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Duivenvoorden AAM, Metz FM, Wijenbergh R, Verberght HCR, van Bijnen AAJHM, Olde Damink SWM, Geelkerken RH, Lenaerts K, Lubbers T. Intestinal Fatty Acid Binding Protein as a Predictor of Early Mesenteric Injury Preceding Clinical Presentation: A Case Report. EJVES Vasc Forum 2024; 61:136-140. [PMID: 38884076 PMCID: PMC11176664 DOI: 10.1016/j.ejvsvf.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/01/2024] [Accepted: 04/23/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Diagnosing non-occlusive mesenteric ischaemia (NOMI) in patients is complicated, due to poor signs and symptoms and non-specific laboratory tests, leading to a high mortality rate. This case study presents the rare case of a patient who developed mesenteric ischaemia after an emergency thoracic endovascular aneurysm repair (TEVAR) for a type B aortic dissection (TBAD) and peri-operative cardiogenic shock. Study outcomes revealed that intestinal fatty acid binding protein (I-FABP) identified early mucosal damage two days before the clinical presentation. Report A 43 year old male patient was admitted to the emergency department with an acute TBAD and a dissection of the superior mesenteric artery (SMA), for which TEVAR was performed with additional stent placement in the SMA. Peri-operatively, the patient went into cardiogenic shock with a sustained period of hypotension. Post-operatively, the plasma I-FABP levels were measured prospectively, revealing an initial increase on post-operative day five (551.1 pg/mL), which continued beyond day six (610.3 pg/mL). On post-operative day seven, the patient developed a fever and demonstrated signs of peritonitis and bowel perforation. He underwent an emergency laparotomy, followed by an ileocaecal resection (<100 cm) with a transverse ileostomy. Pathological analysis confirmed the diagnosis of mesenteric ischaemia. Discussion The diagnosis of NOMI in critically ill patients is often complicated, and the currently available diagnostic markers lack the specificity and sensitivity to detect early intestinal injury. This case report highlights that elevated I-FABP in plasma levels may indicate the presence of early mesenteric injury. Further research needs to be conducted before I-FABP can be applied in daily practice.
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Affiliation(s)
- Annet A M Duivenvoorden
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Flores M Metz
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
- Dutch Expert Centre for Gastrointestinal Ischaemia, Enschede, the Netherlands
| | - Robin Wijenbergh
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Hanne C R Verberght
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Annemarie A J H M van Bijnen
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Steven W M Olde Damink
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Robert H Geelkerken
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
- Dutch Expert Centre for Gastrointestinal Ischaemia, Enschede, the Netherlands
| | - Kaatje Lenaerts
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Tim Lubbers
- Department of Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
- GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Boccatonda A, D’Ardes D, Tallarico V, Vicari S, Bartoli E, Vidili G, Guagnano MT, Cocco G, Cipollone F, Schiavone C, Accogli E. Gastrointestinal Ultrasound in Emergency Setting. J Clin Med 2023; 12:jcm12030799. [PMID: 36769448 PMCID: PMC9917741 DOI: 10.3390/jcm12030799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
Acute bowel diseases are responsible for more than one third of subjects who were referred to the emergency department for acute abdominal pain and gastrointestinal evaluation. Gastrointestinal ultrasound (GIUS) is often employed as the first imaging method, with a good diagnostic accuracy in the setting of acute abdomen, and it can be an optimal diagnostic strategy in young females due to the radiation exposure related to X-ray and computed tomography methods. The physician can examine the gastrointestinal system in the area with the greatest tenderness by ultrasound, thus obtaining more information and data on the pathology than the standard physical examination. In this comprehensive review, we have reported the most relevant indications and advantages to using ultrasound in the investigation of abdominal acute pain.
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Affiliation(s)
- Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Bentivoglio (BO), 40010 Bologna, Italy
- Correspondence: ; Tel.: +39-051-664-4111
| | - Damiano D’Ardes
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Viola Tallarico
- Department of Internal Medicine, Bologna University, 40138 Bologna, Italy
| | - Susanna Vicari
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Bentivoglio (BO), 40010 Bologna, Italy
| | - Elena Bartoli
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, Bentivoglio (BO), 40010 Bologna, Italy
| | - Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Maria Teresa Guagnano
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Giulio Cocco
- Internistic Ultrasound Unit, SS Annunziata Hospital, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Cosima Schiavone
- Internistic Ultrasound Unit, SS Annunziata Hospital, “G. d’Annunzio” University, 66100 Chieti, Italy
| | - Esterita Accogli
- Internal Medicine, Centre of Research and Learning in Ultrasound, Maggiore Hospital, 40133 Bologna, Italy
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Bugurov SV, Karpenko AA, Osipova OS, Gostev AA, Saaya SB, Cheban AV, Mochalova AB, Ignatenko PV, Rabtsun AA, Obedinsky AA, Zeydlits GA. Chronic mesenteric ischemia: causes, methods of diagnosis and treatment. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Chronic mesenteric ischemia (CMI) is an urgent public health problem. The long asymptomatic course of the disease, sudden onset and an unfavorable prognosis in the absence of treatment make it necessary to pay closer attention to this pathology. There are currently two competitive treatments for CMI: surgical and endovascular revascularization. Despite numerous studies comparing these methods, the question of which one is more effective and reliable remains open. The review includes current data from clinical trials and meta-analyses demonstrating the advantages and disadvantages of both methods.
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Okumura E, Jimbo H, Sunaga S, Otsuka K, Okada H, Onitsuka T. Nonocclusive Mesenteric Ischemia Is a Potentially Lethal Complication Just after Stroke Onset: Report of Six Case Studies. NMC Case Rep J 2022; 8:631-635. [PMID: 35079527 PMCID: PMC8769417 DOI: 10.2176/nmccrj.cr.2021-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/11/2021] [Indexed: 01/16/2023] Open
Abstract
Nonocclusive mesenteric ischemia (NOMI) is a rare but life-threatening post-stroke complication. This is the first case series report of NOMI after stroke, describing its characteristics and the difficulty of diagnosis. We retrospectively reviewed 367 stroke patients from April 2018 to May 2019 in our hospital. We identified six patients (1.6%) with NOMI after stroke and described their clinical presentation, including characteristics, vital signs, laboratory parameters, treatment, and outcomes. The mean interval between stroke onset and diagnosis of NOMI was 4.6 days (range, 3–10 days). Five patients had disturbance of consciousness caused by stroke, and therefore the major complaints and symptoms associated with NOMI were nonspecific, possibly resulting in delayed diagnosis and treatment. All patients had a high respiratory rate (≥22 breaths/min). C-reactive protein and lactate levels were high (mean, 21.6 mg/L and 2.4 mmol/L, respectively). All patients underwent emergent abdominal operations. Four patients were discharged with modified Rankin Scale scores ≥4, and two patients died. NOMI can be a fatal post-stroke complication and is challenging to diagnose. Further investigations should be conducted to determine the most efficient way to diagnose NOMI after stroke.
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Affiliation(s)
- Eitaro Okumura
- Neurosurgery Department, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Hiroyuki Jimbo
- Neurosurgery Department, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Shigeki Sunaga
- Neurosurgery Department, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Kunitoshi Otsuka
- Neurosurgery Department, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Hirofumi Okada
- Neurosurgery Department, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
| | - Toshiaki Onitsuka
- Neurosurgery Department, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan
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Grotelueschen R, Miller V, Heidelmann LM, Melling N, Ghadban T, Grupp K, Reeh M, Welte MN, Uzunoglu FG, Izbicki JR, Bachmann KA. Acute Mesenteric Infarction: The Chameleon of Acute Abdomen Evaluating the Quality of the Diagnostic Parameters in Acute Mesenteric Ischemia. Dig Surg 2021; 38:149-157. [PMID: 33503619 DOI: 10.1159/000512779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/25/2020] [Indexed: 12/10/2022]
Abstract
INTRODUCTION/OBJECTIVE Acute mesenteric ischemia (AMI) is difficult to diagnose. Since the established parameters have low sensitivity and specificity, the aim of this study is to analyze the diagnostic quality of the established parameters of AMI. METHODS All patients that underwent emergency surgery due to suspected diagnosis of mesenteric ischemia at the University Medical Center Hamburg-Eppendorf between 2008 and 2014 were evaluated. Overall, 275 patients were enrolled and pre-, intra- and postoperative data were evaluated. RESULTS In 200 patients, a mesenteric ischemia was confirmed intraoperatively, and 75 patients had no ischemia. Comparing these groups, the rate of patients with pH < 7.2 (25 vs. 12%; p = 0.021) and elevated mean CRP level (175 ± 117 mg/L vs. 139 ± 104 mg/L; p = 0.019) was significantly higher in ischemic patients. There was no significant difference in the level of preoperative lactate. Concerning abdominal CT scan, a sensitivity and specificity of 61 and 68%, respectively, was found. CONCLUSION New diagnostic parameters are needed. So far, explorative laparotomy is the only reliable diagnostic method to detect mesenteric infarction.
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Affiliation(s)
- Rainer Grotelueschen
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Verena Miller
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Lena M Heidelmann
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany,
| | - Nathaniel Melling
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Tarik Ghadban
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Grupp
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Reeh
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Maria-Noemi Welte
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Faik Güntac Uzunoglu
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kai A Bachmann
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Hollerweger A, Maconi G, Ripolles T, Nylund K, Higginson A, Serra C, Dietrich CF, Dirks K, Gilja OH. Gastrointestinal Ultrasound (GIUS) in Intestinal Emergencies - An EFSUMB Position Paper. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:646-657. [PMID: 32311749 DOI: 10.1055/a-1147-1295] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
An interdisciplinary group of European experts summarizes the value of gastrointestinal ultrasound (GIUS) in the management of three time-critical causes of acute abdomen: bowel obstruction, gastrointestinal perforation and acute ischemic bowel disease. Based on an extensive literature review, statements for a targeted diagnostic strategy in these intestinal emergencies are presented. GIUS is best established in case of small bowel obstruction. Metanalyses and prospective studies showed a sensitivity and specificity comparable to that of computed tomography (CT) and superior to plain X-ray. GIUS may save time and radiation exposure and has the advantage of displaying bowel function directly. Gastrointestinal perforation is more challenging for less experienced investigators. Although GIUS in experienced hands has a relatively high sensitivity to establish a correct diagnosis, CT is the most sensitive method in this situation. The spectrum of intestinal ischemia ranges from self-limited ischemic colitis to fatal intestinal infarction. In acute arterial mesenteric ischemia, GIUS may provide information, but prompt CT angiography is the gold standard. On the other end of the spectrum, ischemic colitis shows typical ultrasound features that allow correct diagnosis. GIUS here has a diagnostic performance similar to CT and helps to differentiate mild from severe ischemic colitis.
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Affiliation(s)
- Alois Hollerweger
- Department of Radiology, Hospital Barmherzige Brüder, Salzburg, Austria
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, "L.Sacco" University Hospital, Milan, Italy
| | - Tomas Ripolles
- Department of Radiology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Kim Nylund
- Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - Antony Higginson
- Department of Radiology, Queen-Alexandra-Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom of Great Britain and Northern Ireland
| | - Carla Serra
- Internal Medicine and Gastroenterology, S. Orsola University Hospital, Bologna, Italy
| | - Christoph F Dietrich
- Department of General Internal Medicine Kliniken Hirslanden Beau-Site, Salem und Permanence, Bern, Switzerland
| | - Klaus Dirks
- Gastroenterology and Internal Medicine, Rems-Murr-Klinikum Winnenden, Germany
| | - Odd Helge Gilja
- Haukeland University Hospital, National Centre for Ultrasound in Gastroenterology, Bergen, Norway
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Ascher S, Wilms E, Pontarollo G, Formes H, Bayer F, Müller M, Malinarich F, Grill A, Bosmann M, Saffarzadeh M, Brandão I, Groß K, Kiouptsi K, Kittner JM, Lackner KJ, Jurk K, Reinhardt C. Gut Microbiota Restricts NETosis in Acute Mesenteric Ischemia-Reperfusion Injury. Arterioscler Thromb Vasc Biol 2020; 40:2279-2292. [PMID: 32611241 DOI: 10.1161/atvbaha.120.314491] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Recruitment of neutrophils and formation of neutrophil extracellular traps (NETs) contribute to lethality in acute mesenteric infarction. To study the impact of the gut microbiota in acute mesenteric infarction, we used gnotobiotic mouse models to investigate whether gut commensals prime the reactivity of neutrophils towards formation of neutrophil extracellular traps (NETosis). Approach and Results: We applied a mesenteric ischemia-reperfusion (I/R) injury model to germ-free (GF) and colonized C57BL/6J mice. By intravital imaging, we quantified leukocyte adherence and NET formation in I/R-injured mesenteric venules. Colonization with gut microbiota or monocolonization with Escherichia coli augmented the adhesion of leukocytes, which was dependent on the TLR4 (Toll-like receptor-4)/TRIF (TIR-domain-containing adapter-inducing interferon-β) pathway. Although neutrophil accumulation was decreased in I/R-injured venules of GF mice, NETosis following I/R injury was significantly enhanced compared with conventionally raised mice or mice colonized with the minimal microbial consortium altered Schaedler flora. Also ex vivo, neutrophils from GF and antibiotic-treated mice showed increased LPS (lipopolysaccharide)-induced NETosis. Enhanced TLR4 signaling in GF neutrophils was due to elevated TLR4 expression and augmented IRF3 (interferon regulatory factor-3) phosphorylation. Likewise, neutrophils from antibiotic-treated conventionally raised mice had increased NET formation before and after ischemia. Increased NETosis in I/R injury was abolished in conventionally raised mice deficient in the TLR adaptor TRIF. In support of the desensitizing influence of enteric LPS, treatment of GF mice with LPS via drinking water diminished LPS-induced NETosis in vitro and in the mesenteric I/R injury model. CONCLUSIONS Collectively, our results identified that the gut microbiota suppresses NETing neutrophil hyperreactivity in mesenteric I/R injury, while ensuring immunovigilance by enhancing neutrophil recruitment.
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Affiliation(s)
- Stefanie Ascher
- From the Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University of Mainz (JGU), Germany (S.A., E.W., G.P., H.F., F.B., M.M., F.M., A.G., M.B., M.S., I.B., K.G., K.K., K.J., C.R.).,Institute for Pharmacy & Biochemistry, Johannes Gutenberg University of Mainz, Germany (S.A.)
| | - Eivor Wilms
- From the Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University of Mainz (JGU), Germany (S.A., E.W., G.P., H.F., F.B., M.M., F.M., A.G., M.B., M.S., I.B., K.G., K.K., K.J., C.R.)
| | - Giulia Pontarollo
- From the Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University of Mainz (JGU), Germany (S.A., E.W., G.P., H.F., F.B., M.M., F.M., A.G., M.B., M.S., I.B., K.G., K.K., K.J., C.R.)
| | - Henning Formes
- From the Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University of Mainz (JGU), Germany (S.A., E.W., G.P., H.F., F.B., M.M., F.M., A.G., M.B., M.S., I.B., K.G., K.K., K.J., C.R.)
| | - Franziska Bayer
- From the Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University of Mainz (JGU), Germany (S.A., E.W., G.P., H.F., F.B., M.M., F.M., A.G., M.B., M.S., I.B., K.G., K.K., K.J., C.R.)
| | - Maria Müller
- From the Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University of Mainz (JGU), Germany (S.A., E.W., G.P., H.F., F.B., M.M., F.M., A.G., M.B., M.S., I.B., K.G., K.K., K.J., C.R.)
| | - Frano Malinarich
- From the Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University of Mainz (JGU), Germany (S.A., E.W., G.P., H.F., F.B., M.M., F.M., A.G., M.B., M.S., I.B., K.G., K.K., K.J., C.R.)
| | - Alexandra Grill
- From the Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University of Mainz (JGU), Germany (S.A., E.W., G.P., H.F., F.B., M.M., F.M., A.G., M.B., M.S., I.B., K.G., K.K., K.J., C.R.).,German Center for Cardiovascular Research, Partner Site RheinMain, Mainz, Germany (A.G., C.R.)
| | - Markus Bosmann
- From the Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University of Mainz (JGU), Germany (S.A., E.W., G.P., H.F., F.B., M.M., F.M., A.G., M.B., M.S., I.B., K.G., K.K., K.J., C.R.).,Pulmonary Center, Department of Medicine, Boston University School of Medicine, MA (M.B.)
| | - Mona Saffarzadeh
- From the Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University of Mainz (JGU), Germany (S.A., E.W., G.P., H.F., F.B., M.M., F.M., A.G., M.B., M.S., I.B., K.G., K.K., K.J., C.R.)
| | - Inês Brandão
- From the Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University of Mainz (JGU), Germany (S.A., E.W., G.P., H.F., F.B., M.M., F.M., A.G., M.B., M.S., I.B., K.G., K.K., K.J., C.R.).,Centro de Apoio Tecnológico Agro Alimentar (CATAA), Zona Industrial de Castelo Branco, Portugal (I.B.)
| | - Kathrin Groß
- From the Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University of Mainz (JGU), Germany (S.A., E.W., G.P., H.F., F.B., M.M., F.M., A.G., M.B., M.S., I.B., K.G., K.K., K.J., C.R.)
| | - Klytaimnistra Kiouptsi
- From the Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University of Mainz (JGU), Germany (S.A., E.W., G.P., H.F., F.B., M.M., F.M., A.G., M.B., M.S., I.B., K.G., K.K., K.J., C.R.)
| | - Jens M Kittner
- I. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Germany (J.M.K.)
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Germany (K.J.L.)
| | - Kerstin Jurk
- From the Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University of Mainz (JGU), Germany (S.A., E.W., G.P., H.F., F.B., M.M., F.M., A.G., M.B., M.S., I.B., K.G., K.K., K.J., C.R.)
| | - Christoph Reinhardt
- From the Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University of Mainz (JGU), Germany (S.A., E.W., G.P., H.F., F.B., M.M., F.M., A.G., M.B., M.S., I.B., K.G., K.K., K.J., C.R.).,German Center for Cardiovascular Research, Partner Site RheinMain, Mainz, Germany (A.G., C.R.)
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Cojocari N, David L. Acute Intestinal Infarction Due to Diffuse Jejunoileal and Mesenteric Lipomatosis in a 39-Year-Old Woman. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e922830. [PMID: 32348294 PMCID: PMC7209906 DOI: 10.12659/ajcr.922830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Patient: Female, 39-year-old Final Diagnosis: Acute intestinal infarction Symptoms: Painful Medication: — Clinical Procedure: Intestinal resection Specialty: Surgery
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Affiliation(s)
- Nadejda Cojocari
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - Leonard David
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania
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Al-Diery H, Phillips A, Evennett N, Pandanaboyana S, Gilham M, Windsor JA. The Pathogenesis of Nonocclusive Mesenteric Ischemia: Implications for Research and Clinical Practice. J Intensive Care Med 2018; 34:771-781. [PMID: 30037271 DOI: 10.1177/0885066618788827] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nonocclusive mesenteric ischemia (NOMI) is a condition that can encompass ischemia, inflammation, and infarction of the intestinal wall. In contrast to most patients with acute mesenteric ischemia, NOMI is distinguished by patent arteries and veins. The clinical presentation of NOMI is often insidious and nonspecific, resulting in a delayed diagnosis. Patients most at risk are those with severe acute and critical disease, including major surgery and trauma. Nonocclusive mesenteric ischemia is part of a spectrum, from mild, asymptomatic, and an unexpected finding on CT scanning, through to those exhibiting abdominal distension and peritonitis. Severe NOMI is associated with a significant mortality rate. This review of NOMI pathophysiology was conducted to document current concepts and evidence, to examine the implications for diagnosis and treatment, and to identify gaps in knowledge that might direct future research. The key pathologic mechanisms involved in the genesis of NOMI represent an exaggerated normal physiological response to maintain perfusion of vital organs at the expense of mesenteric perfusion. A supply-demand mismatch develops in the intestine due to the development of persistent mesenteric vasoconstriction resulting in reduced blood flow and oxygen delivery to the intestine, particularly to the vulnerable superficial mucosa. This mismatch can be exacerbated by raised intra-abdominal pressure, enteral nutrition, and the use of certain vasoactive drugs, ultimately resulting in the development of intestinal ischemia. Strategies for prevention, early detection, and treatment are urgently needed.
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Affiliation(s)
- Hussam Al-Diery
- 1 Faculty of Medical and Health Sciences, Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Anthony Phillips
- 1 Faculty of Medical and Health Sciences, Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand.,2 Applied Surgery and Metabolism Laboratory, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Nicholas Evennett
- 3 HBP/Upper GI Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Sanjay Pandanaboyana
- 1 Faculty of Medical and Health Sciences, Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand.,3 HBP/Upper GI Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Michael Gilham
- 4 Cardiovascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
| | - John A Windsor
- 1 Faculty of Medical and Health Sciences, Department of Surgery, School of Medicine, University of Auckland, Auckland, New Zealand.,2 Applied Surgery and Metabolism Laboratory, School of Biological Sciences, University of Auckland, Auckland, New Zealand.,3 HBP/Upper GI Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand.,5 Surgical Centre for Outcomes Research and Evaluation, Department of Surgery, University of Auckland, Auckland, New Zealand
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Weatherspoon K, Gilbertie W, Catanzano T. Emergency Computed Tomography Angiogram of the Chest, Abdomen, and Pelvis. Semin Ultrasound CT MR 2017; 38:370-383. [PMID: 28865527 DOI: 10.1053/j.sult.2017.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the setting of blunt trauma, the rapid assessment of internal injuries is essential to prevent potentially fatal outcomes. Computed tomography is a useful diagnostic tool for both screening and diagnosis. In addition to trauma, acute chest syndromes often warrant emergent computed tomographic angiography, looking for etiologies such as aortic aneurysms or complications of aortic aneurysms, or both, pulmonary emboli, as well as other acute vascular process like aortic dissection and Takayasu aortitis. With continued improvements in diagnostic imaging, computed tomographic angiography of the chest, abdominal and pelvis proves to be an effective modality to image the aorta and other major vascular structures.
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Affiliation(s)
- Kimberly Weatherspoon
- Department of Radiology, Baystate Medical Center-University of Massachusetts, Springfield, MA.
| | - Wayne Gilbertie
- Department of Radiology, Baystate Medical Center-University of Massachusetts, Springfield, MA
| | - Tara Catanzano
- Department of Radiology, Baystate Medical Center-University of Massachusetts, Springfield, MA
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Hamaoka T, Omi W, Sekiguti Y, Takata S, Kaneko S, Inoue O, Takashima S, Murai H, Usui S, Kato T, Furusho H, Takamura M. Intestinal angina in a patient with hypertrophic obstructive cardiomyopathy: a case report. J Med Case Rep 2016; 10:271. [PMID: 27686381 PMCID: PMC5043615 DOI: 10.1186/s13256-016-1055-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/05/2016] [Indexed: 11/25/2022] Open
Abstract
Background Intestinal angina is characterized by recurrent postprandial abdominal pain and anorexia. Commonly, these symptoms are caused by severe stenosis of at least two vessels among the celiac and mesenteric arteries. However, intestinal perfusion is affected not only by the degree of arterial stenosis but also by systemic perfusion. We experienced a unique case of intestinal angina caused by relatively mild stenosis of the abdominal arteries complicated with hypertrophic obstructive cardiomyopathy. Case presentation We report an 86-year old Japanese man with hypertrophic obstructive cardiomyopathy and advanced atrioventricular block who was diagnosed with intestinal angina. Computed tomography showed mild stenosis of the celiac artery and severe stenosis of the inferior mesenteric artery, and these lesions were relatively mild compared with other reports. A dual-chamber pacemaker with right ventricular apical pacing was implanted to improve the obstruction of the left ventricular outflow tract. After implantation, the patient’s abdominal symptoms diminished markedly, and improvement of the left ventricular outflow tract obstruction was observed. Conclusions Although intestinal angina is generally defined by severe stenosis of at least two vessels among the celiac and mesenteric arteries, the present case suggests that hemodynamic changes can greatly affect intestinal perfusion and induce intestinal angina in the presence of mild stenosis of the celiac and mesenteric arteries.
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12
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Ricci ZJ, Mazzariol FS, Kaul B, Oh SK, Chernyak V, Flusberg M, Stein MW, Rozenblit AM. Hollow organ abdominal ischemia, part II: clinical features, etiology, imaging findings and management. Clin Imaging 2016; 40:751-64. [PMID: 27317221 DOI: 10.1016/j.clinimag.2016.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/16/2016] [Accepted: 02/17/2016] [Indexed: 12/20/2022]
Abstract
Acute hollow organ ischemia commonly presents with acute pain prompting radiologic evaluation and almost always requires urgent treatment. Despite different risk factors and anatomic differences, ischemia is commonly due to low flow states but can also be due to arterial and venous occlusion. Radiologic diagnosis is critical as many present with nonspecific symptoms. Contrast-enhanced computed tomography (CT) is the modality of choice. Magnetic resonance imaging (MRI) is preferred in suspected appendicitis in pregnant patients and is superior in biliary necrosis. This article provides a pictorial review of the CT/MRI features of hollow abdominal organ ischemia while highlighting key clinical features, pathogenesis, and management.
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Affiliation(s)
- Zina J Ricci
- Department of Diagnostic Radiology, Montefiore Medical Center of the Albert Einstein School of Medicine, 111 E 210th St., Bronx, NY 10467.
| | - Fernanda S Mazzariol
- Department of Diagnostic Radiology, Montefiore Medical Center of the Albert Einstein School of Medicine, 111 E 210th St., Bronx, NY 10467.
| | - Bindu Kaul
- Department of Diagnostic Radiology, Jack D. Weiler Hospital of the Albert Einstein School of Medicine, 1825 Eastchester Rd., Bronx, NY 10461.
| | - Sarah K Oh
- Department of Diagnostic Radiology, Montefiore Medical Center of the Albert Einstein School of Medicine, 111 E 210th St., Bronx, NY 10467.
| | - Victoria Chernyak
- Department of Diagnostic Radiology, Montefiore Medical Center of the Albert Einstein School of Medicine, 111 E 210th St., Bronx, NY 10467.
| | - Milana Flusberg
- Department of Diagnostic Radiology, Montefiore Medical Center of the Albert Einstein School of Medicine, 111 E 210th St., Bronx, NY 10467.
| | - Marjorie W Stein
- Department of Diagnostic Radiology, Montefiore Medical Center of the Albert Einstein School of Medicine, 111 E 210th St., Bronx, NY 10467.
| | - Alla M Rozenblit
- Department of Diagnostic Radiology, Montefiore Medical Center of the Albert Einstein School of Medicine, 111 E 210th St., Bronx, NY 10467.
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Mazzei MA, Volterrani L. Nonocclusive mesenteric ischaemia: think about it. Radiol Med 2014; 120:85-95. [DOI: 10.1007/s11547-014-0460-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 08/11/2014] [Indexed: 01/16/2023]
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Pizarro-Moreno A, Araujo Miguez A, Garzón Benavides M, Nacarino V. [The role of endovascular treatment in chronic mesenteric ischemia]. Rev Clin Esp 2012; 212:416-8. [PMID: 22483532 DOI: 10.1016/j.rce.2012.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 02/06/2012] [Indexed: 10/28/2022]
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