zhejiang, People's Republic of China
| | - Xiao-Ning Ye
- The First Clinical Medical Institute, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ting-Ting Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325015, Zhejiang, People's Republic of China
| | - Yi-Hui Qiu
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325015, Zhejiang, People's Republic of China
| | - Jing-Yong Huang
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325015, Zhejiang, People's Republic of China
| | - Xiang-Wu Zheng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325015, Zhejiang, People's Republic of China.
| | - Fan-Feng Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325015, Zhejiang, People's Republic of China.
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Shaheen NH, Stroebel M, Welsh C, Gibney B, Hardie AD. Use of novel photon – counting detector CT for diagnosis of bowel infarction. Radiol Case Rep 2022; 17:1674-1677. [PMID: 35342489 PMCID: PMC8942790 DOI: 10.1016/j.radcr.2022.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 11/24/2022] Open
Abstract
A 75 year old male with a history of thoraco-abdominal surgery presented with acute onset epigastric pain. CT of the abdomen and pelvis with contrast performed on a novel photon-counting detector CT demonstrated dilated loops of small bowel herniating into the thoracic cavity through a defect in the left hemidiaphragm. On conventional CT reconstructions, the bowel wall demonstrated a thin rim of hyper-density which could have been interpreted as normal mucosal enhancement in viable bowel. However, spectral-imaging data including the iodine map revealed a complete lack of enhancement within the herniated loops of bowel compatible with infarction. With the added diagnostic information, the patient was taken rapidly to surgery for small bowel resection, with good outcome.
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Computed-tomography angiography in arterial acute intestinal ischemia: prognostic interest of vascular semiology. Abdom Radiol (NY) 2022; 47:1614-1624. [PMID: 34687324 DOI: 10.1007/s00261-021-03312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate vascular features on abdominal Computed-Tomography Angiography (CTA) correlated with 48-h mortality in patients who underwent arterial acute intestinal ischemia (AAII) surgery. The secondary objective was to create a prognostic score on the 48-h mortality after surgery, based on the most relevant signs. METHOD We included 104 patients who underwent surgery for acute mesenteric ischemia. 2 radiologists retrospectively blind reviewed the preoperative CTA scans. They used a standardized analysis grid for the arterial and venous vascular signs described in angiography. When signs were present, the affected abdominal quadrant was specified in coronal reconstruction. Each sign was analyzed for 48-h mortality on CTA. A score based on signs correlated with early mortality was developed and evaluated by ROC curve analysis. RESULTS 22 patients died within 48 h. The number of superior mesenteric artery (SMA) branches was significantly reduced in deceased patients (p = 0.006). Other prognostic factors associated with 48-h mortality were decreased venous return in area number 1 corresponding to right colic flexure, proximal half of the transverse colon, proximal ileum (p = 0.04) and decreased venous return in more than 2 zones (p = 0.01). The weighted AAII48 score included 1 protective clinical item and 5 radiological items. The area under the ROC curve was 0.784 with, for a 6-point threshold value, a sensitivity of 68% and a specificity of 77%. The intraclass correlation coefficient for interobserver reproducibility of the score was 0.81 [95% CI 0.73; 0.87]. CONCLUSION Three vascular signs on CTA were found to be prognostic factors for early mortality: SMA branches number ≤ 5 (p = 0.006), decreased venous return in area 1 (p = 0.04), and > 2 areas of decreased venous return (p = 0.01). They were incorporated into the AAII48 score. This score could help to identify patients at risk and to adapt subsequent management.
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116
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Lendzion RJ, Frahm-Jensen G, Keck J. Acute Mesenteric Ischemia. Clin Colon Rectal Surg 2022; 35:227-236. [PMID: 35966379 PMCID: PMC9374525 DOI: 10.1055/s-0042-1743283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The surgical treatment of occlusive acute mesenteric ischemia (AMI) without revascularization is associated with an 80% overall mortality. Early diagnosis is crucial, and revascularization may reduce overall mortality in AMI by up to 50%. A diagnosis of AMI requires a high index of clinical suspicion and the collaborative effort of emergency department physicians, general and vascular surgeons, and radiologists. This article provides an overview of the etiology, physiology, evaluation, and management of acute mesenteric ischemia.
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Affiliation(s)
| | | | - James Keck
- Colorectal Department, St. Vincent's Health, Melbourne, Australia
- Department of Colorectal Surgery, Eastern Health, Melbourne, Australia
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117
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Imamura H, Hata J, Takata T. Contrast-enhanced ultrasonographic findings of non-occlusive mesenteric ischemia: a case series. Abdom Radiol (NY) 2022; 47:1654-1659. [PMID: 33835224 DOI: 10.1007/s00261-021-03002-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Diagnosis of non-occlusive mesenteric ischemia (NOMI) is difficult, with diagnostic imaging being mainly performed using angiography or contrast-enhanced computed tomography. Contrast-enhanced ultrasonography (CEUS) offers an alternative diagnostic method, although diagnosis of NOMI using CEUS is not common. In this report, we review CEUS findings in a series of patients with NOMI. METHODS The records of patients diagnosed with NOMI who underwent a surgical procedure in our institution between January 2015 and February 2020 were retrospectively assessed. Grayscale ultrasonography and CEUS findings were evaluated. RESULTS Ten patients (mean age 65 ± 25 years, 7 men) were studied. Grayscale ultrasonography revealed bowel dilatation, the presence of intestinal pneumatosis, portal venous gas, bowel wall thickening, and no or decreased peristalsis. A CEUS finding of note was a partial lack of enhancement of the bowel wall. CONCLUSION In a small case series of 10 patients with surgically/histopathology confirmed NOMI, partial lack of ultrasound contrast-enhancement of the bowel wall was observed.
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118
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Dual-energy CT of acute bowel ischemia. Abdom Radiol (NY) 2022; 47:1660-1683. [PMID: 34191075 DOI: 10.1007/s00261-021-03188-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/17/2022]
Abstract
Acute bowel ischemia is a condition with high mortality and requires rapid intervention to avoid catastrophic outcomes. Swift and accurate imaging diagnosis is essential because clinical findings are commonly nonspecific. Conventional contrast enhanced CT of the abdomen has been the imaging modality of choice to evaluate suspected acute bowel ischemia. However, subtlety of image findings and lack of non-contrast or arterial phase images can make correct diagnosis challenging. Dual-energy CT provides valuable information toward assessing bowel ischemia. Dual-energy CT exploits the differential X-ray attenuation at two different photon energy levels to characterize the composition of tissues and reveal the presence or absence of faint intravenous iodinated contrast to improve reader confidence in detecting subtle bowel wall enhancement. With the same underlying technique, virtual non-contrast images can help to show non-enhancing hyperdense hemorrhage of the bowel wall in intravenous contrast-enhanced scans without the need to acquire actual non-contrast scans. Dual-energy CT derived low photon energy (keV) virtual monoenergetic images emphasize iodine contrast and provide CT angiography-like images from portal venous phase scans to better evaluate abdominal arterial patency. In Summary, dual-energy CT aids diagnosing acute bowel ischemia in multiple ways, including improving visualization of the bowel wall and mesenteric vasculature, revealing intramural hemorrhage in contrast enhanced scans, or possibly reducing intravenous contrast dose.
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119
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The experience from a case of acute superior mesenteric artery embolism caused by constipation after hemorrhoid surgery. Asian J Surg 2022; 45:2420-2422. [DOI: 10.1016/j.asjsur.2022.05.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/13/2022] [Indexed: 12/24/2022] Open
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120
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Kayali F, Sarodaya V, Shah HI, Hayat MY, Leung MST, Harky A. Predicting outcomes of mesenteric ischemia postcardiac surgery: A systematic review. J Card Surg 2022; 37:2025-2039. [PMID: 35488799 DOI: 10.1111/jocs.16516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This systematic review aims to identify predictors of outcomes of mesenteric ischemia in patients following cardiac surgery. METHODS A comprehensive literature search was done on EMBASE, PubMed, Ovid MEDLINE, and SCOPUS using keywords relating to bowel ischemia and cardiac surgery. Database search results were screened by at least two authors and 32 articles were selected for inclusion in this review. RESULTS Data on 1907 patients were analyzed. The mean age was 70.0 ± 2.99 years and the prevalence of bowel ischemia was 1.74%. Advanced age was a significant risk factor. 63.16% of patients reported were men, and 58.4% of patients died in hospital. There was heterogeneity in the reported significance of the following preoperative risk factors: hypertension, smoking status, type 2 diabetes mellitus, end-stage renal disease, preoperative left ventricular ejection fraction <35%. Cardiopulmonary bypass (CPB) time, preoperative/operative intra-aortic balloon pump (IABP) support, and inotrope usage were significantly associated with the development of mesenteric ischemia; however, other intraoperative factors including the type of cardiac surgery and duration of aortic cross-clamping had varying levels of reported significance. There were discrepancies in the reported significance of leukocytosis and metabolic acidosis (pH <7.3) as postoperative markers. Postoperative vasopressor use, prolonged ventilation time, and elevation in lactate, transaminases, creatinine, and intestinal fatty acid-binding protein (IFABP) levels were found to be strongly associated with bowel ischemia. CONCLUSION This systematic review found the strongest associations of mesenteric ischemia postcardiac surgery to be advanced age, CPB time, rise in lactate, transaminases, creatinine, and IFABP. IABP support, vasopressor, and inotrope use as well as prolonged ventilation were strongly linked too.
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Affiliation(s)
- Fatima Kayali
- UCLan Medical School, University of Central Lancashire, Preston, UK
| | - Varun Sarodaya
- Department of Critical Care Medicine, Barts Health NHS Trust, London, UK
| | - Hussain I Shah
- UCL Medical School, University College London, London, UK
| | - Muhammad Y Hayat
- Faculty of Medicine, St George's Hospital Medical School, London, UK
| | - Marco S T Leung
- Department of Surgery, Imperial Healthcare Trust, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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121
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González-Pacheco H, Gopar-Nieto R, Torres-Machorro A, Pérez-Pinetta PE, Arias-Mendoza A. Acute Mesenteric Ischemia Prior to Emergency Cardiac Surgery for Infective Endocarditis: Can We Design a Strategy to Improve Outcomes? Cureus 2022; 14:e24532. [PMID: 35506119 PMCID: PMC9053355 DOI: 10.7759/cureus.24532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 12/03/2022] Open
Abstract
Infective endocarditis (IE) can be complicated by systemic embolization. Unfortunately, in some situations, it requires radical and urgent therapeutic approaches. Herein, we describe a case of IE complicated by acute mesenteric ischemia (AMI) due to septic embolism prior to emergent cardiac surgery. A previously healthy 38-year-old woman was admitted to our emergency department with a diagnosis of mitral valve IE. She presented with tachycardia and was tachypneic. In addition, a systolic murmur in the mitral area and Janeway lesions were documented. Transthoracic and transesophageal echocardiography confirmed large mobile vegetations on the mitral valve and the presence of mitral regurgitation. A thoracic computed tomography scan showed splenic and bilateral renal infarctions. Emergency mitral valve replacement was scheduled. Prior to surgery, AMI developed because of occlusion of the superior mesenteric artery (SMA). Endovascular treatment was performed with percutaneous aspiration, thrombectomy, and in situ fibrinolysis, yielding satisfactory results. Ten hours later, she underwent cardiac surgery. AMI developed postoperatively due to re-occlusion of the SMA, requiring an open laparotomy with mesenteric revascularization and extensive resection of the necrotic bowel. The patient died 18 days after hospitalization. In the IE setting, AMI is a very rare, potentially life-threatening complication. This case highlights the importance of recognizing this complication and designing a better therapeutic strategy to reduce the associated mortality rate.
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122
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Martin SJ, Stephen VS. Pitfalls in medicine: pain out of proportion to examination findings. Br J Hosp Med (Lond) 2022; 83:1-8. [DOI: 10.12968/hmed.2021.0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Most life-threatening conditions form a coherent clinical picture, with examination findings confirming the patient's history. However, pain out of proportion to examination findings can also signify an emergency – acute compartment syndrome, bowel ischaemia, necrotising fasciitis and acute aortic dissection may all present in this way. A lack of situational awareness leads doctors to erroneously rely on examination findings to flag impending catastrophe, but in such cases misdiagnosis or delayed treatment can have dire consequences. Patients with unexplained pain risk significant morbidity and mortality, and doctors are vulnerable to litigation and reputational damage. This article addresses this danger, exploring the causes and pathology of pain that is out of proportion, and presenting an approach to mitigate risk and prevent catastrophe.
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Affiliation(s)
- Stephen-John Martin
- School of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
| | - Victoria S Stephen
- Division of Emergency Medicine, Far East Rand Hospital, University of the Witwatersrand, South Africa
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123
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The healing effects of Ganoderma lucidum on intestinal ischemia-reperfusion damage in rats. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1029203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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124
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Kyuno T, Otsuka K, Kobayashi M, Yoshida E, Sato K, Kawagishi R, Kono T, Chiba T, Kimura T, Yonezawa H, Funato O, Takagane A. Time limit to rescue intestine with viability at risk caused by blood flow disruption in patients presenting with acute abdomen. Surg Today 2022; 52:1627-1633. [PMID: 35338428 PMCID: PMC9592629 DOI: 10.1007/s00595-022-02495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/27/2022] [Indexed: 11/24/2022]
Abstract
Purpose Early management is crucial for acute intestinal blood flow disorders; however, no published study has identified criteria for the time limit for blood flow resumption. This study specifically examines the time factors for avoiding intestinal resection. Methods The subjects of this retrospective cohort study were 125 consecutive patients who underwent emergency surgery for a confirmed diagnosis of intestinal strangulation (n = 86), incarceration (n = 27), or volvulus (n = 12), between January 2015 and March 2021. Intestinal resection was performed when intestinal irreversible changes had occurred even after ischemia was relieved surgically. We analyzed the relationship between the time from computed tomography (CT) imaging to the start of surgery (C-S time) and intestinal resection using the Kaplan–Meier method and calculated the estimated intestinal rescue rate. Patient background factors affecting intestinal resection were also examined. Results The time limit for achieving 80% intestinal rescue rate was 200 min in C-S time, and when this exceeded 300 min, the intestinal rescue rate dropped to less than 50%. Multivariate analysis identified the APACHE II score as a significant influencing factor. Conclusion A rapid transition from early diagnosis to early surgery is critical for patients with acute abdomen originating from intestinal blood flow disorders. The times from presentation at the hospital to surgery should be reduced further, especially for severe cases.
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Affiliation(s)
- Takuro Kyuno
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan.
| | - Kanki Otsuka
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Makoto Kobayashi
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Eiji Yoshida
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Kei Sato
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Ryoko Kawagishi
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Tsuyoshi Kono
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Takehiro Chiba
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Toshimoto Kimura
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Hitoshi Yonezawa
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Osamu Funato
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
| | - Akinori Takagane
- Department of Surgery, Hakodate Goryoukaku Hospital, 38-3, Goryoukaku-cho, Hakodate, Japan
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Mehdorn M, Gockel I, Jansen-Winkeln B, Meyer HJ. Akute Mesenterialischämie. COLOPROCTOLOGY 2022. [DOI: 10.1007/s00053-022-00594-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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126
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Bent C. Severe abdominal pain in a healthy man. J Am Coll Emerg Physicians Open 2022; 3:e12670. [PMID: 35141705 PMCID: PMC8817626 DOI: 10.1002/emp2.12670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/06/2022] [Accepted: 01/10/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Chris Bent
- Riverside University Health System Moreno Valley California USA
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127
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l-lactate kinetics after abdominal aortic surgery and intestinal ischemia - An observational cohort study. Int J Surg 2022; 98:106220. [PMID: 34999001 DOI: 10.1016/j.ijsu.2021.106220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/12/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Postoperative intestinal ischemia is a severe complication in abdominal aortic surgery. Early diagnosis is needed for adequate and timely treatment. We studied the postoperative kinetics of l-lactate in vascular patients to assess its value as a marker for early postoperative intestinal ischemia detection. MATERIAL AND METHODS We performed a prospective non-randomized single-center observational cohort study in eighty elective patients, fifty operated on for abdominal aortic aneurysm (AAA) and thirty for aortoiliac occlusive disease (AIOD). Serum l-lactate was measured preoperatively, intraoperatively, and postoperatively at defined timepoints up to postoperative day 7. Intestinal ischemia was detected using MRI enterocolography. We have used univariate logistic regression and receiver operating characteristics curves for the evaluation of marker accuracy. RESULTS We recorded 6 cases of postoperative intestinal ischemia (7.5%), five non-transmural and one transmural. Two patients died because of this complication (mortality 33%). The comparison of AAA and AIOD cohorts showed a significant difference in l-lactate levels at one intraoperative timepoint, which was attributable to procedure differences. The only preoperative factor associated with higher l-lactate levels at some timepoints was chronic kidney disease. Patients suffering postoperative intestinal ischemia had elevated serum l-lactate levels at multiple timepoints. The most accurate timepoint for diagnosis was 24 h after the declamping of the vascular reconstruction (DC24H), the second was 10 min after declamping. Sensitivity, specificity, positive and negative predictive values at timepoint DC24H were 100%, 82%, 32%, and 100%, respectively. CONCLUSION Serum l-lactate levels might help in the early detection of postoperative intestinal ischemia after aortic surgery if proper timepoints are used. Cutoff values need to be established in large-scale prospective studies.
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128
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Aziz AA, Christmas D. Acute Mesenteric Ischemia in a Chronically Anticoagulated Patient With Atrial Fibrillation: Anticoagulation Reversal, Management and Preventing Recurrence. Cureus 2022; 14:e21642. [PMID: 35233319 PMCID: PMC8881081 DOI: 10.7759/cureus.21642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 11/05/2022] Open
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Kaçer İ, Çağlar A, Akıllı NB. The Prognostic Value of C-Reactive Protein/Albumin Ratio in Acute Mesenteric Ischemia. Am Surg 2022:31348221074220. [DOI: 10.1177/00031348221074220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Diagnosis of acute mesenteric ischemia (AMI) in its early stages is important for reversing ischemic damage. The CRP to albumin (CRP/Alb) ratio has been defined as an inflammatory indicator and is associated with the severity of inflammation and mortality rates. However, the prognostic value of CRP/Alb has not been evaluated in patients with AMI. Here, we aimed to examine the prognostic significance of CRP/Alb and compare it with other inflammatory markers. Materials and Methods In this retrospective, case-control study, we included patients diagnosed with AMI at the emergency department between January 1, 2016, and December 31, 2020. In addition to demographic characteristics, lactate, D-dimer, white blood cell (WBC), CRP/Alb, and neutrophil/lymphocyte ratio (NLR) were recorded. Testing characteristics of CRP/Alb in predicting in-hospital mortality were studied. Results The mean age of 132 patients was 66.48 ± 15.95 years and 71 (53.8%) of them were male. The cut-off value obtained using the receiver operating characteristic (ROC) curve for in-hospital mortality was a CRP/Alb ratio of >1.32 (sensitivity, 93.65%; specificity, 69.57%; +LR, 3.08; −LR, .091; AUC, .782; 95% CI, .70-.85; P < .0001). The comparison of ROC curves between CRP/Alb and WBC, NLR, and lactate revealed a statistically significant difference ( P < .05), whereas there was not any statistically significant difference between the ROC curves of CRP/Alb and D-dimer ( P = .47). Conclusion C-reactive protein/albumin ratio is a powerful predictor of in-hospital mortality for AMI patients. It was superior to WBC, NLR, and lactate. It could be used to determine low-risk patients and help clinicians with treatment options.
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Affiliation(s)
- İlker Kaçer
- Department of Emergency Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Ahmet Çağlar
- Department of Emergency Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Nazire Belgin Akıllı
- Department of Emergency Medicine, University of Health Science, Konya Training and Research Hospital, Konya, Turkey
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130
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Martini V, Lederer AK, Fink J, Chikhladze S, Utzolino S, Fichtner-Feigl S, Kousoulas L. Clinical characteristics and outcome of patients with acute mesenteric ischemia: a retrospective cohort analysis. Langenbecks Arch Surg 2022; 407:1225-1232. [PMID: 35043258 PMCID: PMC9151533 DOI: 10.1007/s00423-021-02423-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 12/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Acute mesenteric ischemia (AMI) is an uncommon, but life-threatening clinical entity due to late diagnosis resulting in irreversible ischemic bowel necrosis. The most common causes of AMI are the embolic occlusion and the acute thrombosis of the mesenteric circulation. Typical treatment is composed of an early revascularization of the mesenteric circulation followed by abdominal surgery for resection of nonviable intestine and restoration of the intestinal continuity, but the mortality rates remain high. METHODS A retrospective cohort analysis was conducted, aiming to evaluate clinical characteristics, performed surgical procedures and outcomes of patients with acute mesenteric ischemia who underwent emergency abdominal surgery at a high volume surgical center in Germany. RESULTS Overall, 53 patients were identified with the intraoperatively proven diagnosis of AMI. Overall hospital mortality was with 62% comparable to the literature. Nineteen patients presented with an intraoperatively verified complete and non-reversible intestinal infarction without any angiographic or surgical option for a revascularization of the mesenteric circulation or an option for intestinal resection. From the rest of the patients, 14 underwent intestinal resection of the ischemic area without restoration of intestinal continuity; the other 20 underwent resection with a primary anastomosis to restore intestinal continuity. The mortality rate of these patients with curative-intended surgery remained high (41% of patients died). Pre- and postoperative hyperlactatemia were associated with lower survival of these patients. CONCLUSION AMI remains a life-threatening abdominal emergency. Therapeutic approaches are highly depended on acting surgeon's decision, being affected by subjectively rated bowel viability and physical condition of the affected patient. Only selected patients with good bowel viability appear to be suitable for receiving primary anastomosis. The results clearly indicate the need for further research to develop therapeutic approaches for a better management of AMI and to improve outcome of affected patients.
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Affiliation(s)
- Verena Martini
- Center of Surgery, Department of General and Visceral Surgery, Medical Center, University of Freiburg, Faculty of Medicine, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Ann-Kathrin Lederer
- Center of Surgery, Department of General and Visceral Surgery, Medical Center, University of Freiburg, Faculty of Medicine, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Jodok Fink
- Center of Surgery, Department of General and Visceral Surgery, Medical Center, University of Freiburg, Faculty of Medicine, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Sophia Chikhladze
- Center of Surgery, Department of General and Visceral Surgery, Medical Center, University of Freiburg, Faculty of Medicine, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Stefan Utzolino
- Center of Surgery, Department of General and Visceral Surgery, Medical Center, University of Freiburg, Faculty of Medicine, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Stefan Fichtner-Feigl
- Center of Surgery, Department of General and Visceral Surgery, Medical Center, University of Freiburg, Faculty of Medicine, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Lampros Kousoulas
- Center of Surgery, Department of General and Visceral Surgery, Medical Center, University of Freiburg, Faculty of Medicine, Hugstetter Straße 55, 79106, Freiburg, Germany.
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131
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Smith MV, Yang M, Roarke MC. Identification of Acute Mesenteric Ischemia on 18F-FDG PET/CT. Clin Nucl Med 2022; 47:e103-e104. [PMID: 34269724 DOI: 10.1097/rlu.0000000000003819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ABSTRACT Acute mesenteric ischemia resulting in bowel necrosis is a surgical emergency. First identification of acute mesenteric ischemia with FDG PET/CT is uncommon, because patients with bowel ischemia are usually diagnosed by other imaging methods such as CT. Nevertheless, prompt imager recognition of the PET/CT findings of mesenteric ischemia and necrosis is critical for proper triage of the patient to potentially lifesaving interventions. We present a 39-year-old woman with portal vein thrombosis who was sent for 18F-FDG PET/CT evaluation of a suspected pancreatic head neoplasm but was unexpectedly found to have ischemic and necrotic small bowel secondary to mesenteric venous infarction.
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Affiliation(s)
- Mathew V Smith
- From the Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ
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132
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Pankratov AA, Snitsar AV, Vasilchenko MI, Zelenin DA, Matkov IV, Varfalomeev SI, Izrailov RE, Perekhodov SN. [CT angiography and endovascular treatment in acute mesenteric ischemia]. Khirurgiia (Mosk) 2022:50-55. [PMID: 35289549 DOI: 10.17116/hirurgia202203150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To optimize the treatment strategy for acute mesenteric ischemia (AMI). MATERIAL AND METHODS The study included 43 patients aged 76.4±10.3 years. CT angiography and endovascular repair of mesenteric vessels underlie the new treatment approach. RESULTS CT angiography according to the established criteria was performed in 31 patients with suspected AMI throughout 1 year. Sensitivity was 90.0%, specificity - 100%, accuracy - 95%. Endovascular interventions were applied in 13 patients (successful in 8 cases and unsuccessful in 5 patients). Mortality rate was 37.5%. Fifteen patients with clinical signs of peritonitis or after previous unsuccessful interventional revascularization underwent open surgery. Mortality rate was 86.7%. CONCLUSION CT angiography is valuable to diagnose AMI at the stage of reversible changes in bowel wall in some cases. Endovascular revascularization as the first-line treatment has certain prospects.
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Affiliation(s)
- A A Pankratov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Demikhov Moscow City Clinical Hospital, Moscow, Russia
| | - A V Snitsar
- Demikhov Moscow City Clinical Hospital, Moscow, Russia
| | | | - D A Zelenin
- Demikhov Moscow City Clinical Hospital, Moscow, Russia
| | - I V Matkov
- Demikhov Moscow City Clinical Hospital, Moscow, Russia
| | | | - R E Izrailov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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134
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Acute Mesenteric Ischemia in COVID-19 Patients. J Clin Med 2021; 11:jcm11010200. [PMID: 35011941 PMCID: PMC8745985 DOI: 10.3390/jcm11010200] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/19/2021] [Accepted: 12/27/2021] [Indexed: 01/08/2023] Open
Abstract
Acute mesenteric ischemia is a rare but extremely severe complication of SARS-CoV-2 infection. The present review aims to document the clinical, laboratory, and imaging findings, management, and outcomes of acute intestinal ischemia in COVID-19 patients. A comprehensive search was performed on PubMed and Web of Science with the terms “COVID-19” and “bowel ischemia” OR “intestinal ischemia” OR “mesenteric ischemia” OR “mesenteric thrombosis”. After duplication removal, a total of 36 articles were included, reporting data on a total of 89 patients, 63 being hospitalized at the moment of onset. Elevated D-dimers, leukocytosis, and C reactive protein (CRP) were present in most reported cases, and a contrast-enhanced CT exam confirms the vascular thromboembolism and offers important information about the bowel viability. There are distinct features of bowel ischemia in non-hospitalized vs. hospitalized COVID-19 patients, suggesting different pathological pathways. In ICU patients, the most frequently affected was the large bowel alone (56%) or in association with the small bowel (24%), with microvascular thrombosis. Surgery was necessary in 95.4% of cases. In the non-hospitalized group, the small bowel was involved in 80%, with splanchnic veins or arteries thromboembolism, and a favorable response to conservative anticoagulant therapy was reported in 38.4%. Mortality was 54.4% in the hospitalized group and 21.7% in the non-hospitalized group (p < 0.0001). Age over 60 years (p = 0.043) and the need for surgery (p = 0.019) were associated with the worst outcome. Understanding the mechanisms involved and risk factors may help adjust the thromboprophylaxis and fluid management in COVID-19 patients.
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135
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Zhang J, Basu R, Gaffey A, Glaser J, Kalapatapu V. Retrograde Superior Mesenteric Artery Stenting in Case of SMA Shuttering. Vasc Endovascular Surg 2021; 56:408-411. [PMID: 34965787 DOI: 10.1177/15385744211072948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This case describes a patient who underwent endovascular repair for an extent V thoracoabdominal aneurysm with planned coverage of the celiac artery. Following deployment of the stent graft, the superior mesenteric artery was shuttered, and the patient subsequently developed signs and symptoms of bowel ischemia. The patient underwent successful retrograde open superior mesenteric artery stenting with resolution of her symptoms. Although retrograde open mesenteric artery stenting (ROMS) has been primarily shown to be effective in acute mesenteric ischemia, this case demonstrates that ROMS can be used as a salvage option for shuttering during endovascular procedures.
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Affiliation(s)
- Jason Zhang
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rohan Basu
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ann Gaffey
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Julia Glaser
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Venkat Kalapatapu
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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136
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Chen C, Li YW, Shi PF, Qian SX. Acute Mesenteric Ischemia in Patients with COVID-19: Review of the literature. J Natl Med Assoc 2021; 114:47-55. [PMID: 34973847 PMCID: PMC8715336 DOI: 10.1016/j.jnma.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/19/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in a global health emergency. In addition to common respiratory symptoms, some patients with COVID-19 infections may experience a range of extra-pulmonary manifestations, such as digestive system involvement. Patients with COVID-19 have been reported to suffer from acute mesenteric ischemia (AMI) that is associated with disease-related severity and mortality. However, in the context of COVID-19, the exact cause of AMI has yet to be clearly defined. This review provides a comprehensive overview of the available data and elucidates the possible underlying mechanisms linking COVID-19 to AMI, in addition to highlighting therapeutic approaches for clinicians. Finally, given the severe global impact of COVID-19, we emphasize the importance of coordinated vaccination programs.
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Affiliation(s)
- Can Chen
- Department of Hematology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang, China
| | - Yi-Wei Li
- Department of Intensive Care Unit, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang, China
| | - Peng-Fei Shi
- Department of Hematology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang, China
| | - Shen-Xian Qian
- Department of Hematology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang, China.
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137
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Yang F, Guo XC, Rao XL, Sun L, Xu L. Acute appendicitis complicated by mesenteric vein thrombosis: A case report. World J Clin Cases 2021; 9:11400-11405. [PMID: 35071571 PMCID: PMC8717517 DOI: 10.12998/wjcc.v9.i36.11400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 06/29/2021] [Accepted: 11/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute appendicitis with mesenteric vein thrombosis (MVT) is an uncommon condition and usually lacks specific clinical manifestations, which leads to a high rate of misdiagnosis or delayed diagnosis, especially when it is accompanied by other abdominal diseases. Prompt and accurate recognition is vital for treatment and prognosis.
CASE SUMMARY A 37-year-old woman had a history of acute metastatic right lower abdominal pain, nausea, and fever. A contrast-enhanced computed tomography (CT) scan showed a filling defect in the mesenteric vessels. The patient was diagnosed with acute appendicitis complicated by MVT and was treated with anticoagulation and intravenous antibiotics. The follow-up CT scan showed full resolution of the thrombosis and inflammation.
CONCLUSION Clinical awareness is essential for recognizing MVT, especially when it is accompanied by other common acute abdominal diseases, such as acute appendicitis. Contrast-enhanced CT is helpful for the diagnosis of MVT and is recommended for patients with acute abdominal diseases.
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Affiliation(s)
- Fan Yang
- Department of General Surgery, Peking University First Hospital, Beijing 100034, Beijing Province, China
| | - Xiao-Chao Guo
- Department of Radiology, Peking University First Hospital, Beijing 100034, Beijing Province, China
| | - Xiao-Long Rao
- Endoscopy Center, Peking University First Hospital, Beijing 100034, Beijing Province, China
| | - Lie Sun
- Department of General Surgery, Peking University First Hospital, Beijing 100034, Beijing Province, China
| | - Ling Xu
- Breast Disease Center, Peking University First Hospital, Beijing 100034, Beijing Province, China
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138
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Chen B, Cao J, Yan C, Zheng C, Chen J, Guo C. A promising new predictive factor for detecting bowel resection in childhood intussusception: the lymphocyte-C-reactive protein ratio. BMC Pediatr 2021; 21:577. [PMID: 34915876 PMCID: PMC8675458 DOI: 10.1186/s12887-021-03068-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
Background The most critical concern for the management of childhood intussusception is bowel resection due to intestinal ischemia and necrosis. The early prediction of this problem is of great importance. We investigated the value of various combinations of inflammatory factors to predict intestinal necrosis and resection. Methods We retrospectively reviewed the medical records of pediatric patients with intussusception who underwent surgical management. During the research period, 47 patients who underwent intestinal resection due to intestinal necrosis and 68 patients who did not undergo intestinal resection were enrolled. We evaluated the diagnostic value of various combinations of inflammatory markers from preoperative laboratory analyses using the receiver operating characteristic (ROC) method. Results In the current cohort, 115 patients underwent operations for intussusception; among them, 47 patients (40.9%) underwent intestinal resections. In the patients with intestinal resection, the neutrophil count(p = 0.013), CRP level(p = 0.002), platelet–lymphocyte ratio (PLR, p = 0.008), NLR (neutrophil–lymphocyte ratio, p = 0.026), and LCR (lymphocyte–CRP ratio, p < 0.001) values were significantly higher than those in the patients without any resection. The receiver operating characteristic (ROC) analysis results showed that the combination of lymphocytic count along with C-reactive protein levels (LCR) demonstrated the highest correlation with intestinal resection due to intussusception compared with other parameters in the patients, with a sensitivity of 0.82 (0.73–0.86) and specificity of 0.80 (0.57–0.94) for the diagnosis of strangulation. Conclusion The preoperative LCR level is a useful marker to predict the need for intestinal resection due to intestinal necrosis in patients with intussusception.
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Affiliation(s)
- Bailin Chen
- Department of Pediatric General Surgery, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Jian Cao
- Department of Pediatric General Surgery, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Chengwei Yan
- Department of Pediatric General Surgery, Chongqing University Three Gorges Hospital, Chongqing, People's Republic of China
| | - Chao Zheng
- Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.,Department II of Orthopedics, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Rd., Chongqing, 400014, People's Republic of China
| | - Jingyu Chen
- Department of Pediatric General Surgery, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China. .,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China. .,Department of Ultrasound, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Rd., Chongqing, 400014, People's Republic of China.
| | - Chunbao Guo
- Department of Pediatric General Surgery, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China. .,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China. .,Department of Pediatric General Surgery, Chongqing University Three Gorges Hospital, Chongqing, People's Republic of China. .,Department of Ultrasound, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Rd., Chongqing, 400014, People's Republic of China.
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139
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Yadong S, Haobo S, Liang C, Hao H, Zhaoxuan L, Jianping G. Endovascular Revascularization as Primary Treatment for Acute Embolic Mesenteric Ischemia: Stent Thrombectomy plus Aspiration versus Aspiration Alone. J Vasc Interv Radiol 2021; 33:295-303. [PMID: 34915163 DOI: 10.1016/j.jvir.2021.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/05/2021] [Accepted: 12/04/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the outcomes of stent thrombectomy combined with aspiration versus aspiration alone in acute mesenteric ischemia (AMI). METHODS This was a single-center, retrospective cohort study. Between 1 May 2012 and 1 January 2021, 41 patients (mean age, 73.8±7.9 years) with AMI who underwent stent thrombectomy plus aspiration (Group 1, n=14) or aspiration alone (Group 2, n=27) were included. Patients' treatment regimens, clinical and follow-up outcomes were reviewed and analyzed. The group differences were compared using a Chi square test, Fisher's exact test, independent t test, or Mann-Whitney U test. The cumulative survival rate was calculated using a Kaplan-Meier curve. RESULTS The overall clinical success rate was 78.0% (32/41), and no significant difference was found between Group 1 and Group 2 (78.6% vs. 77.8%, p = 1.00). Whereas Group 1 was associated with a higher complete clearance rate (78.6% vs. 44.4%, p = 0.04), less adjunctive local thrombolysis (14.3% vs. 48.1%, p = 0.03), and shorter length of hospital stay (5.7±4.7 vs. 10.7±9.0 days, p = 0.03). The estimated survival rate at 1 month, 3 months, 6 months, 1 year, and 2 years was 73.2%, 72.5%, 71.4%, 65.3%, and 59.8%, respectively. No significant difference was found in survival rate between the groups (log-rank, p = 0.96). The recurrence rate for Group 1 and Group 2 were 8.3% (1/12) and 4.0% (1/25), respectively. CONCLUSIONS Compared with aspiration alone, additional stent thrombectomy showed superiorities in higher complete clearance rate, reduced adjunctive thrombolysis, and shorter length of hospital stay.
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Affiliation(s)
- Shi Yadong
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Su Haobo
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Chen Liang
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Huang Hao
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Lu Zhaoxuan
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Gu Jianping
- The Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China.
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140
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Kip AM, Valverde JM, Altelaar M, Heeren RMA, Hundscheid IHR, Dejong CHC, Olde Damink SWM, Balluff B, Lenaerts K. Combined Quantitative (Phospho)proteomics and Mass Spectrometry Imaging Reveal Temporal and Spatial Protein Changes in Human Intestinal Ischemia-Reperfusion. J Proteome Res 2021; 21:49-66. [PMID: 34874173 PMCID: PMC8750167 DOI: 10.1021/acs.jproteome.1c00447] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
![]()
Intestinal ischemia–reperfusion
(IR) injury is a severe
clinical condition, and unraveling its pathophysiology is crucial
to improve therapeutic strategies and reduce the high morbidity and
mortality rates. Here, we studied the dynamic proteome and phosphoproteome
in the human intestine during ischemia and reperfusion, using liquid
chromatography-tandem mass spectrometry (LC-MS/MS) analysis to gain
quantitative information of thousands of proteins and phosphorylation
sites, as well as mass spectrometry imaging (MSI) to obtain spatial
information. We identified a significant decrease in abundance of
proteins related to intestinal absorption, microvillus, and cell junction,
whereas proteins involved in innate immunity, in particular the complement
cascade, and extracellular matrix organization increased in abundance
after IR. Differentially phosphorylated proteins were involved in
RNA splicing events and cytoskeletal and cell junction organization.
In addition, our analysis points to mitogen-activated protein kinase
(MAPK) and cyclin-dependent kinase (CDK) families to be active kinases
during IR. Finally, matrix-assisted laser desorption ionization time-of-flight
(MALDI-TOF) MSI presented peptide alterations in abundance and distribution,
which resulted, in combination with Fourier-transform ion cyclotron
resonance (FTICR) MSI and LC-MS/MS, in the annotation of proteins
related to RNA splicing, the complement cascade, and extracellular
matrix organization. This study expanded our understanding of the
molecular changes that occur during IR in the human intestine and
highlights the value of the complementary use of different MS-based
methodologies.
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Affiliation(s)
- Anna M Kip
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Juan Manuel Valverde
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Padualaan 8, Utrecht 3584 CH, The Netherlands
| | - Maarten Altelaar
- Biomolecular Mass Spectrometry and Proteomics, Bijvoet Center for Biomolecular Research and Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Padualaan 8, Utrecht 3584 CH, The Netherlands
| | - Ron M A Heeren
- Maastricht Multimodal Molecular Imaging Institute (M4i), Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Inca H R Hundscheid
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Cornelis H C Dejong
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.,Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Steven W M Olde Damink
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.,Department of General, Visceral- and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Benjamin Balluff
- Maastricht Multimodal Molecular Imaging Institute (M4i), Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Kaatje Lenaerts
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Coffey JC, Byrnes KG, Walsh DJ, Cunningham RM. Update on the mesentery: structure, function, and role in disease. Lancet Gastroenterol Hepatol 2021; 7:96-106. [PMID: 34822760 DOI: 10.1016/s2468-1253(21)00179-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/14/2021] [Accepted: 05/14/2021] [Indexed: 12/19/2022]
Abstract
Over the past 5 years, systematic investigation of the mesenteric organ has expanded and shown that the mesentery is the organ in and on which all abdominal digestive organs develop and remain connected to. In turn, this observation has clarified the anatomical foundation of the abdomen and the fundamental order at that level. Findings related to the shape and development of the mesentery have illuminated its function, advancing our understanding of the pathobiology, diagnosis, and treatment of several abdominal and systemic diseases. Inclusion of the mesentery in surgical resections alters the course of benign and malignant diseases. Mesenteric-based scoring systems can enhance the radiological interpretation of abdominal disease. Emerging findings reconcile observations across scientific and clinical fields and have been assimilated into reference curricula and practice guidelines. This Review summarises the developmental, anatomical, and clinical advances made since the mesentery was redesignated as an organ in 2016.
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Affiliation(s)
- J Calvin Coffey
- Department of Surgery, University Hospital Limerick, Limerick, Ireland; School of Medicine, University of Limerick, Limerick, Ireland.
| | - Kevin G Byrnes
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Dara John Walsh
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
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142
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Zhang P, Li XJ, Guo RM, Hu KP, Xu SL, Liu B, Wang QL. Idiopathic acute superior mesenteric venous thrombosis after renal transplantation: A case report. World J Clin Cases 2021; 9:9896-9902. [PMID: 34877328 PMCID: PMC8610927 DOI: 10.12998/wjcc.v9.i32.9896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/05/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute superior mesenteric venous thrombosis (MVT) is a rare condition associated with a high mortality rate. The treatment strategy for MVT is clinically challenging due to its insidious onset and rapid development, especially when accompanied by kidney transplantation.
CASE SUMMARY Here we present a rare case of acute MVT developed 3 years after renal transplantation. A 49-year-old patient was admitted with acute abdominal pain and diagnosed as MVT with intestinal necrosis. An emergency exploratory laparotomy was performed to remove the infarcted segment of the bowel. Immediate systemic anticoagulation was also initiated. During the treatment, the patient experienced bleeding, anastomotic leakage, and sepsis. However, after aggressive treatment was administered, all thrombi were completely resolved, and the patient recovered with his renal graft function unimpaired.
CONCLUSION The present case suggests that accurate diagnosis and timely surgical treatment are important to improve the survival rate of MVT patients. Bleeding with anastomotic fistula needs to be treated with caution because of grafts. Also, previously published cases of mesenteric thrombosis after renal transplantation were reviewed.
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Affiliation(s)
- Peng Zhang
- Department of General Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510530, Guangdong Province, China
| | - Xiao-Jie Li
- Laboratory Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510530, Guangdong Province, China
| | - Ruo-Mi Guo
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510530, Guangdong Province, China
| | - Kun-Peng Hu
- Department of General Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510530, Guangdong Province, China
| | - Shi-Lei Xu
- Department of General Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510530, Guangdong Province, China
| | - Bo Liu
- Department of General Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510530, Guangdong Province, China
| | - Qing-Liang Wang
- Department of General Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510530, Guangdong Province, China
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143
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Bagheripour MH, Zakeri MA. Acute Mesenteric Ischemia in a COVID-19 Patient: Delay in Referral and Recommendation for Surgery. Case Rep Gastrointest Med 2021; 2021:1999931. [PMID: 34777882 PMCID: PMC8589525 DOI: 10.1155/2021/1999931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/10/2021] [Accepted: 10/29/2021] [Indexed: 12/22/2022] Open
Abstract
Coronavirus (COVID-19) is more common with symptoms such as fever, dry cough, and shortness of breath. However, it may be associated with COVID-19-induced gastrointestinal (GI) symptoms including acute mesenteric ischemia (AMI). These conditions make the diagnosis of AMI challenging. Timely referral with correct diagnosis and attention to the uncommon symptoms of COVID-19 can play an important role in the management and treatment of AMI in COVID-19 patients. We present a patient with AMI due to thrombotic complications of COVID-19, who referred to the hospital too late and ignored the recommendation for abdominal surgery.
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Affiliation(s)
| | - Mohammad Ali Zakeri
- Social Determinants of Health Research Centre, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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144
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Naazar AA, Omair A, Chu SH, Keane KG, Weber DG. A Shifting Trend Towards Endovascular Intervention in the Treatment of Acute Mesenteric Ischemia. Cureus 2021; 13:e18544. [PMID: 34754689 PMCID: PMC8570678 DOI: 10.7759/cureus.18544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 01/16/2023] Open
Abstract
Background Acute mesenteric ischemia (AMI) is a vascular emergency with a quite low incidence, but it is associated with disproportionately more severe morbidity and mortality. The aim of this study was to assess the current trend in the treatment of AMI and to see if endovascular intervention is an effective treatment modality in the selected group of patients. Methods A retrospective review of patients admitted with AMI between 2007 and 2018 was performed. Outcome measures were length of stay (LOS) at hospital and intensive care unit (ICU), and post-treatment mortality. Results A total of 98 patients with AMI were admitted during the study period. Patients undergoing endovascular treatment compared with surgery were younger (62.9 ± 13.7 years vs. 69.5 ± 12.8 years; p = 0.01). Shorter LOS in hospital and ICU was observed for those treated with endovascular approach (6.8 ± 3.4 and 3.25 ± 0.5 days) compared to the surgical group (25 ± 8.6 and 12.8 ± 26.8 days; p < 0.001). Out of 39 patients requiring ICU admission, 48.7% were surgically treated and 10.2% underwent endovascular intervention (p < 0.001). Mortality associated with surgery was 30.6% compared to only 6.6% with endovascular intervention (p < 0.001). Between 2007 and 2012, only one patient underwent endovascular intervention and 20 underwent surgery compared to 14 patients treated with endovascular approach and 16 with surgery between 2013 and 2018. Conclusion In this non-randomized, retrospective case series, patients with endovascular treatment fared clinically better and the intervention was found to be safe and feasible in the selected group of patients. We suggest a preference for this modality where possible. At our hospital, a trend favoring this approach is apparent during the last six years.
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Affiliation(s)
- Ali A Naazar
- General Surgery, Royal Perth Hospital, Perth, AUS
| | - Ahmad Omair
- Pathology, College of Science & Health Professions, King Saud bin Abdulaziz University for Health Sciences & King Abdullah International Medical Research Center, Riyadh, SAU
| | - Samuel H Chu
- General Surgery, Royal Perth Hospital, Perth, AUS
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145
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Temporal Transcript Profiling Identifies a Role for Unfolded Protein Stress in Human Gut Ischemia-Reperfusion Injury. Cell Mol Gastroenterol Hepatol 2021; 13:681-694. [PMID: 34774803 PMCID: PMC8761776 DOI: 10.1016/j.jcmgh.2021.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS Intestinal ischemia-reperfusion injury is a serious and life-threatening condition. A better understanding of molecular mechanisms related to intestinal ischemia-reperfusion injury in human beings is imperative to find therapeutic targets and improve patient outcome. METHODS First, the in vivo dynamic modulation of mucosal gene expression of the ischemia-reperfusion-injured human small intestine was studied. Based on functional enrichment analysis of the changing transcriptome, one of the predominantly regulated pathways was selected for further investigation in an in vitro human intestinal organoid model. RESULTS Ischemia-reperfusion massively changed the transcriptional landscape of the human small intestine. Functional enrichment analysis based on gene ontology and pathways pointed to the response to unfolded protein as a predominantly regulated process. In addition, regulatory network analysis identified hypoxia-inducing factor 1A as one of the key mediators of ischemia-reperfusion-induced changes, including the unfolded protein response (UPR). Differential expression of genes involved in the UPR was confirmed using quantitative polymerase chain reaction analysis. Electron microscopy showed signs of endoplasmic reticulum stress. Collectively, these findings point to a critical role for unfolded protein stress in intestinal ischemia-reperfusion injury in human beings. In a human intestinal organoid model exposed to hypoxia-reoxygenation, attenuation of UPR activation with integrated stress response inhibitor strongly reduced pro-apoptotic activating transcription factor 4 (ATF4)-CCAAT/enhancer-binding protein homologous protein (CHOP) signaling. CONCLUSIONS Transcriptome analysis showed a crucial role for unfolded protein stress in the response to ischemia-reperfusion in human small intestine. UPR inhibition during hypoxia-reoxygenation in an intestinal organoid model suggests that downstream protein kinase R-like ER kinase (PERK) signaling may be a promising target to reduce intestinal ischemia-reperfusion injury. Microarray data are available in GEO (https://www.ncbi.nlm.nih.gov/gds, accession number GSE37013).
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146
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Gebran A, Gallastegi AD, Fagenholz P, King D, Kaafarani HMA, Paranjape C, Velmahos GC, Hwabejire JO. Factors that Predict Survival From Mesenteric Ischemia in the Geriatric Patient: Not a Death Sentence. Am Surg 2021:31348211050585. [PMID: 34748456 DOI: 10.1177/00031348211050585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The mortality rate from mesenteric ischemia is reported to be as high as 80%. The goal of our study was to identify demographic and clinical predictors of post-operative mortality and discharge disposition among elderly patients with mesenteric ischemia. METHODS All patients 65 years and older who underwent emergency surgery (ES) for the management of mesenteric ischemia in the American College of Surgeons-National Surgical Quality Improvement Program database from 2007 to 2017 were included. Univariate analyses and logistic regressions were used to identify independent predictors of mortality and discharge disposition. RESULTS A total of 2438 patients met inclusion criteria, with a median age of 77 years and 60.8% being female. The 30-day mortality of the overall cohort was 31.5% and the 30-day morbidity was 65.3%. The following were the major predictors of 30-day mortality: pre-operative diagnosis of septic shock [OR: 2.46, (95% CI: 1.94-3.13)], dialysis dependence [OR: 2.05, (95% CI: 1.45-2.90)], recent weight loss [OR: 1.80, (95% CI: 1.16-2.79)], age ≥80 years [OR: 1.67, (95% CI: 1.25-2.23)], and ventilator dependence [OR: 1.65, (95% CI: 1.23-2.23)]. In the absence of these predictors, survival rate was 84%. The major predictors of discharge to post-acute care (PAC) included age ≥80 years [OR: 3.70, (95% CI: 2.50-5.47)] and pre-operative septic shock [OR: 2.20, (95% CI: 1.42-3.41)]. CONCLUSION In the geriatric patient, a diagnosis of mesenteric ischemia does not equate to an automatic death sentence. The presence of certain pre-operative risk factors confers a high risk of mortality, whereas their absence is associated with a high chance of survival.
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Affiliation(s)
- Anthony Gebran
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital, Boston, MA, USA
| | - Ander Dorken Gallastegi
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital, Boston, MA, USA
| | - Peter Fagenholz
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital, Boston, MA, USA
| | - David King
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital, Boston, MA, USA
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital, Boston, MA, USA
| | - Charu Paranjape
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital, Boston, MA, USA
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital, Boston, MA, USA
| | - John O Hwabejire
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, 548305Massachusetts General Hospital, Boston, MA, USA
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147
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Reply to: Letter to the Editor on Endovascular Revascularization with Stent Implantation in Patients with Acute Mesenteric Ischemia Due to Acute Arterial Thrombosis: Clinical Outcome and Predictive Factors. Cardiovasc Intervent Radiol 2021; 44:2013-2014. [PMID: 34704153 PMCID: PMC8626378 DOI: 10.1007/s00270-021-02985-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 11/25/2022]
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148
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Brillantino A, Lanza M, Antropoli M, Amendola A, Squillante S, Bottino V, Renzi A, Castriconi M. Usefulness of damage control approach in patients with limited acute mesenteric ischemia: a prospective study of 85 patients. Updates Surg 2021; 74:337-342. [PMID: 34686970 DOI: 10.1007/s13304-021-01192-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 10/10/2021] [Indexed: 02/03/2023]
Abstract
To evaluate the efficacy of the damage control approach by two-step surgical procedure in not critical patients (without sepsis or septic shock) with peritonitis from limited acute mesenteric ischemia. From April 2013 to April 2020, 85 patients [49 (57.7%) women and 36 (42.3%) men, median age 69.5 (range 38-92)] were enrolled in this study and underwent emergency surgery. After resection of ischemic bowel, basing on the individual decision of the single surgeon, the patients underwent primary end-to-end anastomosis (Group 1) or damage control approach (Group 2) including primary laparotomy with resection of ischemic bowel, temporary abdominal closure and a second-look procedure at 48 h with re-evaluation of bowel vitality. Forty-seven (55.3%) patients underwent one-stage surgical treatment and 38 (44.7%) patients received a two-step procedure. In the latter group, at second exploration, 8 (21%) patients required a further intestinal resection, due to mesenteric ischemia progression. Both anastomosis dehiscence rate and need for ileostomy in Group 1 patients were significantly higher than in Group 2 (23.4% vs 5.3%: p = 0.03 and 19.1% vs 2.6%: p = 0.03; Fisher's exact test). No significative differences in mortality and morbidity rate were found between the two groups. The damage control approach by two-step surgical procedure may represent a valid innovative option in the management of not critical patients with limited acute mesenteric ischemia, achieving a better clinical outcome if compared with surgical treatment by one-step procedure.
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Affiliation(s)
- Antonio Brillantino
- Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Michele Lanza
- Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Massimo Antropoli
- Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Alfonso Amendola
- Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Simone Squillante
- Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Vincenzo Bottino
- Department of Surgery, "Villa Betania" Hospital, Via Argine 604, 80147, Naples, Italy
| | - Adolfo Renzi
- Department of Surgery, "Buonconsiglio Fatebenefratelli" Hospital, Via Alessandro Manzoni 220, 80123, Naples, Italy
| | - Maurizio Castriconi
- Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
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149
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Augène E, Lareyre F, Chikande J, Guidi L, Mutambayi G, Lê CD, Jean-Baptiste E, Katsiki N, Mikhailidis DP, Raffort J. Incidence of contrast-induced acute kidney injury in patients with acute mesenteric ischemia and identification of potential predictive factors. Vascular 2021; 30:1097-1106. [PMID: 34645315 DOI: 10.1177/17085381211050766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Contrast-enhanced computed tomography angiography (CTA) is commonly used to investigate acute abdominal conditions, but the risk of contrast-induced acute kidney injury (CI-AKI) has been poorly investigated in patients with acute mesenteric ischemia. The aim of the present study was to evaluate the incidence of CI-AKI in these patients and identify potential predictive factors. METHODS Patients admitted for acute mesenteric ischemia who had a diagnostic CTA with contrast medium and a follow-up of creatinine concentration were retrospectively included. RESULTS Among 53 patients included, 9 (16.9%) developed CI-AKI. The prevalence of chronic kidney disease did not differ significantly between those who developed CI-AKI and those who did not (33.3 vs 18.2%, p=.372). Plasma total bilirubin and conjugated bilirubin levels were significantly higher in patients who developed CI-AKI (17.5 vs 8.0 μmol/L, p=.013 and 8.0 vs 3.0 μmol/L, p=.031, respectively). The proportion of patients who had revascularization was similar between patients who developed CI-AKI and those who did not (11.1 vs 20.5%, p>.999). No significant difference was observed for 30-day mortality and all-cause mortality for a median follow-up of 168 days (22.2 vs 13.6%, p=.611; and 33.3 vs 61.4%, p=.153, respectively). CONCLUSION This study reports the incidence of CI-AKI in patients with acute mesenteric ischemia after diagnostic CTA with contrast medium. Plasma bilirubin levels were a predictive factor of CI-AKI in these patients. The administration of contrast media during revascularization was not associated with an increased risk of CI-AKI.
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Affiliation(s)
- Emmanuel Augène
- Department of Visceral Surgery, 37045University Hospital of Nice, France
| | - Fabien Lareyre
- Department of Vascular Surgery, 70607Hospital of Antibes Juan-les-Pins, France.,Université Côte d'Azur, 37045CHU, Inserm U1065, C3M, Nice, France
| | - Julien Chikande
- Department of Vascular Surgery, 37045University Hospital of Nice, France
| | - Lucas Guidi
- Department of Vascular Surgery, 37045University Hospital of Nice, France
| | | | - Cong Duy Lê
- Department of Vascular Surgery, 70607Hospital of Antibes Juan-les-Pins, France
| | - Elixène Jean-Baptiste
- Université Côte d'Azur, 37045CHU, Inserm U1065, C3M, Nice, France.,Department of Vascular Surgery, 37045University Hospital of Nice, France
| | - Niki Katsiki
- First Department of Internal Medicine, Diabetes Center, Division of Endocrinology and Metabolism, 571848AHEPA University Hospital, Thessaloniki, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
| | - Juliette Raffort
- Université Côte d'Azur, 37045CHU, Inserm U1065, C3M, Nice, France.,Clinical Chemistry Laboratory, 37045University Hospital of Nice, France
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150
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Kiseleva EB, Ryabkov MG, Sizov MA, Bederina EL, Komarova AD, Moiseev AA, Bagryantsev MV, Vorobiev AN, Gladkova ND. Effect of Surgical Technique on the Microstructure and Microcirculation of the Small Intestine Stump during Delayed Anastomosis: Multimodal OCT Data. Sovrem Tekhnologii Med 2021; 13:36-45. [PMID: 34603762 PMCID: PMC8482830 DOI: 10.17691/stm2021.13.4.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Indexed: 12/19/2022] Open
Abstract
The aim of the study was to use multimodal optical coherence tomography (MM OCT) to evaluate microstructure and microcirculation in the proximal and distal sections of the intestine relative to the resected area in acute mesenteric ischemia.
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Affiliation(s)
- E B Kiseleva
- Senior Researcher, Scientific Laboratory of Optical Coherence Tomography, Research Institute of Experimental Oncology and Biomedical Technologies; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - M G Ryabkov
- Associate Professor, Leading Researcher, University Clinic; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - M A Sizov
- Surgeon; City Clinical Hospital No.30, 85A Berezovskaya St., Nizhny Novgorod, 603157, Russia
| | - E L Bederina
- Pathologist, Junior Researcher, University Clinic; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - A D Komarova
- Student, Department of Biophysics; National Research Lobachevsky State University of Nizhni Novgorod, 23 Prospekt Gagarina, Nizhny Novgorod, 603950, Russia; Laboratory Assistant, Laboratory of Fluorescent Bioimaging, Research Institute of Experimental Oncology and Biomedical Technologies; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - A A Moiseev
- Senior Researcher, Laboratory of Highly Sensitive Optical Measurements; Federal Research Center Institute of Applied Physics of the Russian Academy of Sciences, 46 Ulyanova St., Nizhny Novgorod, 603950, Russia
| | - M V Bagryantsev
- Surgeon; City Clinical Hospital No.30, 85A Berezovskaya St., Nizhny Novgorod, 603157, Russia
| | - A N Vorobiev
- Surgeon; City Clinical Hospital No.30, 85A Berezovskaya St., Nizhny Novgorod, 603157, Russia
| | - N D Gladkova
- Professor, Head of the Scientific Laboratory of Optical Coherence Tomography, Research Institute of Experimental Oncology and Biomedical Technologies; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
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