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Beloborodov V, Vorobev V, Sokolova S, Frolov A, Kornilov D, Sorokina L, Golub I. Mesenteric Vessel Thrombosis Treatment Experience. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: One of the most serious diseases among all emergency abdominal pathology is an acute violation of the mesenteric blood circulation. The rapid development of intestinal ischemia results in its infarction and necrosis.
AIM: The study aims to assess the survival rate of patients with mesenteric vascular thrombosis, taking into account, the predictor characteristics influence of disease development factors.
METHODS: The study presents a retrospective analysis of mesenteric vascular thrombosis clinical cases for 2016–2019. During this period, there were 147 patients with an established diagnosis at the Irkutsk Clinical Hospital No. 1, 21 of them met the study criteria.
RESULTS: According to the type of thrombosis, there were two groups – occlusive (Group I, n = 11) and non occlusive (Group II, n = 10). Four patients (36.3%) of Group I and 7 patients (70%) of Group II (p = 0.388) recovered from the disease. Three patients (27.2%) of Group I and 4 patients (40%) of Group II (p = 0.662) received conservative therapy, 2 of them (66.6%) in Group I and 4 (100%) in Group II (p = 0.724) recovered from the disease. In addition, the authors performed a mortality assessment, according to the timing of the visit to a medical institution. Four (50%) out of eight patients who applied in the first 12 h, 2 (66%) out of three – in the first 12–24 h, and 5 (50%) out of 10 for more than 24 h of illness had a positive treatment result in the combined group.
CONCLUSION: The patients over 70 years old with peritoneal symptoms and established intestinal necrosis have an extremely unfavorable prognosis. The primary mesenteric vessel thrombosis with additional contrast angiography still gives a moderate treatment prognosis.
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Laparoscopy in Emergency: Why Not? Advantages of Laparoscopy in Major Emergency: A Review. Life (Basel) 2021; 11:life11090917. [PMID: 34575066 PMCID: PMC8470929 DOI: 10.3390/life11090917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 01/09/2023] Open
Abstract
A laparoscopic approach is suggested with the highest grade of recommendation for acute cholecystitis, perforated gastroduodenal ulcers, acute appendicitis, gynaecological disorders, and non-specific abdominal pain (NSAP). To date, the main qualities of laparoscopy for these acute surgical scenarios are clearly stated: quicker surgery, faster recovery and shorter hospital stay. For the remaining surgical emergencies, as well as for abdominal trauma, the role of laparoscopy is still a matter of debate. Patients might benefit from a laparoscopic approach only if performed by experienced teams and surgeons which guarantee a high standard of care. More precisely, laparoscopy can limit damage to the tissue and could be effective for the reduction of the overall amount of cell debris, which is a result of the intensity with which the immune system reacts to the injury and the following symptomatology. In fact, these fragments act as damage-associated molecular patterns (DAMPs). DAMPs, as well as pathogen associated molecular patterns (PAMPs), are recognised by both surface and intracellular receptors of the immune cells and activate the cascade which, in critically ill surgical patients, is responsible for a deranged response. This may result in the development of progressive and multiple organ dysfunctions, manifesting with acute respiratory distress syndrome (ARDS), coagulopathy, liver dysfunction and renal failure. In conclusion, none of the emergency surgical scenarios preclude laparoscopy, provided that the surgical tactic could ensure sufficient cleaning of the abdomen in addition to resolving the initial tissue damage caused by the “trauma”.
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153
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Olson KA, Teixeira PG. Mesenteric Ischemia: When and How to Revascularize. Adv Surg 2021; 55:75-87. [PMID: 34389101 DOI: 10.1016/j.yasu.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kristofor A Olson
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, 1500 Red River Street, Annex, Austin, TX 78701, USA
| | - Pedro G Teixeira
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, 1500 Red River Street, Annex, Austin, TX 78701, USA.
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Holm MA, Emfield K, Iles TL, Iaizzo PA. High-resolution 3D reconstructions of human vasculatures: creation of educational tools and benchtop models for transcatheter devices. Cardiovasc Interv Ther 2021; 37:519-525. [PMID: 34468961 DOI: 10.1007/s12928-021-00804-4] [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: 03/21/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022]
Abstract
Transcatheter therapies are a common way to treat cardiovascular diseases. These therapies are complicated by significant anatomical patient-to-patient variations that exist in terms of transcatheter vascular pathways. Adding to the complexity of transcatheter procedures, the training tools used for physician education often overlook vast patient-to-patient variations and utilize idealized models of patient anatomy that may be unrealistic. In this study, anatomically accurate models were created from high-resolution images of real patient vasculatures. Using fourteen human cadavers donated for research, we collected high-resolution images to generate 3D computational renderings of various patient anatomies. These models make up the "Transcatheter Pathways Vasculature Database" that can be used for physician education and training, as well as improving transcatheter delivery system design. We performed multiple studies that emphasize the anatomical differences that exist in patient vasculatures. Using 3D printing and virtual reality, we developed educational materials and benchtop models to train physicians using true patient anatomies. These tools can also provide device designers with data to improve their products based on real patient vessels. The "Transcatheter Pathways Vasculature Database" highlights differences between patient vasculatures. By educating and training physicians with patient anatomies that accurately represent significant patient-to-patient variations, learning is more translatable to what is seen in the clinic.
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Affiliation(s)
- Mikayle A Holm
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Kendall Emfield
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Tinen L Iles
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Paul A Iaizzo
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA. .,Department of Surgery, University of Minnesota, Minneapolis, MN, USA. .,Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA. .,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA.
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155
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Tolonen M, Lemma A, Vikatmaa P, Peltola E, Mentula P, Björkman P, Leppäniemi A, Sallinen V. The implementation of a pathway and care bundle for the management of acute occlusive arterial mesenteric ischemia reduced mortality. J Trauma Acute Care Surg 2021; 91:480-488. [PMID: 34086659 PMCID: PMC8404963 DOI: 10.1097/ta.0000000000003305] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute mesenteric ischemia (AMI) is a disease with high mortality and requires a multidisciplinary approach for effective management. A pathway and care bundle were developed and implemented with the objective to reduce mortality. The aim of this retrospective comparative study was to analyze the effects of the pathway on patient management and outcome. METHODS All consecutive patients operated in a secondary and tertiary referral center because of occlusive arterial AMI were identified between 2014 and April 2020. The pathway aimed to increase overall awareness, and hasten and improve diagnostics and management. Patients treated before implementation of the pathway (pregroup, years 2014-2017) were compared with patients treated using the pathway (postgroup, May 2018 to April 2020). Univariate and multivariate analyses were used to compare the groups. RESULTS There were 78 patients in the pregroup and 67 patients in the postgroup with comparable baseline characteristics and disease acuity. The postgroup was more often diagnosed with contrast-enhanced computed tomography (58 [74%] vs. 63 [94%], p = 0.001) and had shorter mean in-hospital delay to operating room (7 hours [interquartile range, 3.5-12.5] vs. 3 hours [interquartile range, 2-11], p = 0.023). Revascularization was done more often in the postgroup (53 [68%] vs. 56 [84%], p = 0.030) especially using endovascular treatment (26 [33%] vs. 43 [64%], p < 0.001). Thirty-day mortality was lower in the postgroup (23 [51%] vs. 17 [25%], p = 0.001). Being managed in the postgroup remained as a protective factor (odds ratio, 0.32; 95% confidence interval, 0.14-0.75; p = 0.008) for 30-day mortality in the multivariate analysis. CONCLUSION Implementing a pathway and care bundle resulted in enhanced regional and in-hospital awareness of AMI, more appropriate computed tomography imaging, shorter in-hospital delays, increased number of revascularizations, and, hence, lower mortality. LEVEL OF EVIDENCE Therapeutic/Care Management, level IV.
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156
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Sakamoto T, Kubota T, Funakoshi H, Lefor AK. Multidisciplinary management of acute mesenteric ischemia: Surgery and endovascular intervention. World J Gastrointest Surg 2021; 13:806-813. [PMID: 34512904 PMCID: PMC8394382 DOI: 10.4240/wjgs.v13.i8.806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/09/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023] Open
Abstract
Acute mesenteric ischemia (AMI) is a rare cause of the “acute abdomen”, characterized by impaired blood flow to the intestine. The principle of treatment is restoration of perfusion to ischemic bowel and resection of any necrotic intestine. Surgery and endovascular intervention are two complementary approaches to mesenteric ischemia. Endovascular intervention is not an alternative to the surgical approach, but it has the potential to improve the prognosis of patients with AMI when judiciously combined with a surgical approach. Due to the need for emergent treatment of patients with acute mesenteric ischemia, the treatment strategy needs to be modified for each facility. This review aims to highlight cutting-edge studies and provide reasonable treatment strategies for patients with acute mesenteric ischemia based on available evidence.
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Affiliation(s)
- Takashi Sakamoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo 1130033, Japan
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba 2790001, Japan
| | - Tadao Kubota
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba 2790001, Japan
| | - Hiraku Funakoshi
- Department of Interventional Radiology, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba 2790001, Japan
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Casili G, Scuderi SA, Lanza M, Filippone A, Basilotta R, Mannino D, Campolo M, Esposito E, Paterniti I. The protective role of prolyl oligopeptidase (POP) inhibition in acute lung injury induced by intestinal ischemia-reperfusion. Oncotarget 2021; 12:1663-1676. [PMID: 34434495 PMCID: PMC8378771 DOI: 10.18632/oncotarget.28041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/27/2021] [Indexed: 12/15/2022] Open
Abstract
Intestinal ischemia-reperfusion (II/R) develops when the blood flow to the intestines decreases, followed by the reestablishment of the blood supply to the ischemic tissue, resulting in intestinal mucosal barrier dysfunction, with consequent severe local and systemic inflammation. Acute lung injury (ALI) represents the most serious complication after II/R. KYP-2047 is a selective inhibitor of prolyl oligopeptidase (POP), a serine protease involved in the release of pro-angiogenic and inflammatory molecules. The aim of the present study is to assess the effects of POP-inhibition mediated by KYP-2047 treatment in the pathophysiology of ALI following II/R. An in vivo model of II/R was performed and mice were subjected to KYP-2047 treatment (intraperitoneal, 1, 2.5 and 5 mg/kg). Histological analysis, Masson’s trichrome staining, immunohistochemical, immunofluorescence, biochemical and western blots analysis were performed on ileum and lung samples. KYP-2047 treatment ameliorated histological alteration in ileum and lung, reduced collagen amount and lowered inflammatory protein levels. Moreover, TGF-β1, eNOS, VEGF and CD34 positive staining has been modulated; also, a reduction in apoptosis expression was confirmed. This research revealed the strong anti-inflammatory potential of KYP-2047 associated to its modulatory role on angiogenesis and apoptosis, suggesting POP as a novel therapeutic target for ALI after II/R.
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Affiliation(s)
- Giovanna Casili
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Sarah Adriana Scuderi
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Marika Lanza
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Alessia Filippone
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Rossella Basilotta
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Deborah Mannino
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Michela Campolo
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Emanuela Esposito
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Irene Paterniti
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
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158
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Abstract
Ischemic bowel disease (ISBODI) includes colon ischemia, acute mesenteric ischemia (AMI) and chronic mesenteric ischemia (CMI). Epidemiologically, colon ischemia is the most common type followed by AMI and CMI. There are various risk factors for the development of ISBODI. Abdominal pain is the common presenting symptom of each type. High clinical suspicion is essential in ordering appropriate tests. Imaging studies and colonoscopy with biopsy are the main diagnostic tests. Treatment varies from conservative measures to surgical resection and revascularization. Involvement of multidisciplinary team is essential in managing ISBODI. Although open surgery with revascularization plays an important role, recently there is an increasing interest in percutaneous endovascular treatment.
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Affiliation(s)
- Monjur Ahmed
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA 19107, United States
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159
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Pirola L, Palermo A, Mulinacci G, Ratti L, Fichera M, Invernizzi P, Viganò C, Massironi S. Acute mesenteric ischemia and small bowel imaging findings in COVID-19: A comprehensive review of the literature. World J Gastrointest Surg 2021; 13:702-716. [PMID: 34354803 PMCID: PMC8316849 DOI: 10.4240/wjgs.v13.i7.702] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/12/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), an infectious condition caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide since its first description in Wuhan in December 2019. Even though respiratory manifestations are the most prevalent and responsible for disease morbidity and mortality, extrapulmonary involvement has progressively gained relevance. In particular, gastrointestinal (GI) signs and symptoms, reported in up to two-thirds of patients with COVID-19, might represent the first and, in some cases, the only disease presentation. Their presence has been associated in some studies with an increased risk of a severe disease course. Proposed pathogenic mechanisms explaining GI tract involvement are either direct viral access to intestinal cells via angiotensin-converting enzyme 2 or indirect damage of the intestinal wall through mesenteric ischemia induced by the hypercoagulable state associated with COVID-19 infection. Although not typical of SARS-CoV-2 infection, several small bowel manifestations have been described in infected patients who underwent any form of abdominal imaging. The radiological findings were mainly reported in patients with abdominal symptoms, among which abdominal pain was the most common.
AIM To discuss small bowel radiological manifestations of SARS-CoV-2 infection in abdominal imaging studies.
METHODS Bibliographical searches were performed in PubMed, using the following keywords: “COVID-19” AND “imaging” AND “gastrointestinal” OR “abdominal” OR “small bowel”.
RESULTS Of 62 patients with described radiologic small bowel alterations, mesenteric ischemia was diagnosed in 31 cases (50%), small bowel wall thickening in 10 cases (16%), pneumatosis in nine cases (15%), intussusception in eight cases (13%), pneumoperitoneum in two cases (3%) and paralytic ileus in two cases (3%). We also reported mesenteric adipose tissue hypertrophy and lymph nodes enlargement in a young woman.
CONCLUSION So far it is difficult to establish whether these manifestations are the direct consequence of SARS-CoV-2 infection or collateral findings in infected patients, but their recognition would be pivotal to set a closer follow-up and to reduce missed diagnoses.
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Affiliation(s)
- Lorena Pirola
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Andrea Palermo
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Giacomo Mulinacci
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Laura Ratti
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Maria Fichera
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Chiara Viganò
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
| | - Sara Massironi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
- European Reference Network on Hepatological Diseases, San Gerardo Hospital, Monza 20900, Italy
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Lee S, Namgoong JM, Kim Y, Cha J, Kim JK. Multimodal imaging of laser speckle contrast imaging combined with mosaic filter-based hyperspectral imaging for precise surgical guidance. IEEE Trans Biomed Eng 2021; 69:443-452. [PMID: 34260344 DOI: 10.1109/tbme.2021.3097122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To enable a real-time surgical guidance system that simultaneously monitors blood vessel perfusion, oxygen saturation, thrombosis, and tissue recovery by combining multiple optical imaging techniques into a single system: visible imaging, mosaic filter-based snapshot hyperspectral imaging (HSI), and laser speckle contrast imaging (LSCI). METHODS The multimodal optical imaging system was demonstrated by clamping blood vessels in the small intestines of rats to create areas of restricted blood flow. Subsequent tissue damage and regeneration were monitored during procedures. Using LSCI, vessel perfusion was measured, revealing the biological activity and survival of organ tissues. Blood oxygen saturation was monitored using HSI in the near-infrared region. Principal component analysis was used over the spectral dimension to identify an HSI wavelength combination optimized for hemodynamic biomarker visualization. HSI and LSCI were complimentary, identifying thrombus generation and tissue recovery, which was not possible in either modality alone. RESULTS AND CONCLUSION By analyzing multimodal tissue information from visible imaging, LSCI perfusion imaging, and HSI, a recovery prognosis could be determined based on the blood supply to the organ. The unique combination of the complementary imaging techniques into a single surgical microscope holds promise for improving the real-time determination of blood supply and tissue prognosis during surgery. SIGNIFICANCE Precise real-time monitoring for vascular anomalies promises to reduce the risk of organ damage in precise surgical operations such as tissue resection and transplantation. In addition, the convergence of label-free imaging technologies removes delays associated with the injection and diffusion of vascular monitoring dyes.
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161
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Schoettler JJ, Kirschning T, Hagmann M, Hahn B, Fairley AM, Centner FS, Schneider-Lindner V, Herrle F, Tzatzarakis E, Thiel M, Krebs J. Maintaining oxygen delivery is crucial to prevent intestinal ischemia in critical ill patients. PLoS One 2021; 16:e0254352. [PMID: 34242347 PMCID: PMC8270469 DOI: 10.1371/journal.pone.0254352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/24/2021] [Indexed: 01/16/2023] Open
Abstract
Background Intestinal ischemia is a common complication with obscure pathophysiology in critically ill patients. Since insufficient delivery of oxygen is discussed, we investigated the influence of oxygen delivery, hemoglobin, arterial oxygen saturation, cardiac index and the systemic vascular resistance index on the development of intestinal ischemia. Furthermore, we evaluated the predictive power of elevated lactate levels for the diagnosis of intestinal ischemia. Methods In a retrospective case-control study data (mean oxygen delivery, minimum oxygen delivery, systemic vascular resistance index) of critical ill patients from 02/2009–07/2017 were analyzed using a proportional hazard model. General model fit and linearity were tested by likelihood ratio tests. The components of oxygen delivery (hemoglobin, arterial oxygen saturation and cardiac index) were individually tested in models. Results 59 out of 874 patients developed intestinal ischemia. A mean oxygen delivery less than 250ml/min/m2 (LRT vs. null model: p = 0.018; LRT for non-linearity: p = 0.012) as well as a minimum oxygen delivery less than 400ml/min/m2 (LRT vs null model: p = 0.016; LRT for linearity: p = 0.019) were associated with increased risk of the development of intestinal ischemia. We found no significant influence of hemoglobin, arterial oxygen saturation, cardiac index or systemic vascular resistance index. Receiver operating characteristics analysis for elevated lactate levels, pH, CO2 and central venous saturation was poor with an area under the receiver operating characteristic of 0.5324, 0.52, 0.6017 and 0.6786. Conclusion There was a significant correlation for mean and minimum oxygen delivery with the incidence of intestinal ischemia for values below 250ml/min/m2 respectively 400ml/min/m2. Neither hemoglobin, arterial oxygen saturation, cardiac index, systemic vascular resistance index nor elevated lactate levels could be identified as individual risk factors.
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Affiliation(s)
- Jochen J. Schoettler
- Department of Anaesthesiology and Surgical Intensive Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
- * E-mail:
| | - Thomas Kirschning
- Clinic for Thorax- and Cardiovascular Surgery HDZ NRW, University of Ruhr-University Bochum, Bochum, Germany
| | - Michael Hagmann
- Interdisciplinary Center for Scientific Computing, Heidelberg University, Heidelberg, Germany
| | - Bianka Hahn
- Department of Anaesthesiology and Surgical Intensive Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Anna-Meagan Fairley
- Department of Anaesthesiology and Surgical Intensive Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Franz-Simon Centner
- Department of Anaesthesiology and Surgical Intensive Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Verena Schneider-Lindner
- Department of Anaesthesiology and Surgical Intensive Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Florian Herrle
- Surgical Department, University Medical Center Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Emmanouil Tzatzarakis
- Surgical Department, University Medical Center Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Manfred Thiel
- Department of Anaesthesiology and Surgical Intensive Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
| | - Joerg Krebs
- Department of Anaesthesiology and Surgical Intensive Care Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of Heidelberg University, Mannheim, Germany
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Huffman J, Nichols WK, Bath J. Current Hybrid Interventions in Vascular Surgery: Merging Past and Present. MISSOURI MEDICINE 2021; 118:381-386. [PMID: 34373675 PMCID: PMC8343637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
As the United States population continues to age, the prevalence of vascular disease continues to increase and thus the role of vascular surgeons in disease intervention has become more important than ever. Over the last 30 years, endovascular techniques have become the mainstay for management of vascular disease. However, open operations continue to play a role in management of complex vascular disease. This article provides an update and discussed the role of hybrid interventions in vascular surgery with a focus on its use in femoral endarterectomy and peripheral stenting, retrograde open mesenteric stenting.
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Affiliation(s)
- Jennifer Huffman
- Third year general surgery resident, University of Missouri-Columbia School of Medicine, Columbia, Missouri
| | - W Kirt Nichols
- Professor of Vascular Surgery, Vice Chair of the Hugh E. Stephenson, Jr., MD, Department of Surgery, University of Missouri-Columbia School of Medicine, Columbia, Missouri
| | - Jonathan Bath
- Vascular Surgery Missouri Medicine Editorial Board Member, Assistant Professor of Surgery, Program Director for Vascular Surgery, Medical Director of Surgical Clinics, University of Missouri-Columbia School of Medicine, Columbia, Missouri
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Brennan CA, Osei-Bonsu P, McClenaghan RE, Nassar A, Forget P, Kaye C, Ramsay G. Vasoactive agents in acute mesenteric ischaemia in critical care. A systematic review. F1000Res 2021; 10:453. [PMID: 34621507 PMCID: PMC8459625 DOI: 10.12688/f1000research.52782.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Acute mesenteric ischaemia (AMI) is a surgical emergency which has an associated high mortality. The mainstay of active treatment includes early surgical intervention, with resection of non-viable bowel, and revascularisation of the ischaemic bowel where possible. Due to the physiological insult of AMI however, perioperative care often involves critical care and the use of vasoactive agents to optimise end organ perfusion. A number of these vasoactive agents are currently available with varied mechanism of action and effects on splanchnic blood flow. However, specific guidance on which is the optimal vasoactive drug to use in these settings is limited. This systematic review aimed to evaluate the current evidence comparing vasoactive drugs in AMI. Methods: A systematic search of Ovid Medline, Ovid Embase, Cochrane CENTRAL and the Cochrane Database of Systematic Review was performed on the 5th of November 2020 to identify randomised clinical trials comparing different vasoactive agents in AMI on outcomes including mortality. The search was performed through the Royal College of Surgeons of England (RCSEng) search support library. Results were analysed using the Rayyan platform, and independently screened by four investigators. Results: 614 distinct papers were identified. After screening, there were no randomised clinical trials meeting the inclusion criteria. Conclusions: This review identifies a gap in literature, and therefore recommends an investigation into current practice and clinician preference in relation to vasoactive agents in AMI. Multicentre randomised controlled trials comparing these medications on clinical outcomes will therefore be required to address this question.
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Affiliation(s)
| | | | | | - Ahmed Nassar
- NHS Grampian, Aberdeen, UK
- University of Aberdeen, Aberdeen, UK
| | - Patrice Forget
- NHS Grampian, Aberdeen, UK
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Callum Kaye
- NHS Grampian, Aberdeen, UK
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - George Ramsay
- NHS Grampian, Aberdeen, UK
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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Brennan CA, Osei-Bonsu P, McClenaghan RE, Nassar A, Forget P, Kaye C, Ramsay G. Vasoactive agents in acute mesenteric ischaemia in critical care. A systematic review. F1000Res 2021; 10:453. [PMID: 34621507 PMCID: PMC8459625 DOI: 10.12688/f1000research.52782.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 04/04/2024] Open
Abstract
Background: Acute mesenteric ischaemia (AMI) is a surgical emergency which has an associated high mortality. The mainstay of active treatment includes early surgical intervention, with resection of non-viable bowel, and revascularisation of the ischaemic bowel where possible. Due to the physiological insult of AMI however, perioperative care often involves critical care and the use of vasoactive agents to optimise end organ perfusion. A number of these vasoactive agents are currently available with varied mechanism of action and effects on splanchnic blood flow. However, specific guidance on which is the optimal vasoactive drug to use in these settings is limited. This systematic review aimed to evaluate the current evidence comparing vasoactive drugs in AMI. Methods: A systematic search of Ovid Medline, Ovid Embase, Cochrane CENTRAL and the Cochrane Database of Systematic Review was performed on the 5th of November 2020 to identify randomised clinical trials comparing different vasoactive agents in AMI on outcomes including mortality. The search was performed through the Royal College of Surgeons of England (RCSEng) search support library. Results were analysed using the Rayyan platform, and independently screened by four investigators. Results: 614 distinct papers were identified. After screening, there were no randomised clinical trials meeting the inclusion criteria. Conclusions: This review identifies a gap in literature, and therefore recommends an investigation into current practice and clinician preference in relation to vasoactive agents in AMI. Multicentre randomised controlled trials comparing these medications on clinical outcomes will therefore be required to address this question.
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Affiliation(s)
| | | | | | - Ahmed Nassar
- NHS Grampian, Aberdeen, UK
- University of Aberdeen, Aberdeen, UK
| | - Patrice Forget
- NHS Grampian, Aberdeen, UK
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Callum Kaye
- NHS Grampian, Aberdeen, UK
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - George Ramsay
- NHS Grampian, Aberdeen, UK
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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165
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Ebrahimi N, Ng KS, Young CJ. Superior mesenteric vein thrombosis in a pregnant woman: Diagnostic and management challenge. ANZ J Surg 2021; 92:265-267. [PMID: 34060201 DOI: 10.1111/ans.16998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Nargus Ebrahimi
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kheng-Seong Ng
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Christopher J Young
- Department of Colorectal Surgery, Discipline of Surgery, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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166
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Gutiérrez-Sánchez G, García-Alonso I, Gutiérrez Sáenz de Santa María J, Alonso-Varona A, Herrero de la Parte B. Antioxidant-Based Therapy Reduces Early-Stage Intestinal Ischemia-Reperfusion Injury in Rats. Antioxidants (Basel) 2021; 10:antiox10060853. [PMID: 34071753 PMCID: PMC8226848 DOI: 10.3390/antiox10060853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 12/02/2022] Open
Abstract
Intestinal ischemia-reperfusion injury (i-IRI) is a rare disorder with a high mortality rate, resulting from the loss of blood flow to an intestinal segment. Most of the damage is triggered by the restoration of flow and the arrival of cytokines and reactive oxygen species (ROS), among others. Inactivation of these molecules before tissue reperfusion could reduce intestinal damage. The aim of this work was to analyze the preventive effect of allopurinol and nitroindazole on intestinal mucosal damage after i-IRI. Wag/RijHsd rats were subjected to i-IRI by clamping the superior mesenteric artery (for 1 or 2 h) followed by a 30 min period of reperfusion. Histopathological intestinal damage (HID) was assessed by microscopic examination of histological sections obtained from injured intestine. HID was increased by almost 20% by doubling the ischemia time (from 1 to 2 h). Nitroindazole reduced HID in both the 1 and 2 h period of ischemia by approximately 30% and 60%, respectively (p < 0.001). Our preliminary results demonstrate that nitroindazole has a preventive/protective effect against tissue damage in the early stages of i-IRI. However, to better understand the molecular mechanisms underlying this phenomenon, further studies are needed.
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Affiliation(s)
- Gaizka Gutiérrez-Sánchez
- Department of Surgery and Radiology and Physical Medicine, University of The Basque Country, ES48940 Leioa, Biscay, Spain; (G.G.-S.); (I.G.-A.); (J.G.S.d.S.M.)
| | - Ignacio García-Alonso
- Department of Surgery and Radiology and Physical Medicine, University of The Basque Country, ES48940 Leioa, Biscay, Spain; (G.G.-S.); (I.G.-A.); (J.G.S.d.S.M.)
- Interventional Radiology Research Group, Biocruces Bizkaia Health Research Institute, ES48903 Barakaldo, Biscay, Spain
| | - Jorge Gutiérrez Sáenz de Santa María
- Department of Surgery and Radiology and Physical Medicine, University of The Basque Country, ES48940 Leioa, Biscay, Spain; (G.G.-S.); (I.G.-A.); (J.G.S.d.S.M.)
| | - Ana Alonso-Varona
- Department of Cell Biology and Histology, University of The Basque Country, ES48940 Leioa, Biscay, Spain;
| | - Borja Herrero de la Parte
- Department of Surgery and Radiology and Physical Medicine, University of The Basque Country, ES48940 Leioa, Biscay, Spain; (G.G.-S.); (I.G.-A.); (J.G.S.d.S.M.)
- Interventional Radiology Research Group, Biocruces Bizkaia Health Research Institute, ES48903 Barakaldo, Biscay, Spain
- Correspondence:
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167
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Janež J, Klen J. Multidisciplinary diagnostic and therapeutic approach to acute mesenteric ischaemia: A case report with literature review. SAGE Open Med Case Rep 2021; 9:2050313X211004804. [PMID: 34094562 PMCID: PMC8142014 DOI: 10.1177/2050313x211004804] [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: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 01/16/2023] Open
Abstract
Superior mesenteric artery embolisation is the most common cause of acute mesenteric ischaemia. Superior mesenteric artery embolisation can be caused by various cardiac diseases (myocardial ischaemia or infarction, atrial tachyarrhythmias, endocarditis, cardiomyopathies, ventricular aneurysms and valvular disorders), arterial aneurysms, ulcerated atherosclerotic plaques of the major arteries and others. A case of 65-year-old, previously healthy man with superior mesenteric artery embolism, who was found to also have mural aortic thrombi, is presented. The patient underwent an emergency procedure; small intestine and cecum were resected and jejuno-ascendo anastomosis was performed. The patient was put on lifelong anticoagulation therapy. Neither cardiac diseases nor arterial aneurysms were detected. There were no signs of underlying atherosclerosis. Work-up for antiphospholipid antibodies and rheumatic diseases was negative. Tumour markers were within normal levels and blood cultures were negative. This case represents the challenges in recognising an underlying cause of acute mesenteric embolism and highlights the importance of multidisciplinary diagnostic and treatment approach.
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Affiliation(s)
- Jurij Janež
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jasna Klen
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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168
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Vasodilator Therapy and Mortality in Nonocclusive Mesenteric Ischemia: A Nationwide Observational Study. Crit Care Med 2021; 48:e356-e361. [PMID: 32044841 DOI: 10.1097/ccm.0000000000004255] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Previous studies have suggested that vasodilator therapy may be beneficial for patients with nonocclusive mesenteric ischemia. However, robust evidence supporting this contention is lacking. We examined the hypothesis that vasodilator therapy may be effective in patients diagnosed with nonocclusive mesenteric ischemia. DESIGN Retrospective cohort study. SETTING The Japanese Diagnosis Procedure Combination inpatient database. PATIENTS A total of 1,837 patients with nonocclusive mesenteric ischemia from July 2010 to March 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We compared patients who received vasodilator therapy (vasodilator group; n = 161) and those who did not (control group; n = 1,676) using one-to-four propensity score matching. Vasodilator therapy was defined as papaverine and/or prostaglandin E1 administered via venous and/or arterial routes within 2 days of admission. Only patients who did not receive abdominal surgery within 2 days of admission were analyzed. The main outcomes were in-hospital mortality and abdominal surgery performed greater than or equal to 3 days after admission. After propensity score matching, in-hospital mortality was significantly lower in the vasodilator group (risk difference, -11.6%; p = 0.005). The proportion of patients who received abdominal surgery at greater than or equal to 3 days after admission was also significantly lower in the vasodilator group (risk difference, -10.2%; p = 0.002). CONCLUSIONS Vasodilator therapy with papaverine and/or prostaglandin E1 is associated with lower in-hospital mortality and prevalence of abdominal surgery in patients with nonocclusive mesenteric ischemia.
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169
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Belov DV, Shivanov IV, Saevets GA, Danko NA, Shopova EN, Pleshakov OO. Endovascular therapy in acute mesenteric ischemia after coronary artery bypass grafting: a case report and literature review. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In the pattern of abdominal complications after cardiac surgery, acute mesenteric ischemia is rare but high-mortality pathology. In the initial stages, the disease has no specific signs, which makes it difficult to perform early multislice computed tomography to diagnose it. Risk stratification and an individual approach to the choice of diagnostic and therapeutic measures aimed at early restoration of mesenteric blood flow will reduce the mortality in this complication.
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Affiliation(s)
- D. V. Belov
- South Ural State Medical University; Federal Center for Cardiovascular Surgery
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170
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Arifa RDN, de Paula TP, Lima RL, Brito CB, Andrade MER, Cardoso VN, Pinheiro MVB, Ladeira LO, Krambrock K, Teixeira MM, Fagundes CT, Souza DG. Anti-inflammatory and antioxidant effects of the nanocomposite Fullerol decrease the severity of intestinal inflammation induced by gut ischemia and reperfusion. Eur J Pharmacol 2021; 898:173984. [PMID: 33647256 DOI: 10.1016/j.ejphar.2021.173984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
Intestinal ischemia is a vascular emergency that arises when blood flow to the intestine is compromised. Reperfusion is necessary to restore intestinal function but might lead to local and systemic inflammatory responses and bacterial translocation, with consequent multiple organ dysfunction syndrome (MODS). During reperfusion occurs production of reactive oxygen species. These species contribute to intestinal injury through direct toxicity or activation of inflammatory pathways. Fullerol is a nanacomposite which has been shown to act as reactive oxygen species and reactive nitrogen species (RNS) scavengers. Thus, our aim was to evaluate whether Fullerol confer anti-inflammatory activity during intestinal ischemia and reperfusion (IIR). Intestinal ischemia was induced by total occlusion of the superior mesenteric artery. Groups were treated with vehicle or Fullerol 10 min before reperfusion. Mice were euthanized after 6 h of reperfusion, and small intestines were collected for evaluation of plasma extravasation, leukocyte influx, cytokine production and histological damage. Bacterial translocation to the peritoneal cavity and reactive oxygen and nitrogen species production by lamina propria cells were also evaluated. Our results showed that treatment with Fullerol inhibited bacterial translocation to the peritoneal cavity, delayed and decreased the lethality rates and diminished neutrophil influx and intestinal injury induced by IIR. Reduced severity of reperfusion injury in Fullerol-treated mice was associated with blunted reactive oxygen and nitrogen species production in leukocytes isolated from gut lamina propria and decreased production of pro-inflammatory mediators. Thus, the present study shows that Fullerol is a potential therapy to treat inflammatory bowel disorders associated with bacterial translocation, such as IIR.
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Affiliation(s)
| | - Talles Prosperi de Paula
- Laboratório de Interação Microrganismo Hospedeiro, Departamento de Microbiologia, Belo Horizonte, MG, Brazil
| | - Renata Lacerda Lima
- Laboratório de Interação Microrganismo Hospedeiro, Departamento de Microbiologia, Belo Horizonte, MG, Brazil
| | - Camila Bernardo Brito
- Laboratório de Interação Microrganismo Hospedeiro, Departamento de Microbiologia, Belo Horizonte, MG, Brazil
| | | | | | | | - Luiz Orlando Ladeira
- Departamento de Física, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Klaus Krambrock
- Departamento de Física, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Mauro Martins Teixeira
- Laboratório de Imunofarmacologia, Departamento de Bioquímica e Imunologia, Belo Horizonte, MG, Brazil; Centro de Pesquisa e Desenvolvimento de Fármacos, Instituto de Ciências Biológicas, Belo Horizonte, MG, Brazil
| | - Caio Tavares Fagundes
- Laboratório de Interação Microrganismo Hospedeiro, Departamento de Microbiologia, Belo Horizonte, MG, Brazil; Centro de Pesquisa e Desenvolvimento de Fármacos, Instituto de Ciências Biológicas, Belo Horizonte, MG, Brazil
| | - Daniele Gloria Souza
- Laboratório de Interação Microrganismo Hospedeiro, Departamento de Microbiologia, Belo Horizonte, MG, Brazil.
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171
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Davarpanah AH, Ghamari Khameneh A, Khosravi B, Mir A, Saffar H, Radmard AR. Many faces of acute bowel ischemia: overview of radiologic staging. Insights Imaging 2021; 12:56. [PMID: 33914188 PMCID: PMC8085211 DOI: 10.1186/s13244-021-00985-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
Acute bowel ischemia (ABI) can be life threatening with high mortality rate. In spite of the advances made in diagnosis and treatment of ABI, no significant change has occurred in the mortality over the past decade. ABI is potentially reversible with prompt diagnosis. The radiologist plays a central role in the initial diagnosis and preventing progression to irreversible intestinal ischemic injury or bowel necrosis. The most single imaging findings described in the literature are either non-specific or only present in the late stages of ABI, urging the use of a constellation of features to reach a more confident diagnosis. While ABI has been traditionally categorized based on the etiology with a wide spectrum of imaging findings overlapped with each other, the final decision for patient’s management is usually made on the stage of the ABI with respect to the underlying pathophysiology. In this review, we first discuss the pathologic stages of ischemia and then summarize the various imaging signs and causes of ABI. We also emphasize on the correlation of imaging findings and pathological staging of the disease. Finally, a management approach is proposed using combined clinical and radiological findings to determine whether the patient may benefit from surgery or not.
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Affiliation(s)
- Amir H Davarpanah
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, USA
| | - Afshar Ghamari Khameneh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bardia Khosravi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, 14117, North Kargar St., Tehran, Iran
| | - Ali Mir
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hiva Saffar
- Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, 14117, North Kargar St., Tehran, Iran.
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172
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Ismavel VA, Kichu M, Hechhula DP, Yanadi R. Right paraduodenal hernia with extensive bowel gangrene treated with staged surgery: a Bogota bag followed by resection in a low-resource setting. BMJ Case Rep 2021; 14:14/4/e239250. [PMID: 33910790 PMCID: PMC8094322 DOI: 10.1136/bcr-2020-239250] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of right paraduodenal hernia with strangulation of almost the entire small bowel at presentation. Since resection of all bowel of doubtful viability would have resulted in too little residual length to sustain life, a Bogota bag was fashioned using transparent plastic material from an urine drainage bag and the patient monitored intensively for 18 hours. At re-laparotomy, clear demarcation lines had formed with adequate length of viable bowel (100 cm) and resection with anastomosis was done with a good outcome on follow-up, 9 months after surgery. Our description of a rare cause of strangulated intestinal obstruction and a novel method of maximising length of viable bowel is reported for its successful outcome in a low-resource setting.
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Affiliation(s)
- Vijay Anand Ismavel
- Department of Surgery, Makunda Christian Leprosy and General Hospital, Karimganj, India
| | - Moloti Kichu
- Department of General Surgery, Makunda Christian Leprosy and General Hospital, Karimganj, India
| | - David Paul Hechhula
- Department of Anesthesia, Makunda Christian Leprosy and General Hospital, Karimganj, India
| | - Rebecca Yanadi
- Department of Anatomy, Makunda Christian Leprosy and General Hospital, Karimganj, India
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173
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Mishra SS, Mishra TS, Mitra S, Kumar P. Intestinal thromboangiitis obliterans: a case report. J Med Case Rep 2021; 15:215. [PMID: 33892806 PMCID: PMC8067351 DOI: 10.1186/s13256-021-02719-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background Thromboangiitis obliterans or Buerger’s disease is a form of peripheral vascular disease in young male smokers. The involvement of the intestine occurs in only about 2% of the cases, when they may present as acute abdomen due to mesenteric ischemia. The uncommonness of the condition makes it a less suspected differential diagnosis, leading to a delay in appropriate management, thereby increasing chances of morbidity or mortality. Cessation of smoking is known to stall the disease progression including visceral involvement, but may not always be the case as happened in the case being presented. Case presentation Our Indian Hindu male patient, a known smoker, presented with diffuse abdominal pain along with bouts of vomiting and loose motions. He had a prior history of amputation of the right foot, 4 years before. At presentation he had abdominal distension with diffuse tenderness and guarding. An omental band attached to the tip of the appendix was discovered at the initial exploration along with dilated proximal bowel loops, for which a release of the omental band along with appendectomy was done. He developed an enterocutaneous fistula on the 6th postoperative day for which he had to be reexplored, and multiple jejunal perforations were found. Segmental jejunal resection and a Roux-en-Y gastrojejunostomy with distal ileostomy were done along with a feeding jejunostomy. The patient however again had feculent discharge from the wound for which a third exploration was done. The gastrojejunostomy and feeding jejunostomy sites were leaky, both of which were repaired primarily. The patient developed septicemia which progressed to refractory septic shock, and he ultimately succumbed to his illness on the 23rd postoperative day of the index surgery. Conclusion Acute abdomen in a young man who is a chronic smoker and having an antecedent history of amputation of some part of an extremity for a nontraumatic cause should raise the suspicion of Buerger’s disease of the intestine. Although it is a progressive disease and the situation has already progressed by the time intestinal symptoms manifest, early detection may give some scope of salvage and decrease the morbidity and mortality.
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Affiliation(s)
- Swastik Sourav Mishra
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Tushar Subhadarshan Mishra
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India. .,AIIMS Bhubaneswar, Room No. 403, Academic building, AIIMS Road, Patrapada, Bhubaneswar, Sijua, 751019, India.
| | - Suvradeep Mitra
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Pankaj Kumar
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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174
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Kiseleva E, Ryabkov M, Baleev M, Bederina E, Shilyagin P, Moiseev A, Beschastnov V, Romanov I, Gelikonov G, Gladkova N. Prospects of Intraoperative Multimodal OCT Application in Patients with Acute Mesenteric Ischemia. Diagnostics (Basel) 2021; 11:705. [PMID: 33920827 PMCID: PMC8071199 DOI: 10.3390/diagnostics11040705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Despite the introduction of increasingly multifaceted diagnostic techniques and the general advances in emergency abdominal and vascular surgery, the outcome of treatment of patients with acute impaired intestinal circulation remains unsatisfactory. The non-invasive and high-resolution technique of optical coherence tomography (OCT) can be used intraoperatively to assess intestine viability and associated conditions that frequently emerge under conditions of impaired blood circulation. This study aims to demonstrate the effectiveness of multimodal (MM) OCT for intraoperative diagnostics of both the microstructure (cross-polarization OCT mode) and microcirculation (OCT angiography mode) of the small intestine wall in patients with acute mesenteric ischemia (AMI). METHODS AND PARTICIPANTS A total of 18 patients were enrolled in the study. Nine of them suffered from AMI in segments II-III of the superior mesenteric artery (AMI group), whereby the ischemic segments of the intestine were examined. Nine others were operated on for adenocarcinoma of the colon (control group), thus allowing areas of their normal small intestine to be examined for comparison. Data on the microstructure and microcirculation in the walls of the small intestine were obtained intraoperatively from the side of the serous membrane using the MM OCT system (IAP RAS, Russia) before bowel resection. The MM OCT data were compared with the results of histological examination. RESULTS The study finds that MM OCT visualized the damage to serosa, muscularis externa, and blood vessels localized in these layers in 100% of AMI cases. It also visualized the submucosa in 33.3% of AMI cases. The MM OCT images of non-ischemic (control group), viable ischemic, and necrotic small intestines (AMI group) differed significantly across stratification of the distinguishable layers, the severity of intermuscular fluid accumulations, and the type and density of the vasculature. CONCLUSION The MM OCT diagnostic procedure optimally meets the requirements of emergency surgery. Data on the microstructure and microcirculation of the intestinal wall can be obtained simultaneously in real time without requiring contrast agent injections. The depth of visualization of the intestinal wall from the side of the serous membrane is sufficient to assess the volume of the affected tissues. However, the methodology for obtaining MM OCT data needs to be improved to minimize the motion artefacts generated in actual clinical conditions.
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Affiliation(s)
- Elena Kiseleva
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia;
| | - Maxim Ryabkov
- Thermal Injury Group, University Clinic, Privolzhsky Research Medical University, 18/1 Verkhnevolzhskaya Naberezhnaja, 603155 Nizhny Novgorod, Russia;
| | - Mikhail Baleev
- City Clinical Hospital No.30, 85A Berezovskaya St., 605157 Nizhny Novgorod, Russia; (M.B.); (V.B.); (I.R.)
| | - Evgeniya Bederina
- The Department of Pathology, University Clinic, Privolzhsky Research Medical University, 18/1 Verkhnevolzhskaya Naberezhnaja, 603155 Nizhny Novgorod, Russia;
| | - Pavel Shilyagin
- Institute of Applied Physics of the RAS, 46 Ulyanova St., 603950 Nizhny Novgorod, Russia; (P.S.); (A.M.); (G.G.)
| | - Alexander Moiseev
- Institute of Applied Physics of the RAS, 46 Ulyanova St., 603950 Nizhny Novgorod, Russia; (P.S.); (A.M.); (G.G.)
| | - Vladimir Beschastnov
- City Clinical Hospital No.30, 85A Berezovskaya St., 605157 Nizhny Novgorod, Russia; (M.B.); (V.B.); (I.R.)
| | - Ivan Romanov
- City Clinical Hospital No.30, 85A Berezovskaya St., 605157 Nizhny Novgorod, Russia; (M.B.); (V.B.); (I.R.)
| | - Grigory Gelikonov
- Institute of Applied Physics of the RAS, 46 Ulyanova St., 603950 Nizhny Novgorod, Russia; (P.S.); (A.M.); (G.G.)
| | - Natalia Gladkova
- Institute of Experimental Oncology and Biomedical Technologies, Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Sq., 603950 Nizhny Novgorod, Russia;
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175
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Chou EL, Wang LJ, McLellan RM, Feldman ZM, Latz CA, LaMuraglia GM, Clouse WD, Eagleton MJ, Conrad MF. Evolution in the Presentation, Treatment, and Outcomes of Patients with Acute Mesenteric Ischemia. Ann Vasc Surg 2021; 74:53-62. [PMID: 33823263 DOI: 10.1016/j.avsg.2021.01.116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Acute mesenteric ischemia (AMI) is a life-threatening condition associated with dismal outcomes. This study sought to evaluate the evolution of presentation, treatment, and outcomes of AMI over the past two decades. METHODS AMI patients presenting at a single institution were reviewed (1993-2016). Venous thrombosis patients were excluded. Primary outcome was 30-day mortality. Patients were stratified by etiology and diagnosis date (before 2004 versus 2004 and later). Ordered logistic regression was performed for longitudinal temporal analysis. RESULTS 303 patients were identified. AMI mechanisms included: embolic (49%), thrombotic (29%), and non-occlusive (NOMI) (22%). The majority were women (55%), 50% had atrial fibrillation, and 23% were on anticoagulation (AC) therapy. Mean age was 72±13 years. 345 procedures were performed in 242 patients: 321 open and 24 hybrid/endovascular. Among the 189 embolic/thrombotic patients who were managed operatively, 45% (n=85) underwent mesenteric revascularization while 39 (21%) had findings of non-survivable bowel necrosis (NSBN). Among the 104 patients who did not undergo revascularization, 64 (62%) died within 30-days compared to 36 out of 85 (42%) patients who were revascularized (P=0.01). 30-day mortality was 61% and stable over time (P=0.91); when stratified by AMI etiology, the thrombotic cohort had worse survival than embolic and NOMI patients (P=0.04). Since 2000, there was a significant decrease in the percentage of embolic AMI events (P=0.04). The percentage of patients who underwent operative management decreased also over time (P=0.01, 81% → 61%), which was correlated with an increasing number of patients being made comfort measures only (CMO) prior to surgical intervention (50% → 70%, P=0.02). The majority of patients (55%) were ultimately made CMO during their hospitalization. Predictors of 30-day mortality included a preoperative white blood cell count (WBC) ≥ 25 K/ µL. (OR 3.0, P=0.002) and lactate ≥ 2.3 mmol/L (OR 2.8, P=0.045). NSBN predictors included WBC ≥ 24 K/ µL. (OR 3.4 P=0.03) and lactate ≥ 3.8 mmol/L (OR 3.6, P=0.04). CONCLUSIONS Despite advances in critical care over the past 25 years, AMI continues to be associated with poor prognosis. The survival benefit observed in patients who undergo revascularization supports an aggressive approach towards early vascular intervention, although this requires further study. The importance of early diagnosis, prognostication and advanced directives is highlighted given the high morbidity, mortality and use of comfort measures associated with AMI.
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Affiliation(s)
- Elizabeth L Chou
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
| | - Linda J Wang
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Rachel M McLellan
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Zach M Feldman
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Christopher A Latz
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Glenn M LaMuraglia
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - W Darrin Clouse
- Division of Vascular and Endovascular Surgery, University of Virginia
| | - Matthew J Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Mark F Conrad
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
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Abstract
PURPOSE OF REVIEW To summarize current evidence on acute mesenteric ischemia (AMI) in critically ill patients, addressing pathophysiology, definition, diagnosis and management. RECENT FINDINGS A few recent studies showed that a multidiscipliary approach in specialized centers can improve the outcome of AMI. Such approach incorporates current knowledge in pathophysiology, early diagnosis with triphasic computed tomography (CT)-angiography, immediate endovascular or surgical restoration of mesenteric perfusion, and damage control surgery if transmural bowel infarction is present. No specific biomarkers are available to detect early mucosal injury in clinical setting. Nonocclusive mesenteric ischemia presents particular challenges, as the diagnosis based on CT-findings as well as vascular management is more difficult; some recent evidence suggests a possible role of potentially treatable stenosis of superior mesenteric artery and beneficial effect of vasodilator therapy (intravenous or local intra-arterial). Medical management of AMI is supportive, including aiming of euvolemia and balanced systemic oxygen demand/delivery. Enteral nutrition should be withheld during ongoing ischemia-reperfusion injury and be started at low rate after revascularization of the (remaining) bowel is convincingly achieved. SUMMARY Clinical suspicion leading to tri-phasic CT-angiography is a mainstay for diagnosis. Diagnosis of nonocclusive mesenteric ischemia and early intestinal injury remains challenging. Multidisciplinary team effort may improve the outcome of AMI.
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Affiliation(s)
- Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Stefan Acosta
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Yaseen M Arabi
- Intensive Care Department, King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Hyperspectral imaging and indocyanine green fluorescence angiography in acute mesenteric ischemia: A case report on how to visualize intestinal perfusion. Int J Surg Case Rep 2021; 82:105853. [PMID: 33838488 PMCID: PMC8045037 DOI: 10.1016/j.ijscr.2021.105853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 01/06/2023] Open
Abstract
First case of HSI and ICG in Acute mesenteric ischemia. Similar results of moth modalities with regard to well perfused intestine. ICG shows exact vascular blood supply and intestinal perfusion. Hyperspectral imaging can distinguish necrotic and vital intestinal segments in AMI. Combined use helps surgeons to evaluate intestinal perfusion intraoperatively in AMI.
Introduction and importance Acute mesenteric ischemia is a challenging acute condition which is often caused by occlusion of an intestinal vessel. Therapeutic algorithms include revascularization of the occluded vessel and a surgical procedure to remove necrotic intestine. Sometimes necrotic intestine is hard to identify visually. Therefore, tools such as hyperspectral imaging (HSI) and indocyanine green fluorescence angiography (ICGFA) might be helpful for objective intraoperative evaluation of intestinal perfusion. Case presentation We present a case of an 80-year-old woman with an acute superior mesenteric artery occlusion and subsequent intestinal gangrene. After endovascular arterial revascularization, we performed an explorative laparotomy in which we assessed intestinal perfusion by HSI and ICGFA. Both HSI and ICGFA showed a sharp perfusion borderline in the proximal jejunum. The distal intestine showed low tissue oxygenation (HSI) and inhomogeneous perfusion (ICGFA). Clinical discussion Both methods showed reproducible results for tissue perfusion and, thus, could provide additional information on the extent of necrotic bowel with need for resection. Therefore, both modalities might be used in future image-guided surgery in cases of acute mesenteric ischemia where visual discrimination of intestinal perfusion is challenging in order to resect as much bowel as necessary to improve patient outcome. Both methods exert different strengths: i.e. ICGFA is real-time angiography, whereas HSI may expose intestinal necrosis in spectroscopy. Conclusion We show, for the first time, simultaneous imaging of HSI and ICGFA in a case of acute mesenteric ischemia. Both imaging modalities reveal similar results reliably concerning intestinal perfusion.
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Abstract
Severe respiratory syndrome coronavirus 2 (SARS-CoV-2) is well known for causing respiratory and other extrapulmonary manifestations. Patients infected with coronavirus disease 2019 (COVID-19) may demonstrate atypical presentations with gastrointestinal symptoms. Clinicians managing these patients should reserve a high index of suspicion for the rare complication of acute mesenteric ischemia (AMI). It is a challenging diagnosis that is often missed when presenting symptoms are subtle and nonspecific like nausea, emesis, or diarrhea. Outcomes are typically catastrophic and fatal as bowel ischemia progresses to necrosis but may be averted with timely diagnostic and therapeutic methods to swiftly restore blood flow.
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Affiliation(s)
| | - Jason Jacob
- Internal Medicine, Hartford Hospital, Hartford, USA
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179
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Imai T, Tanaka Y, Sato Y, Mase J, Suetsugu T, Fukada M, Yasufuku I, Iwata Y, Imai H, Okumura N, Matsuhashi N, Takahashi T, Yoshida K. Successful treatment of superior mesenteric artery thrombosis via preoperative interventional radiology and surgery using indocyanine green fluorescence. Clin J Gastroenterol 2021; 14:769-775. [PMID: 33772735 DOI: 10.1007/s12328-021-01368-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/22/2021] [Indexed: 11/26/2022]
Abstract
We report a successful case that offered a symbolic therapeutic experience of interventional radiology and surgery collaboration for superior mesenteric artery thrombosis. A 70-year-old man presented with a chief complaint of sudden abdominal pain. Contrast-enhanced computed tomography revealed superior mesenteric artery thrombosis. Interventional radiology was performed, and thrombotic occlusion was observed in the superior mesenteric artery trunk. The abdominal pain disappeared; however, after a while, the thrombus re-formed and the abdominal pain reappeared. Thus, emergency surgery was performed. Before surgery, thrombus aspiration was performed via interventional radiology as much as possible. During surgery, when the blood flow was evaluated using fluorescence with indocyanine green, a region of markedly poor blood flow was detected in the ileum, and the area was excised. The postoperative course was favorable. In this patient, it is possible that preoperative removal of the thrombus via interventional radiology minimized the ischemic area of the intestinal tract, and blood flow evaluation using indocyanine green allowed reliable excision of only the ischemic area. We believe that our case involved a treatment that exploited the advantages of both interventional radiology and surgery using indocyanine green fluorescence.
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Affiliation(s)
- Takeharu Imai
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yoshihiro Tanaka
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Yuta Sato
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Junichi Mase
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Tomonari Suetsugu
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masahiro Fukada
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Itaru Yasufuku
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yoshinori Iwata
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hisashi Imai
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Naoki Okumura
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Nobuhisa Matsuhashi
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Takao Takahashi
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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Kundan M, Chebrolu H, Muniswamppa C, Kumar N, Chintamani, Varma V. Outcomes of Management of Patients with Acute Mesenteric Ischemia: A Prospective Study. Niger J Surg 2021; 27:16-21. [PMID: 34012236 PMCID: PMC8112362 DOI: 10.4103/njs.njs_54_20] [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: 05/15/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Acute mesenteric ischemia (AMI) is the sudden onset of small intestinal hypoperfusion, which can be due to reduction or cessation of arterial inflow. It can be embolic or thrombotic. AMI is a potentially fatal vascular emergency, with overall mortality of 60%-80%. The present study was designed to study presentation, risk factors, and various outcomes of AMI patients, who were treated in the tertiary hospital. Methodology All patients with features suggestive of AMI were taken in study. All patients underwent explorative laparotomy with exteriorization of bowel after initial resuscitation. Postoperatively, refeeding enteroclysis was done. Observation and Results The total mortality rate was 62.50%. In patients with functional bowel length of 1 foot, 90.90% patients died. In patients with functional bowel length of 5-6 feet, only 12.50% died. It was observed that the mortality rate was more in the age group of 50-59 years with functional bowel length of 1 foot or <1 foot. Refeeding enteroclysis is an effective technique to use distal bowel. Contrast-enhanced computed tomography of the abdomen more suggestive of this pathology. Conclusions A strong clinical suspicion and an aggressive approach should be considered in dealing with this condition because the outcome mainly depends on rapid diagnosis and treatment. With understanding of the pathogenesis of AMI and the better utilization of available radiological investigations, an improved outcome can be achieved. Mortality rates with refeeding enteroclysis are comparable with that of bowel anastomosis. This condition needs future research.
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Affiliation(s)
- Meghraj Kundan
- Department of General Surgery, V.M.M.C and Safdarjung Hospital, New Delhi, India
| | - Hethu Chebrolu
- Department of General Surgery, V.M.M.C and Safdarjung Hospital, New Delhi, India
| | - Chetan Muniswamppa
- Department of General Surgery, V.M.M.C and Safdarjung Hospital, New Delhi, India
| | - Niranjan Kumar
- Department of General Surgery, TMH, Jamshedpur, Jharkhand, India
| | - Chintamani
- Department of General Surgery, V.M.M.C and Safdarjung Hospital, New Delhi, India
| | - Vinayak Varma
- Department of General Surgery, V.M.M.C and Safdarjung Hospital, New Delhi, India
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181
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Dominowski L, Kirsch M. Synergistic Effect of β-alanine and Aprotinin on Mesenteric Ischemia. J Surg Res 2021; 263:78-88. [PMID: 33639373 DOI: 10.1016/j.jss.2021.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/10/2021] [Accepted: 01/25/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Acute mesenteric ischemia arises through sudden interruption of mesenteric blood flow, mostly due to an occlusion of the superior mesenteric artery and is associated with a high mortality of approximately 50% to 90%. In previous studies, the single application of β-alanine or aprotinin caused an ameliorated intestinal damage but without any systemic effects. METHODS To analyze the combined effect of β-alanine and aprotinin on acute ischemia and reperfusion of the small intestine, a model with anesthetized rats was used. Ischemia and reperfusion were initiated by occluding and reopening the superior mesenteric artery. After 120 min of ischemia and 180 min of reperfusion, the intestine was analyzed for tissue damage, the activity of the saccharase, and accumulation of granulocytes. In addition, systemic and metabolic as well as inflammatory parameters were measured in blood at certain points in time. RESULTS The combination of β-alanine and aprotinin resulted in a clearly stabilized mean arterial blood pressure and blood glucose level during the reperfusion period. Furthermore, the combined administration resulted in significantly reduced tissue damage parameters, cytokine and cell-free hemoglobin concentrations in blood plasma. In addition, the damage to the small intestine was significantly attenuated, so that the animals ultimately survived the entire test period because of the administration of both substances. CONCLUSIONS Overall, the simultaneous application of both substances leads to a synergistic protection without the occurrence of undesirable side effects. The combined usage of β-alanine and aprotinin can be seen as a promising approach to inhibit the onset of acute mesenteric ischemia.
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Affiliation(s)
- Lisa Dominowski
- Institut für Physiologische Chemie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany
| | - Michael Kirsch
- Institut für Physiologische Chemie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany.
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182
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Soeselo DA, Hambali W, Theresia S. Bowel necrosis in patient with severe case of COVID-19: a case report. BMC Surg 2021; 21:97. [PMID: 33618677 PMCID: PMC7897896 DOI: 10.1186/s12893-021-01104-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/15/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In patients who are critically ill with COVID-19, multiple extrapulmonary manifestations of the disease have been observed, including gastrointestinal manifestations. CASE PRESENTATION We present a case of a 65 year old man with severe COVID-19 pneumonia that developed hypercoagulation and peritonitis. Emergent laparotomy was performed and we found bowel necrosis in two sites. CONCLUSIONS Although rare, the presentation of COVID-19 with bowel necrosis requires emergency treatments, and it has high mortality rate.
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Affiliation(s)
- Daniel Ardian Soeselo
- Department of Surgery, School of Medicine and Health Science, Atma Jaya Catholic University of Indonesia, Pluit Raya No. 2, North Jakarta, 14440, Jakarta, Indonesia.
- Department of Surgery, Pondok Indah Puri Indah Hospital, Puri Indah Raya S-2, West Jakarta, Jakarta, 11610, Indonesia.
| | - Wirawan Hambali
- Department of Internal Medicine, Pondok Indah Puri Indah Hospital, Puri Indah Raya S-2, West Jakarta, 11610, Jakarta, Indonesia
| | - Sandy Theresia
- Department of Surgery, School of Medicine and Health Science, Atma Jaya Catholic University of Indonesia, Pluit Raya No. 2, North Jakarta, 14440, Jakarta, Indonesia
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183
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Kobalava B, Kvashilava A, Giorgobiani G, Datikashvili-David IG, Turava N. A Case of Duodenal Resection and Duodenojejunostomy for Multiple Small Bowel Infarction in Patient With Inherited Thrombophilia and Vitamin K Antagonist Induced Critical Hypocoagulation. Cureus 2021; 13:e13129. [PMID: 33728146 PMCID: PMC7935228 DOI: 10.7759/cureus.13129] [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] [Indexed: 11/22/2022] Open
Abstract
We present a case of the multiple venous intestinal infarction in patient with two inherited thrombophilias: Leiden factor V (LFV) and factor VIII elevation. The patient had a critical hypocoagulation caused by vitamin K antagonist (VKA) overdose. At laparotomy, several intestinal segments were necrotic and ischemic. Coagulopathy was corrected by the transfusion of the fresh frozen plasma. Because of the 4th duodenal segment infarction distal segmental duodenectomy with side-to-side duodenojejunostomy was done, which is a rarely performed procedure. On postoperative day 6 deep vein thrombosis developed, despite nadroparin profillaxes, early mobilisation and compressive stockings. Our case demonstrated that in patients with congenital thrombophilia, development of the mesenteric venous thrombosis is possible even with VKA induced severe hypocoagulation. Venous infarction of the small bowel can be associated with the hemoperitoneum and gastrointestinal bleeding. After resection of the fourth duodenal segment, side-to-side duodenojejunostomy is a feasible method of reconstruction.
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Affiliation(s)
- Badri Kobalava
- Medical School, Course of Surgery, New Vision University, Tbilisi, GEO.,Surgery Department #3, Faculty of Medicine, Tbilisi State Medical University, Tbilisi, GEO.,Surgery Division, Aversi Clinic, Tbilisi, GEO
| | | | - Giorgi Giorgobiani
- Surgery Department #3, Faculty of Medicine, Tbilisi State Medical University, Tbilisi, GEO.,Surgery Division, Aversi Clinic, Tbilisi, GEO
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184
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Zhao H, Meng Y, Zhang P, Zhang Q, Wang F, Li Y. Predictors and risk factors for intestinal necrosis in patients with mesenteric ischemia. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:337. [PMID: 33708964 PMCID: PMC7944323 DOI: 10.21037/atm-20-8154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Mesenteric ischemia results in blood flow that is insufficient to meet metabolic demands and subsequent dysfunction of visceral organs, including arterial obstruction and venous thrombosis. Sustained mesenteric ischemia exhausts the ability of capillaries to provide oxygen and initiate an inflammatory reaction, and eventually leads to intestinal mucosal necrosis, a serious and potentially life-threatening condition. Therefore, it is essential that the predictors and risk factors for intestinal necrosis in patients with mesenteric thrombus are explored. Methods This study retrospectively enrolled 41 patients with mesenteric ischemia (including mesenteric vein embolism, mesenteric artery thrombosis, and portal vein thrombosis) who were admitted to the Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital between May 2016 and October 2019; of the patients, 18 were further diagnosed with intestinal necrosis. Comparisons of symptoms, computed tomography angiography (CTA) features, and laboratory examination results were performed between mesenteric ischemia patients with and without intestinal necrosis. Results White blood cell count showed an excellent predictive ability for intestinal necrosis in patients with mesenteric ischemia, with an area under the receiver operating characteristic (ROC) curve of 0.772 (P=0.009). The four CTA features [pneumatosis (P=0.016), intestinal swelling (P=0.006), ascitic fluid (P<0.001), and decreased intestinal wall enhancement (P=0.004)] differed significantly between patients with and without intestinal necrosis. Peritonitis showed a strong association with intestinal necrosis (P=0.006) in the univariate analysis, and multivariate analysis further showed their association [odds ratio (OR): 8.53; 95%CI: 1.46-49.81; P=0.017]. Conclusions White blood cell count is a potential predictor of intestinal necrosis. Peritonitis is a possible risk factor for intestinal necrosis in patients with mesenteric ischemia. A multi-center prospective study with a larger sample size needs to be performed to further investigate these findings.
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Affiliation(s)
- Hongwei Zhao
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yiting Meng
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Qian Zhang
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Feng Wang
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yuanxin Li
- Department of Gastrointestinal Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Miller AS, Boyce K, Box B, Clarke MD, Duff SE, Foley NM, Guy RJ, Massey LH, Ramsay G, Slade DAJ, Stephenson JA, Tozer PJ, Wright D. The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery. Colorectal Dis 2021; 23:476-547. [PMID: 33470518 PMCID: PMC9291558 DOI: 10.1111/codi.15503] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/15/2022]
Abstract
AIM There is a requirement for an expansive and up to date review of the management of emergency colorectal conditions seen in adults. The primary objective is to provide detailed evidence-based guidelines for the target audience of general and colorectal surgeons who are responsible for an adult population and who practise in Great Britain and Ireland. METHODS Surgeons who are elected members of the Association of Coloproctology of Great Britain and Ireland Emergency Surgery Subcommittee were invited to contribute various sections to the guidelines. They were directed to produce a pathology-based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. Each author was asked to provide a set of recommendations which were evidence-based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after two votes were included in the guidelines. RESULTS All aspects of care (excluding abdominal trauma) for emergency colorectal conditions have been included along with 122 recommendations for management. CONCLUSION These guidelines provide an up to date and evidence-based summary of the current surgical knowledge in the management of emergency colorectal conditions and should serve as practical text for clinicians managing colorectal conditions in the emergency setting.
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Affiliation(s)
- Andrew S. Miller
- Leicester Royal InfirmaryUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | | | - Benjamin Box
- Northumbria Healthcare Foundation NHS TrustNorth ShieldsUK
| | | | - Sarah E. Duff
- Manchester University NHS Foundation TrustManchesterUK
| | | | | | | | | | | | | | - Phil J. Tozer
- St Mark’s Hospital and Imperial College LondonHarrowUK
| | - Danette Wright
- Western Sydney Local Health DistrictSydneyNew South WalesAustralia
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Abstract
PURPOSE OF REVIEW The aim of this study was to describe important features of clinical examination for the surgical abdomen, relevant investigations, and acute management of common surgical problems in the critically ill. RECENT FINDINGS Lactate remains a relatively nonspecific marker of gut ischemia. Dual energy computed tomography (DECT) scan can improve diagnosis of bowel ischemia. Further evidence supports intravenous contrast during CT scan in critically ill patients with acute kidney injury. Outcomes for acute mesenteric ischemia have failed to improve over time; however, increasing use of endovascular approaches, including catheter-directed thrombolysis, may decrease need for laparotomy in the appropriate patient. Nonocclusive mesenteric ischemia remains a challenging diagnostic and management dilemma. Acalculous cholecystitis is managed with a percutaneous cholecystostomy and is unlikely to require interval cholecystectomy. Surgeon comfort with intervention based on point-of-care ultrasound for biliary disease is variable. Mortality for toxic megacolon is decreasing. SUMMARY Physical examination remains an integral part of the evaluation of the surgical abdomen. Interpreting laboratory investigations in context and appropriate imaging improves diagnostic ability; intravenous contrast should not be withheld for critically ill patients with acute kidney injury. Surgical intervention should not be delayed for the patient in extremis. The intensivist and surgeon should remain in close communication to optimize care.
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187
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Hou J, Strand-Amundsen R, Hødnebø S, Tønnessen TI, Høgetveit JO. Assessing Ischemic Injury in Human Intestine Ex Vivo with Electrical Impedance Spectroscopy. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2021; 12:82-88. [PMID: 34966469 PMCID: PMC8667813 DOI: 10.2478/joeb-2021-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Indexed: 05/13/2023]
Abstract
Electrical impedance spectroscopy is a well-established tool for monitoring changes in the electrical properties of tissue. Most tissue and organ types have been investigated in various studies. As for the small intestine, there are several published studies conducted on pig and rat models. This study investigates the changes in passive electrical properties of the complete wall of the human intestine non-invasively during ischemia. We aim to use the passive electrical properties to assess intestinal viability. The bioimpedance measurements were performed using a two-electrode set-up with a Solartron 1260 Impedance/gain-phase analyser. The small intestinal samples were resected from patients who underwent pancreaticoduodenectomy. Impedance measurements were conducted following resection by placing the electrodes on the surface of the intestine. A voltage was applied across the intestinal sample and the measured electrical impedance was obtained in the ZPlot software. Impedance data were further fitted into a Cole model to obtain the Cole parameters. The Py value was calculated from the extracted Cole parameters and used to assess the cell membrane integrity, thus evaluate the intestinal viability. Eight small intestinal segments from different patients were used in this study and impedance measurements were performed once an hour for a ten-hour period. One hour after resection, the impedance decreased, then increased the next two hours, before decreasing until the end of the experiment. For all the intestinal segments, the Py values first increased and reached a plateau which lasted for 1 - 2 hours, before it decreased irreversibly. The time interval where Py value reached the maximum is consistent with reported viable/non-viable limits from histological analysis.
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Affiliation(s)
- Jie Hou
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, 0424Oslo, Norway
- Department of Physics, University of Oslo, 0316Oslo, Norway
- E-mail:
| | - Runar Strand-Amundsen
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, 0424Oslo, Norway
| | - Stina Hødnebø
- Department of Emergencies and Critical Care, Oslo University Hospital, 0424Oslo, Norway
| | - Tor Inge Tønnessen
- Department of Emergencies and Critical Care, Oslo University Hospital, 0424Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0318Oslo, Norway
| | - Jan Olav Høgetveit
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, 0424Oslo, Norway
- Department of Physics, University of Oslo, 0316Oslo, Norway
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188
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Endo A, Saida F, Mochida Y, Kim S, Otomo Y, Nemoto D, Matsubara H, Yamagishi S, Murao Y, Mashiko K, Hirano S, Yoshikawa K, Sera T, Inaba M, Koami H, Kobayashi M, Murata K, Shoko T, Takiguchi N. Planned Versus On-Demand Relaparotomy Strategy in Initial Surgery for Non-occlusive Mesenteric Ischemia. J Gastrointest Surg 2021; 25:1837-1846. [PMID: 32935272 PMCID: PMC7491869 DOI: 10.1007/s11605-020-04792-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 09/06/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND There has been insufficient evidence regarding a treatment strategy for patients with non-occlusive mesenteric ischemia (NOMI) due to the lack of large-scale studies. We aimed to evaluate the clinical benefit of strategic planned relaparotomy in patients with NOMI using detailed perioperative information. METHODS We conducted a multicenter retrospective cohort study that included NOMI patients who underwent laparotomy. In-hospital mortality, 28-day mortality, incidence of total adverse events, ventilator-free days, and intensive care unit (ICU)-free days were compared between groups experiencing the planned and on-demand relaparotomy strategies. Analyses were performed using a multivariate mixed effects model and a propensity score matching model after adjusting for pre-operative, intra-operative, and hospital-related confounders. RESULTS A total of 181 patients from 17 hospitals were included, of whom 107 (59.1%) were treated using the planned relaparotomy strategy. The multivariate mixed effects regression model indicated no significant differences for in-hospital mortality (61 patients [57.0%] in the planned relaparotomy group vs. 28 patients [37.8%] in the on-demand relaparotomy group; adjusted odds ratio [95% confidence interval] = 1.94 [0.78-4.80]), as well as in 28-day mortality, adverse events, and ICU-free days. Significant reduction in ventilator-free days was observed in the planned relaparotomy group. Propensity score matching analysis of 61 matched pairs with comparable patient severity did not show superiority of the planned relaparotomy strategy. CONCLUSIONS The planned relaparotomy strategy, compared with on-demand relaparotomy strategy, did not show clinical benefits after the initial surgery of patients with NOMI. Further studies estimating potential subpopulations who may benefit from this strategy are required.
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Affiliation(s)
- Akira Endo
- grid.474906.8Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Fumitaka Saida
- grid.413376.40000 0004 1761 1035Emergency and Critical Care Medicine, Tokyo Women’s Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, Japan
| | - Yuzuru Mochida
- Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi Tsurumi-ku, Yokohama, Kanagawa Japan
| | - Shiei Kim
- grid.410821.e0000 0001 2173 8328Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Yasuhiro Otomo
- grid.474906.8Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 Japan
| | - Daisuke Nemoto
- Senshu Trauma and Critical Care Center, Rinku General Medical Center, 2-23 Rinku Ourai Kita, Izumisano, Osaka, Japan
| | - Hisahiro Matsubara
- grid.136304.30000 0004 0370 1101Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Japan
| | - Shigeru Yamagishi
- Department of Surgery, Fujisawa Municipal Hospital, 2-6-1, Fujisawa, Kanagawa Japan
| | - Yoshinori Murao
- grid.258622.90000 0004 1936 9967Department of Emergency and Critical Care Medicine, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, Japan
| | - Kazuki Mashiko
- grid.416273.50000 0004 0596 7077Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, Japan
| | - Satoshi Hirano
- grid.39158.360000 0001 2173 7691Department of Gastroenterological Surgery II, Division of Surgery, Graduate School of Medicine, Hokkaido University, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido Japan
| | - Kentaro Yoshikawa
- Department of General Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, Japan
| | - Toshiki Sera
- grid.414173.40000 0000 9368 0105Critical Care Medical Center, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-ku, Hiroshima, Japan
| | - Mototaka Inaba
- grid.416814.e0000 0004 1772 5040Department of Emergency Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutaicho, Kita-ku, Okayama, Japan
| | - Hiroyuki Koami
- grid.412339.e0000 0001 1172 4459Department of Emergency and Critical Cere Medicine, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, Japan
| | - Makoto Kobayashi
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, 1094 Tobera, Toyooka, Hyogo Japan
| | - Kiyoshi Murata
- Department of Emergency Medicine and Acute Care Surgery, Matsudo City General Hospital, 993-1 Sendabori, Matsudo, Chiba, Japan
| | - Tomohisa Shoko
- grid.413376.40000 0004 1761 1035Emergency and Critical Care Medicine, Tokyo Women’s Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, Japan
| | - Noriaki Takiguchi
- grid.410824.b0000 0004 1764 0813Department of Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, Japan
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189
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Strait A, Gasper W, Dhaliwal G. The Resolution of Abdominal Pain: an Ominous Sign of Mesenteric Ischemia. J Gen Intern Med 2021; 36:216-219. [PMID: 33150528 PMCID: PMC7859142 DOI: 10.1007/s11606-020-06313-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Adrienne Strait
- School of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Warren Gasper
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
- Vascular Surgery Section, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Gurpreet Dhaliwal
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Medical Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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190
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Mishra V, Hewage S, Islam S, Harky A. The correlation between bowel complications and cardiac surgery. Scand J Surg 2020; 110:187-192. [PMID: 33372573 DOI: 10.1177/1457496920983618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although advances in knowledge and technology have improved outcomes in surgical cardiac patients over the last decade, complications following cardiac operations still remain to be potentially fatal. Gastrointestinal complications, in particular, tend to have high rates of reintervention and mortality following cardiac surgery, with ischemia and hemorrhage being two of the commonest underlying causes. The intention of this review is to identify which risk factors play important roles in predisposing patients to such complications and to gain better insight into the pathogenesis of the sequelae. Furthermore, strategies for prevention have been discussed to educate and increase awareness of how adverse cardiac surgical outcomes can be minimized.
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Affiliation(s)
- V Mishra
- St George's, University of London, Cranmer Terrace, UK
| | - S Hewage
- St George's, University of London, Cranmer Terrace, UK
| | - S Islam
- St George's, University of London, Cranmer Terrace, UK.,The Shrewsbury & Telford NHS Trust, Princess Royal Hospital, Telford, UK
| | - A Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Congenital Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
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191
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Jarvis JK, Rambhajan A. Adult Intestinal Malrotation in a Non-Paediatric Hospital in Trinidad: A Case Report and Literature Review. Cureus 2020; 12:e12305. [PMID: 33520504 PMCID: PMC7834238 DOI: 10.7759/cureus.12305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Intestinal malrotation (IM) is a congenital aberrancy of midgut rotation during development, which manifests among neonates more than adults. Older reports have estimated an incidence of one in 6,000 live births, which is now as high as one in 500. This congenital anomaly is generally indolent in the adult population. Recent literature research has failed to reveal any publications regarding the incidence within a Caribbean population. This paper aims to discuss the isolated case of a patient with this rare condition, who presented to a non-paediatric centre in Trinidad. This case highlights the implications of the initial radiological interpretation in conjunction with perioperative and intraoperative decision making. An 18-year-old male presented with a one-day history of abdominal pain, radiating to the epigastrium with nausea and excessive vomiting. Vital signs and blood investigations were normal. Initial CT scan results were interpreted as an internal hernia, which was surgically managed as such. Repeat imaging and a second laparotomy were required to correctly diagnose and perform the appropriate Ladd procedure. IM occurs due to the arrest of rotation of the midgut during fetal maturation. The incomplete rotation variant was seen in this case and is predominantly responsible for the symptomatology and morbidity associated with adult intestinal malrotation (AIM). Stringer has classified these anomalies based on the stage of embryonic development that is disrupted. CT helps with diagnostics in 97.5% of cases. This case highlights the implication of incorrect assessment on imaging and how it may misguide the interpretation of the findings at laparotomy leading to inappropriate surgical procedures. As many as 20% of cases undergo surgery without adult intussusception diagnosed. The incidence of IM seems to have increased but is scarcely encountered in the adult setting. When encountering this condition at a low-volume centre in the Caribbean, the adult specialist may be blindsided, and unknowingly underprepared without a high index of suspicion. Diagnosis at childhood should be discussed with the family and again with the patient on approaching adulthood. Patient education may help with the surgical assessment.
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Affiliation(s)
| | - Amrit Rambhajan
- General Surgery, General Hospital Port of Spain, Port of Spain, TTO
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192
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Pankratov AA, Perehodov SN, Zelenin DA, Izrailov RE, Matkov IV. [Is acute mesenteric ischemia incurable situation? The current state of the problem]. Khirurgiia (Mosk) 2020:105-110. [PMID: 33301263 DOI: 10.17116/hirurgia2020121105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Mortality rates in acute mesenteric ischemia remain at an extremely high level for many decades. Early diagnosis and selection of the optimal method of revascularization are among the ways to optimize tactics. The diagnostic study of choice is CT angiography. Its active and systemic use can help to detect ischemia at the reversible stage. The article examines in detail the indications for the application of this diagnostic study. The question of preference for the revascularization method remains debatable. The arguments of proponents of open and endovascular interventions on mesenteric vessels are presented. Other, still unresolved tactical issues are also considered, such as indications for re-operations and application of the principles of damage control tactics.
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Affiliation(s)
- A A Pankratov
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, Russia.,City Clinical Hospital named after V.P. Demihov of the Moscow City Health Department, Moscow, Russia
| | - S N Perehodov
- City Clinical Hospital named after V.P. Demihov of the Moscow City Health Department, Moscow, Russia
| | - D A Zelenin
- City Clinical Hospital named after V.P. Demihov of the Moscow City Health Department, Moscow, Russia
| | - R E Izrailov
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, Russia
| | - I V Matkov
- City Clinical Hospital named after V.P. Demihov of the Moscow City Health Department, Moscow, Russia
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193
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Abu-Much A, Barbash IM, Guetta V, Segev A, Fefer P, Matetzky S, Nissan N, Maor E. Don't Trust the Imaging: Necrotic Bowel Following Transcatheter Aortic Valve Replacement Through Aortic Stent Graft. JACC Case Rep 2020; 2:2339-2343. [PMID: 34317168 PMCID: PMC8305109 DOI: 10.1016/j.jaccas.2020.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/19/2020] [Accepted: 10/27/2020] [Indexed: 06/13/2023]
Abstract
Mesenteric ischemia is a rare but lethal complication of transcatheter aortic valve replacement (TAVR). We present a challenging case of an 80-year-old man who had abdominal pain few hours following TAVR. Repeated abdominal and pelvic imaging showed no vascular obstruction, but exploratory laparoscopy revealed a necrotic bowel. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Arsalan Abu-Much
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Israel M. Barbash
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Victor Guetta
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Amit Segev
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Paul Fefer
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Shlomi Matetzky
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Noam Nissan
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Elad Maor
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
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194
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Tang W, Jin B, Kuang LQ, Zhang J, Li CX, Wang Y. Risk factors of geriatrics index of comorbidity and MDCT findings for predicting mortality in patients with acute mesenteric ischemia due to superior mesenteric artery thromboembolism. Br J Radiol 2020; 93:20190605. [PMID: 32886528 DOI: 10.1259/bjr.20190605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To identify risk factors of geriatrics index of comorbidity (GIC) and multidetector CT (MDCT) findings for predicting mortality in patients with acute mesenteric ischemia (AMI) due to superior mesenteric artery (SMA) thromboembolism. METHODS 33 patients with AMI due to SMA thromboembolism underwent abdominal MDCT and angiography. Patients' comorbidities and MDCT findings of ischemic bowel/mesenteric injuries, regions of SMA involved by thromboembolism, and degrees of SMA stenosis were retrospectively reviewed. The comorbidities were classified into 1-4 levels according to GIC. The association of MDCT signs and GIC classification with mortality were analyzed. Diagnostic performances of risk factors associated with mortality were evaluated by receiver operating characteristic (ROC) curve analyses. RESULTS Eighteen patients (54.5%) died during hospitalization or follow-up, including one patient with class 1, two patients with class 2, eight patients with class 3, and seven patients with class 4 according to GIC. Three risk factors significantly associated with mortality were identified, including pneumatosis and/or portomesenteric venous gas (PPMVG) (p = 0.017), four regions of SMA involved by thromboembolism (region I + II + III + IV) (p = 0.036), and class 3 + 4 of comorbidities (p = 0.001). The sensitivity and specificity of PPMVG, region I + II + III + IV, class 3 + 4 of comorbidities, and the three risk factors combined for diagnosing mortality were 33.3 and 100%, 27.8 and 100%, 83.3 and 73.3%, and 88.9 and 73.3%, respectively. The areas under the ROC curve (AUC) of the three risk factors combined (0.88) and class 3 + 4 of comorbidities (0.78) were larger than that of PPMVG (0.67) and region I + II + III + IV (0.64). The mortality rate rose from 15.4% in patients without risk factor to 66.7%, 100%, and 100% in patients with one, two, and three factors, respectively. CONCLUSION Three risk factors for mortality were identified in patients with AMI due to SMA thromboembolism, including PPMVG and four regions of SMA involved by thromboembolism on MDCT images, and class 3 + 4 of comorbidities. Close monitoring of these risk factors could possibly lower the mortality. ADVANCES IN KNOWLEDGE Risk factors based on GIC and MDCT findings may be used to predict mortality in patients with AMI. Close monitoring of these risk factors could possibly lower the mortality.
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Affiliation(s)
- Wei Tang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, China.,Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Bo Jin
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Lian-Qin Kuang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Jing Zhang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Chun-Xue Li
- Department of Gastrointestinal Surgery, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Yi Wang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, China
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195
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Patel TV, Canario DAH, Isaacson AJ, Mauro DM. Vascular Etiologies of the Acute Abdomen. Semin Roentgenol 2020; 55:417-426. [PMID: 33220787 DOI: 10.1053/j.ro.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tirth V Patel
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Ari J Isaacson
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - David M Mauro
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC.
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196
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Nuzzo A, Joly F, Ronot M, Castier Y, Huguet A, Paugam-Burtz C, Cazals-Hatem D, Tran-Dinh A, Becq A, Panis Y, Bouhnik Y, Maggiori L, Corcos O. Normal Lactate and Unenhanced CT-Scan Result in Delayed Diagnosis of Acute Mesenteric Ischemia. Am J Gastroenterol 2020; 115:1902-1905. [PMID: 33156109 DOI: 10.14309/ajg.0000000000000836] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION To investigate the factors associated with a delayed diagnosis (DD) of acute mesenteric ischemia (AMI). METHODS An observational cohort study from an intestinal failure center. The primary outcome was DD >24 hours. RESULTS Between 2006 and 2015, 74 patients with AMI were included and 39 (53%) had a DD. Plasma lactate <2 mmol/L (odd ratio: 3.2; 95% confidence interval: 1.1-9.1; P = 0.03) and unenhanced computed tomography scan (odds ratio: 5.9; 95% confidence interval: 1.4-25.8; P = 0.01) were independently associated with DD. DISCUSSION Suspicion of AMI should no longer be affected by normal plasma lactate levels and should prompt evaluation by a contrast-enhanced computed tomography-scan.
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Affiliation(s)
- Alexandre Nuzzo
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
| | - Francisca Joly
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
| | - Maxime Ronot
- University of Paris, Paris, France
- APHP, Department of Radiology, Beaujon Hospital, Clichy, France
| | - Yves Castier
- APHP, Department of Vascular Surgery, Bichat Hospital, Paris, France
| | - Audrey Huguet
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
| | - Catherine Paugam-Burtz
- University of Paris, Paris, France
- APHP, Department of Anesthesia and Intensive Care, Beaujon Hospital, Clichy, France
| | - Dominique Cazals-Hatem
- University of Paris, Paris, France
- APHP, Department of Pathology, Beaujon Hospital, Clichy, France
| | - Alexy Tran-Dinh
- University of Paris, Paris, France
- APHP, Department of Anesthesia and Intensive Care, Bichat Hospital, Paris, France
| | - Aymeric Becq
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
| | - Yves Panis
- University of Paris, Paris, France
- APHP, Department of Colorectal Surgery, Beaujon Hospital, Clichy, France
| | - Yoram Bouhnik
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
| | - Leon Maggiori
- University of Paris, Paris, France
- APHP, Department of Colorectal Surgery, Beaujon Hospital, Clichy, France
| | - Olivier Corcos
- APHP, Deparment of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France
- University of Paris, Paris, France
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197
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Koizumi S, Tsubota H, Koyama T. Impact of the collateral network on central-repair-first strategy in superior mesenteric artery occlusion with type A acute aortic dissection. Gen Thorac Cardiovasc Surg 2020; 69:796-802. [PMID: 33090366 DOI: 10.1007/s11748-020-01524-x] [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] [Received: 08/15/2020] [Accepted: 10/12/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Surgery for acute type A aortic dissection with mesenteric malperfusion is challenging. Although the peripheral-reperfusion-first strategy has shown good results, more discussion regarding indicated patients is needed. This study aimed to describe the imaging features and surgical outcomes of mesenteric malperfusion and to clarify which cases should be considered for the peripheral-reperfusion-first strategy. METHODS A total of 200 patients underwent emergent aortic repair for acute type A aortic dissection at our institution between October 2011 and July 2019. Superior mesenteric artery occlusion on preoperative contrast-enhanced computed tomography was detected in 12 patients, who were categorized into two groups based on enhancement (n = 7) or non-enhancement (n = 5) of the superior mesenteric artery peripheral branches. Operative outcomes after central repair were compared between groups. RESULTS Four patients in the enhanced group had no postoperative abdominal complications, and three patients required superior mesenteric artery bypass grafting with the central-repair-first strategy. However, all patients in the enhanced group survived and did not require intestinal resection. In contrast, four patients (80%) in the non-enhanced group had intestinal necrosis, three patients required intestinal resection, and one patient died from multiple organ failure. CONCLUSION The presence or absence of an enhancement of the peripheral superior mesenteric artery by the collateral network could be helpful for decision-making. The central-repair-first strategy may be permitted in patients with enhanced peripheral branches. Conversely, in patients with non-enhanced peripheral branches, a more invasive assessment should be considered before central aortic repair, and peripheral-reperfusion-first strategy may be required.
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Affiliation(s)
- Shigeki Koizumi
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi Chuoku Kobeshi Hyogoken, Kobe, 650-0047, Japan.
| | - Hideki Tsubota
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi Chuoku Kobeshi Hyogoken, Kobe, 650-0047, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi Chuoku Kobeshi Hyogoken, Kobe, 650-0047, Japan
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198
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Karaosmanoglu AD, Uysal A, Akata D, Ozmen MN, Karcaaltincaba M. Role of imaging in visceral vascular emergencies. Insights Imaging 2020; 11:112. [PMID: 33057847 PMCID: PMC7561664 DOI: 10.1186/s13244-020-00913-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023] Open
Abstract
Differential diagnosis in non-traumatic acute abdomen is broad and unrelated diseases may simulate each other from a clinical perspective. Despite the fact that they are not as common, acute abdominal pain due to diseases related to visceral vessels may be life-threating if not detected and treated promptly. Thrombosis, dissection, and aneurysm in the abdominal visceral arteries or thrombosis in visceral veins may cause acute abdominal pain. Imaging with appropriate protocoling plays a fundamental role in both early diagnosis and determination of the treatment approach in these cases where early treatment can be life-saving. Computed tomography (CT) appears to be the most effective modality for the diagnosis as it provides high detail images in a very short time. Patient cooperation is also a less concern as compared to magnetic resonance imaging (MRI). As the imaging findings may sometimes be really subtle, diagnosis may be difficult especially to inexperienced imagers. Correct protocoling is also very critical to detect arterial abnormalities as visceral arterial abnormalities may not be detectable in portal phase only abdominal CT scans. In this article, we aimed to increase awareness among imaging specialists to these not very common causes of acute abdomen.
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Affiliation(s)
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, 06010, Ankara, Turkey
| | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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Ennab RM, Al-Omari MH, Jaradat II, Aljabali AAA. Endovascular management of acute mesenteric ischemia in a young patient with thyrotoxicosis and atrial fibrillation: A case report and review of the literature. Int J Surg Case Rep 2020; 76:190-194. [PMID: 33038846 PMCID: PMC7550828 DOI: 10.1016/j.ijscr.2020.09.180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 01/16/2023] Open
Abstract
Acute mesenteric ischemia has a high mortality rate of 50%–80%. CT angiography is highly valuable in the diagnosis of acute mesenteric ischemia. Patients who present with peritonitis or hemodynamic instability should undergo open surgery. Endovascular management is increasingly being considered as the main modality of management of AMI in selected cases. Endovascular management of AMI involves aspiration thrombectomy, thrombolysis, and/or possible angioplasty and stenting.
Introduction Acute mesenteric ischemia caused by an embolism resulting from atrial fibrillation in a thyrotoxic young male patient is a rare event. Endovascular intervention is increasingly being considered as the primary modality of treatment in selected patients. Presentation of case A 41-years male known to have hyperthyroidism presented with atrial fibrillation, acute mesenteric ischemia, splenic infarction, and left renal infarction. He was successfully managed with endovascular intervention of the superior mesenteric artery. Discussion Acute mesenteric ischemia has a high mortality rate. CT angiography is the investigation of choice for diagnosis of the mesenteric vessels occlusion and assessment of bowel ischemia. The clinical presentation guides into the treatment and the choice between open surgery and endovascular intervention as the primary modality of treatment. Thyrotoxicosis is a risky comorbid condition for any procedure to be done, so proper perioperative management is essential to decrease morbidity and mortality. Conclusion Prompt diagnosis and management of acute mesenteric ischemia is essential to decrease the morbidity and mortality rates. Endovascular management can be considered as a primary modality of treatment in selected cases.
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Affiliation(s)
- Raed M Ennab
- Department of Clinical Sciences/Vascular Surgery, Faculty of Medicine, Yarmouk University, Irbid, Jordan.
| | - Mamoon H Al-Omari
- Department of Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ihab I Jaradat
- Department of Clinical Sciences/General Surgery, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Alaa A A Aljabali
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
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Singh B, Mechineni A, Kaur P, Ajdir N, Maroules M, Shamoon F, Bikkina M. Acute Intestinal Ischemia in a Patient with COVID-19 Infection. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2020; 76:164-166. [PMID: 32969365 DOI: 10.4166/kjg.2020.76.3.164] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022]
Abstract
The World Health Organization has declared novel coronavirus disease 2019 (COVID-19) a global public health emergency. Although respiratory symptoms predominate in COVID-19, thrombosis can occur in patients with COVID-19. This paper reports a case of an 82-year-old female with a prior medical history of hypertension, diabetes presenting with fever and cough, and was diagnosed with COVID-19. The patient subsequently developed progressively worsening of abdominal distention, tenderness, and underwent emergent laparotomy. She was found to have a gangrenous colon. This case adds to the limited literature regarding the extrapulmonary complications of COVID-19.
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Affiliation(s)
- Balraj Singh
- Department of Hematology & Oncology, Saint Joseph's University Medical Center, Paterson, USA
| | - Ashesha Mechineni
- Department of Internal Medicine, Saint Joseph's University Medical Center, Paterson, USA
| | - Parminder Kaur
- Department of Cardiology, Saint Joseph's University Medical Center, Paterson, USA
| | - Nora Ajdir
- Department of Internal Medicine, Saint Joseph's University Medical Center, Paterson, USA
| | - Michael Maroules
- Department of Hematology & Oncology, Saint Joseph's University Medical Center, Paterson, USA
| | - Fayez Shamoon
- Department of Cardiology, Saint Joseph's University Medical Center, Paterson, USA
| | - Mahesh Bikkina
- Department of Cardiology, Saint Joseph's University Medical Center, Paterson, USA
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