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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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Imamura H, Hata J, Takata T. Contrast-enhanced ultrasonographic findings of non-occlusive mesenteric ischemia: a case series. Abdom Radiol (NY) 2022; 47:1654-1659. [PMID: 33835224 DOI: 10.1007/s00261-021-03002-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Diagnosis of non-occlusive mesenteric ischemia (NOMI) is difficult, with diagnostic imaging being mainly performed using angiography or contrast-enhanced computed tomography. Contrast-enhanced ultrasonography (CEUS) offers an alternative diagnostic method, although diagnosis of NOMI using CEUS is not common. In this report, we review CEUS findings in a series of patients with NOMI. METHODS The records of patients diagnosed with NOMI who underwent a surgical procedure in our institution between January 2015 and February 2020 were retrospectively assessed. Grayscale ultrasonography and CEUS findings were evaluated. RESULTS Ten patients (mean age 65 ± 25 years, 7 men) were studied. Grayscale ultrasonography revealed bowel dilatation, the presence of intestinal pneumatosis, portal venous gas, bowel wall thickening, and no or decreased peristalsis. A CEUS finding of note was a partial lack of enhancement of the bowel wall. CONCLUSION In a small case series of 10 patients with surgically/histopathology confirmed NOMI, partial lack of ultrasound contrast-enhancement of the bowel wall was observed.
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Gummadi S, Koenig G, Wessner CE, Machado P, Stem J, Forsberg F, Liu JB, Lyshchik A, O'Kane P, Eisenbrey JR. Contrast-Enhanced Ultrasound in Small Intestinal Ischemia: Proof of Concept. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:835-843. [PMID: 34101877 DOI: 10.1002/jum.15763] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 05/08/2021] [Accepted: 05/26/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Small intestinal ischemia is a challenging diagnosis to make, even with the combination of imaging, laboratory analysis, and physical exam. This pilot study investigated the role of CEUS in evaluating small bowel wall vascularity in participants with suspected ischemia. METHODS In this IRB-approved pilot study, CEUS using perflutren lipid microspheres (DEFINITY®; Lantheus Medical Imaging Inc., N. Billerica, MA) was performed on participants determined by the clinical surgical team to have concerns for small intestinal ischemia. CEUS interpretations were performed at both the bedside and later by a blinded radiologist and compared to clinical imaging, surgical findings, or long-term clinical outcomes. RESULTS Fifteen CEUS examinations were performed on 14 participants. Five of the participants underwent exploratory laparotomy. Of these, one had small intestinal ischemia (without necrosis). Point of care CEUS demonstrated no evidence of bowel necrosis in any case, and delayed enhancement (indicative of intestinal ischemia) in three cases, resulting in a sensitivity of 100% (95% CI 2.5-100%) and specificity of 85.7% (95% CI 57.2-98.2%). CEUS correctly ruled out ischemia in 91.7% of cases with CT suspicion of small bowel obstruction and 60% of cases that underwent surgical intervention. Additionally, the rate of agreement between bedside interpretation and later radiologist read was high (93%). CONCLUSIONS CEUS is uniquely positioned for evaluating the small intestine, because of its high temporal resolution and immediacy of results. Combined with multi-sectional imaging for focal areas of ischemia and/or clinical suspicion for pan ischemia, CEUS may be a useful rule out test for small intestinal ischemia.
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Affiliation(s)
- Sriharsha Gummadi
- Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - George Koenig
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jonathan Stem
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Patrick O'Kane
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Koenig G, Tantawi M, Wessner CE, Eisenbrey JR. Evaluation of Suspected Small Bowel Ischemia Using Contrast-Enhanced Ultrasound with Computed Tomography Fusion. J Emerg Trauma Shock 2022; 15:60-62. [PMID: 35431480 PMCID: PMC9006710 DOI: 10.4103/jets.jets_57_21] [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: 04/20/2021] [Revised: 10/03/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022] Open
Abstract
Small bowel ischemia can lead to fatal complications such as necrosis, perforation, and sepsis. Clinical examinations and laboratory tests are usually inconclusive in critically ill patients. The need for surgical exploration is decided based on imaging, examination, and clinical judgment. The decision to operate is time-critical and can be lifesaving, but surgical intervention has the potential to cause additional morbidity, especially in unstable patients. Contrast-enhanced computed tomography (CECT) is the study of choice in suspected small bowel ischemia but has poor specificity. Contrast-enhanced ultrasound (CEUS) provides real-time visualization of the bowel wall vascularity. In this case report, we used a CEUS with CT fusion examination to rule out small bowel ischemia in a critically ill patient with suspected closed loop small bowel obstruction on CECT and in whom surgical exploration would have not been well tolerated. The patient's condition later improved, and an abdominal CT showed no evidence of obstruction.
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Affiliation(s)
- George Koenig
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mohamed Tantawi
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
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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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Abstract
PURPOSE OF REVIEW Despite restoration of adequate systemic blood flow in patients with shock, single organs may remain hypoperfused. In this review, we summarize the results of a literature research on methods to monitor single organ perfusion in shock. We focused on methods to measure heart, brain, kidney, and/or visceral organ perfusion. Furthermore, only methods that can be used in real-time and at the bedside were included. RECENT FINDINGS We identified studies on physical examination techniques, electrocardiography, echocardiography, contrast-enhanced ultrasound, near-infrared spectroscopy, and Doppler sonography to assess single organ perfusion. SUMMARY Physical examination techniques have a reasonable negative predictive value to exclude single organ hypoperfusion but are nonspecific to detect it. Technical methods to indirectly measure myocardial perfusion include ECG and echocardiography. Contrast-enhanced ultrasound can quantify myocardial perfusion but has so far only been used to detect regional myocardial hypoperfusion. Near-infrared spectroscopy and transcranial Doppler sonography can be used to assess cerebral perfusion and determine autoregulation thresholds of the brain. Both Doppler and contrast-enhanced ultrasound techniques are novel methods to evaluate renal and visceral organ perfusion. A key limitation of most techniques is the inability to determine adequacy of organ blood flow to meet the organs' metabolic demands.
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Linta N, Baron Toaldo M, Del Magno S, Pey P, Quinci M, Diana A. Two-dimensional and contrast-enhanced ultrasound of intestinal ischaemia in cats: four cases. J Feline Med Surg 2020; 22:384-390. [PMID: 30896334 PMCID: PMC10814668 DOI: 10.1177/1098612x19837332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to describe the results of two-dimensional (2D) and contrast-enhancement ultrasound (CEUS) in four cats with intestinal ischaemia. METHODS Data were collected from hospital records of all cats that had intestinal ischaemia between January 2012 and August 2018. The inclusion criteria were complete abdominal ultrasound examination, colour flow Doppler and CEUS of lesions, confirmation of intestinal ischaemia detected by visual assessment of avascular intestinal segment at surgery, and/or necropsy and histopathology. All images and video clips were reviewed by the same experienced operator. RESULTS Four cats with different intestinal ischaemic lesions were included in the study: duodenal perforating ulcer, jejunal necrotising enteritis, necrosis secondary to jejunojejunal intussusception and iatrogenic damage of jejunal arteries. On the 2D ultrasound, all intestinal lesions were characterised by non-specific findings: focal hypoechoic wall thickening with loss of normal layering associated with hyperechoic mesentery surrounding the intestinal tract. CEUS showed a reduced or absent enhancement of the intestinal lesions in comparison to the surrounding perfused wall. CONCLUSIONS AND RELEVANCE Intestinal ischaemia is a potentially fatal disorder. Grey-scale, colour and power Doppler ultrasonography are not sensitive for evaluating this condition. Our preliminary findings illustrate the usefulness of CEUS for the detection of intestinal wall impaired perfusion in cats.
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Affiliation(s)
- Nikolina Linta
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Marco Baron Toaldo
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Sara Del Magno
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Pascaline Pey
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Manuela Quinci
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Alessia Diana
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
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8
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Giannetti A, Matergi M, Biscontri M, Tedone F, Falconi L, Giovannelli L, Ussia V, Franci L, Pieraccini M. Multiparametric ultrasound in the diagnosis and monitoring of ischemic colitis: description of a case of ischemic colitis of the right colon and revision of the literature. J Ultrasound 2019; 22:477-484. [PMID: 31119715 DOI: 10.1007/s40477-019-00386-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022] Open
Abstract
The aim of this paper is to describe the usefulness of multiparametric US in the diagnosis and subsequent follow-up of a case of right-side ischemic colitis and to present a review of the data reported in the literature. Ischemic colitis is frequently diagnosed in the field of gastroenterology. Diagnosis is usually based on the outcome of endoscopy and histological examination, and in case of right-side ischemic colitis also on the results of contrast-enhanced CT. In the described case, multiparametric US indicated the diagnosis including a prognostic judgment, and during follow-up US-monitored patency of the stents positioned under angiographic guidance. One of the available US techniques, CEUS, seems to have a special role in the detection of residual vascularization of the gastrointestinal tract affected by ischemia. However, before introducing this method into daily clinical practice, further studies are required to confirm its diagnostic accuracy.
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Affiliation(s)
- Andrea Giannetti
- Gastroenterology Unit, Misericordia Hospital, Via Senese 169, 58100, Grosseto, Italy.
| | - Marco Matergi
- Gastroenterology Unit, Misericordia Hospital, Via Senese 169, 58100, Grosseto, Italy
| | - Marco Biscontri
- Gastroenterology Unit, Misericordia Hospital, Via Senese 169, 58100, Grosseto, Italy
| | - Francesco Tedone
- Gastroenterology Unit, Misericordia Hospital, Via Senese 169, 58100, Grosseto, Italy
| | - Lucia Falconi
- Gastroenterology Unit, Misericordia Hospital, Via Senese 169, 58100, Grosseto, Italy
| | - Luca Giovannelli
- Gastroenterology Unit, Misericordia Hospital, Via Senese 169, 58100, Grosseto, Italy
| | - Valeria Ussia
- Gastroenterology Unit, Misericordia Hospital, Via Senese 169, 58100, Grosseto, Italy
| | - Luca Franci
- Radiology Department, Misericordia Hospital, Grosseto, Italy
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9
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Nestola M, De Matthaeis N, Ferraro PM, Fuso P, Costanzi S, Zannoni GF, Pizzolante F, Vasquez Quadra S, Gambaro G, Rapaccini GL. Contrast-enhanced ultrasonography in chronic glomerulonephritides: correlation with histological parameters of disease activity. J Ultrasound 2018; 21:81-87. [PMID: 29691759 DOI: 10.1007/s40477-018-0298-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 02/22/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare contrast-enhanced ultrasonography (CEUS)-derived time-intensity (TI) curves with histological findings in kidneys of patients affected by chronic glomerulonephritides (GN) in the early stage of disease. METHODS Research ethics committee approval and patient written informed consent were obtained. Thirty-one patients who showed clinical and laboratory signs of GN, with preserved renal function, were consecutively enrolled. They underwent kidney CEUS, from which TI curves were obtained, and kidney biopsy. TI curves were compared with clinical data, ultrasound (US) Doppler, and histological parameters. RESULTS The persistence of contrast agent signal during the wash-out phase was found to be correlated with the degree of disease activity (p = 0.016) and in particular with the presence of mesangial hyperplasia (p = 0.008). No correlation was observed between TI curves and clinical or Doppler US-derived parameters. CONCLUSIONS The persistence of contrast agent signal in the wash-out phase of CEUS appears to reflect a disturbance of perfusion in glomerular capillaries in the early stages of GN. We found that the histological element directly correlated with the prolonged wash-out was mesangial hyperplasia.
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Affiliation(s)
| | - Nicoletta De Matthaeis
- Gastroenterology Unit, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Pietro Manuel Ferraro
- Nephrology Unit, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Paola Fuso
- Department of Woman and Child Health, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Stefano Costanzi
- Nephrology Unit, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Gian Franco Zannoni
- Pathology Unit, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Fabrizio Pizzolante
- Gastroenterology Unit, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Sabina Vasquez Quadra
- Radiology Unit, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Giovanni Gambaro
- Nephrology Unit, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - Gian Ludovico Rapaccini
- Gastroenterology Unit, Policlinico A. Gemelli, Catholic University, Largo Agostino Gemelli, 8, 00168, Rome, Italy
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Abstract
Contrast-enhanced ultrasound (CEUS) of the gastrointestinal tract provides vascular information helpful for characterizing masses and other pathologies in and around the bowel, similar to contrast applications in other solid organs. However, the use of microbubble contrast agents for the bowel provides additional unique contributions as it gives both subjective and objective information about mural and mesenteric blood flow, invaluable for the determination of disease activity in those many patients affected by inflammatory bowel disease (IBD). IBD is a lifelong chronic disease and has its peak age of onset in adolescence or young adult life. Today, we have moved away from treating patient’s symptoms and strive instead to alter the course of disease by obtaining mucosal healing. Expensive and aggressive biologic therapies and lack of agreement of patient’s symptoms with their disease activity and complications necessitate frequent imaging surveillance, which must be safe, readily available, inexpensive, and effective. Ultrasound with the benefit of contrast enhancement meets these requirements and is shown in meta-analysis to be equivalent to CT and MRI scans for these indications.
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11
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Kayashima H, Maeda T, Harada N, Masuda T, Ohmine T, Yamaguchi S, Matsuyama A, Hamatake M, Tsutsui S, Matsuda H. One-step surgery for acute ischemia of the jejunal loop after pancreatoduodenectomy: report of a case. Surg Case Rep 2016; 2:24. [PMID: 26976614 PMCID: PMC4791446 DOI: 10.1186/s40792-016-0153-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/10/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Pancreatoduodenectomy (PD) is an extensive surgery, and its complications are grave. Acute ischemia of the jejunal loop due to thrombosis of the superior mesenteric vein (SMV) and its branches is one of the most dangerous complications that, although rare, if left untreated leads to abdominal sepsis and death of a patient. CASE PRESENTATION A 77-year-old man underwent PD for pancreatic cancer. On postoperative day 2, the patient developed a severe anemia with hypotension. The computed tomography showed acute ischemia of the jejunal loop due to thrombosis. The emergent surgery was performed. The removal of the ischemic intestine and re-anastomoses of the biliary and pancreatic ducts could be performed all at once because necrosis and inflammation were still very mild in early stage. CONCLUSION If suspicion for thrombosis of the SMV and its branches is raised, re-laparotomy should be considered. Early re-operation can lead to removal of the ischemic intestine and re-anastomoses in one-step surgery.
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Affiliation(s)
- Hiroto Kayashima
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan.
| | - Takashi Maeda
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Noboru Harada
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Takanobu Masuda
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Takahiro Ohmine
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Shohei Yamaguchi
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Ayumi Matsuyama
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Motoharu Hamatake
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Shinichi Tsutsui
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Hiroyuki Matsuda
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
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Kawai R, Hata J, Manabe N, Imamura H, Iida A, Nakatou R, Koyama N, Hirai T, Sadahira Y. Contrast-enhanced ultrasonography with Sonazoid for diagnosis of gangrenous cholecystitis. J Med Ultrason (2001) 2015; 43:193-9. [DOI: 10.1007/s10396-015-0677-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
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13
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Abstract
Acute mesenteric ischaemia (AMI) is a surgical emergency, and has a high mortality. The term AMI covers arterial embolism, arterial thrombosis, non-occlusive mesenteric ischaemia and venous thrombosis which all lead to ischaemia/reperfusion syndrome of the bowel. Multi-detector row helical CT (MDCT) technology has dramatically improved the performance of CT by allowing rapid volumetric data acquisition to provide increased resolution, leading to better identification of the site, level and cause of ischaemia. CT angiography for diagnosing mesenteric ischaemia is now highly sensitive and specific, and should be used as first line when AMI is suspected. The aim of management is to restore intestinal blood flow in a timely manner. Therapeutic decisions are based on the presence of peritonitis, the presence of irreversible ischaemia or infarcted segments of the bowel, the general condition of the patient and the pathophysiological process underlying the ischaemia. AMI remains a challenging condition with high mortality. There is a need for good general surgical cover on the intensive care unit, with continuing care and clinical review by experienced senior surgeons with an interest in this condition.
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14
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Acute mesenteric ischemia after cardiac surgery: an analysis of 52 patients. ScientificWorldJournal 2013; 2013:631534. [PMID: 24288499 PMCID: PMC3826337 DOI: 10.1155/2013/631534] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 09/08/2013] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Acute mesenteric ischemia (AMI) is a rare but serious complication after cardiac surgery. The aim of this retrospective study was to evaluate the incidence, outcome, and perioperative risk factors of AMI in the patients undergoing elective cardiac surgery. METHODS From January 2005 to May 2013, all patients who underwent cardiac surgery were screened for participation, and patients with registered gastrointestinal complications were retrospectively reviewed. Univariate analyses were performed. RESULTS The study included 6013 patients, of which 52 (0.86%) patients suffered from AMI, 35 (67%) of whom died. The control group (150 patients) was randomly chosen from among cases undergoing cardiopulmonary bypass (CPB). Preoperative parameters including age (P = 0.03), renal insufficiency (P = 0.004), peripheral vascular disease (P = 0.04), preoperative inotropic support (P < 0.001), poor left ventricular ejection fraction (P = 0.002), cardiogenic shock (P = 0.003), and preoperative intra-aortic balloon pump (IABP) support (P = 0.05) revealed significantly higher levels in the AMI group. Among intra- and postoperative parameters, CPB time (P < 0.001), dialysis (P = 0.04), inotropic support (P = 0.007), prolonged ventilator time (P < 0.001), and IABP support (P = 0.007) appeared significantly higher in the AMI group than the control group. CONCLUSIONS Prompt diagnosis and early treatment should be initiated as early as possible in any patient suspected of AMI, leading to dramatic reduction in the mortality rate.
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15
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Shanaman MM, Schwarz T, Gal A, O'Brien RT. Comparison between survey radiography, B-mode ultrasonography, contrast-enhanced ultrasonography and contrast-enhanced multi-detector computed tomography findings in dogs with acute abdominal signs. Vet Radiol Ultrasound 2013; 54:591-604. [PMID: 23919809 DOI: 10.1111/vru.12079] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/18/2013] [Indexed: 12/14/2022] Open
Abstract
Contrast-enhanced multi-detector computed tomography (CE-MDCT) is used routinely in evaluating human patients with acute abdominal symptoms. Contrast-enhanced ultrasound (CEUS) continues to be in its infancy as it relates to evaluation of the acute abdomen. The purpose of this study was to compare survey radiography, B-mode ultrasound, CEUS, and CE-MDCT findings in canine patients presenting with acute abdominal signs; with a focus on the ability to differentiate surgical from non-surgical conditions. Nineteen dogs were prospectively enrolled. Inclusion required a clinical diagnosis of acute abdominal signs and confirmed surgical or non-surgical causes for the clinical signs. Agreement for the majority of recorded imaging features was at least moderate. There was poor agreement in the identification of pneumoperitoneum and in the comparison of pancreatic lesion dimensions for B-mode vs. CEUS. The CT feature of fat stranding was detected in cases including, but not limited to, gastric neoplasia with perforation, pancreatitis, and small intestinal foreign body. Ultrasound underestimated the size and number of specific lesions when compared with CE-MDCT. Contrast-enhanced ultrasound was successful in detecting bowel and pancreatic perfusion deficits that CE-MDCT failed to identify. Accuracy for differentiation of surgical vs. non-surgical conditions was high for all modalities; 100%, 94%, and 94% for CE-MDCT, ultrasonography and survey radiography respectively. Findings indicated that CE-MDCT is an accurate screening test for differentiating surgical from non-surgical acute abdominal conditions in dogs. Focused CEUS following CE-MDCT or B-mode ultrasonography may be beneficial for identifying potentially significant hypoperfused lesions.
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Affiliation(s)
- Miriam M Shanaman
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, 61802
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16
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Reginelli A, Genovese E, Cappabianca S, Iacobellis F, Berritto D, Fonio P, Coppolino F, Grassi R. Intestinal Ischemia: US-CT findings correlations. Crit Ultrasound J 2013; 5 Suppl 1:S7. [PMID: 23902826 PMCID: PMC3711730 DOI: 10.1186/2036-7902-5-s1-s7] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Intestinal ischemia is an abdominal emergency that accounts for approximately 2% of gastrointestinal illnesses. It represents a complex of diseases caused by impaired blood perfusion to the small and/or large bowel including acute arterial mesenteric ischemia (AAMI), acute venous mesenteric ischemia (AVMI), non occlusive mesenteric ischemia (NOMI), ischemia/reperfusion injury (I/R), ischemic colitis (IC). In this study different study methods (US, CT) will be correlated in the detection of mesenteric ischemia imaging findings due to various etiologies. Methods Basing on experience of our institutions, over 200 cases of mesenteric ischemia/infarction investigated with both US and CT were evaluated considering, in particular, the following findings: presence/absence of arterial/venous obstruction, bowel wall thickness and enhancement, presence/absence of spastic reflex ileus, hypotonic reflex ileus or paralitic ileus, mural and/or portal/mesenteric pneumatosis, abdominal free fluid, parenchymal ischemia/infarction (liver, kidney, spleen). Results To make an early diagnosis useful to ensure a correct therapeutic approach, it is very important to differentiate between occlusive (arterial,venous) and nonocclusive causes (NOMI). The typical findings of each forms of mesenteric ischemia are explained in the text. Conclusion At present, the reference diagnostic modality for intestinal ischaemia is contrast-enhanced CT. However, there are some disadvantages associated with these techniques, such as radiation exposure, potential nephrotoxicity and the risk of an allergic reaction to the contrast agents. Thus, not all patients with suspected bowel ischaemia can be subjected to these examinations. Despite its limitations, US could constitutes a good imaging method as first examination in acute settings of suspected mesenteric ischemia.
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Affiliation(s)
- A Reginelli
- Second University of Naples, Department of Clinical and Experimental Internistic F, Magrassi - A, Lanzara, Naples, Italy.
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17
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Taslakian B, Issa G, Hourani R, Akel S. Left-sided appendicitis in children with congenital gastrointestinal malrotation: a diagnostic pitfall in the emergency department. BMJ Case Rep 2013; 2013:bcr-2013-009474. [PMID: 23761499 DOI: 10.1136/bcr-2013-009474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute appendicitis is one of the most common conditions requiring emergency surgery. However, acute appendicitis presenting with left lower quadrant abdominal pain is extremely rare. Imaging, particularly CT , plays an important role in establishing an accurate and prompt diagnosis, as delay in diagnosis may occur due to lack of uniformity in the clinical signs and symptoms. We report a rare case of a 10-year-old boy who presented with persistent left lower quadrant pain of several days duration, in which the CT scan of the abdomen and pelvis was essential in establishing the correct diagnosis. The malpositioned inflamed appendix was clearly identified in the left side of the abdomen, with the characteristic CT findings of uncomplicated intestinal malrotation. Left-sided acute appendicitis should be considered in the differential diagnosis of young patients presenting with left lower quadrant pain, in order to avoid delay in diagnosis and guide the surgical intervention.
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Affiliation(s)
- Bedros Taslakian
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
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18
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Nitori N, Deguchi T, Kubota K, Yoshida M, Kato A, Kojima M, Kadomura T, Okada A, Okamura J, Kobayashi M, Sato T, Beck Y, Kitagawa Y, Kitajima M. Successful treatment of non-occlusive mesenteric ischemia (NOMI) using the HyperEye Medical System™ for intraoperative visualization of the mesenteric and bowel circulation: report of a case. Surg Today 2013; 44:359-62. [PMID: 23404392 DOI: 10.1007/s00595-013-0503-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 07/05/2012] [Indexed: 11/25/2022]
Abstract
Non-occlusive mesenteric ischemia (NOMI), leading to intestinal gangrene without a demonstrable occlusion in the mesenteric artery, is a rare condition with extremely high mortality. We report a case of NOMI diagnosed preoperatively by computed tomography and treated successfully with surgery, assisted by indocyanine green (ICG) fluorescence in the HyperEye Medical System (HEMS), a new device that can simultaneously detect color and near-infrared rays under room light. This allowed for precise intraoperative evaluation of the mesenteric and bowel circulation. Although the necrotic bowel wall of the distal ileum and the segmental ischemia of the jejunum were visible, the jejunum was finally preserved because perfusion of ICG fluorescence was confirmed. The patient, an 84-year-old man, had an uneventful postoperative course and is alive without critical illness 8 months after surgery. We report this case to demonstrate the potential effectiveness of HEMS during surgery for NOMI.
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Affiliation(s)
- Nobuhiro Nitori
- Department of Surgery, Mita Hospital, International Health and Welfare University, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan,
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19
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Bein T, Pfister K, Kasprzak P, Schlitt HJ, Graf BM, Jung EM. Correspondence (letter to the editor): A new approach to early diagnosis? DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:710; author reply 710-1. [PMID: 23264818 DOI: 10.3238/arztebl.2012.0710a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Kanzaki T, Hata J, Imamura H, Manabe N, Okei K, Kusunoki H, Kamada T, Shiotani A, Haruma K. Contrast-enhanced ultrasonography with Sonazoid™ for the evaluation of bowel ischemia. J Med Ultrason (2001) 2012; 39:161-7. [DOI: 10.1007/s10396-012-0346-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 12/19/2011] [Indexed: 01/16/2023]
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21
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Johnson-Neitman JL, O'Brien RT, Wallace JD. Quantitative perfusion analysis of the pancreas and duodenum in healthy dogs by use of contrast-enhanced ultrasonography. Am J Vet Res 2012; 73:385-92. [DOI: 10.2460/ajvr.73.3.385] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Braden B, Ignee A, Hocke M, Palmer RM, Dietrich C. Diagnostic value and clinical utility of contrast enhanced ultrasound in intestinal diseases. Dig Liver Dis 2010; 42:667-74. [PMID: 20598952 DOI: 10.1016/j.dld.2010.05.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Revised: 04/08/2010] [Accepted: 05/26/2010] [Indexed: 02/08/2023]
Abstract
Contrast enhanced ultrasound (CEUS) has recently gained increasing attention as it clearly improves the visualisation of perfusion in various tissues. The development of second generation contrast enhancing agents used in low-mechanical-index harmonic ultrasound has enabled real-time assessment of the microvascular circulation and quantification of bowel wall vascularity. For this review Medline was searched for clinical studies using CEUS to investigate the gastrointestinal tract. Many studies demonstrate that acute or chronic inflammation of the intestinal wall is accompanied by increased perfusion of the mesentery, which can be displayed semi-quantitatively using contrast enhanced ultrasound analyzing time intensity curves. In contrast, ischemia is characterized by hypoperfusion of the mesenteric arteries and the bowel wall. The most promising sonographic approach in assessing splanchnic arteries and the bowel wall is combining the analysis of superior and inferior mesenteric inflow by pulsed Doppler scanning (systolic and diastolic velocities, resistance index) with the end-organ vascularity by CEUS. CEUS at a preliminary stage has been described as clinically important in a variety of gastrointestinal disorders, particularly in patients with Crohn's disease. CEUS facilitates the detection of disease extent and activity, and its luminal and extraluminal complications.
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Affiliation(s)
- Barbara Braden
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.
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23
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Giannetti A, Biscontri M, Randisi P, Cortese B, Minacci C, Stumpo M. Contrast-enhanced sonography in the diagnosis of acute mesenteric ischemia: case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:156-160. [PMID: 20013893 DOI: 10.1002/jcu.20657] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Acute mesenteric ischemia is a serious condition associated with high mortality. Multislice CT and magnetic resonance angiography have proved accurate in diagnosing this pathology, which requires a prompt diagnosis to start appropriate therapy. We report the case of an 87-year-old woman with acute mesenteric ischemia, in whom contrast-enhanced sonography visualized the occluded superior mesenteric artery and the infarcted portion of the intestine.
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Affiliation(s)
- Andrea Giannetti
- Department of Gastroenterology, Misericordia Hospital, Grosseto, Italy
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Valentino M, Serra C, Ansaloni L, Mantovani G, Pavlica P, Barozzi L. Sonographic features of acute colonic diverticulitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:457-463. [PMID: 19655391 DOI: 10.1002/jcu.20619] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Acute colonic diverticulitis is a common cause of acute abdominal symptoms, especially in elderly patients. Sonography is frequently used as the initial imaging modality because of its ready availability. This pictorial essay aims to provide an overview of the sonographic features of acute colonic diverticulitis and of the more common differential diagnosis.
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Affiliation(s)
- Massimo Valentino
- Urgency/Emergency, General Surgery and Transplantation Department, Radiology Unit, S. Orsola-Malpighi, University Hospital, Bologna, Italy
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25
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Gore RM, Yaghmai V, Thakrar KH, Berlin JW, Mehta UK, Newmark GM, Miller FH. Imaging in intestinal ischemic disorders. Radiol Clin North Am 2009; 46:845-75, v. [PMID: 19103136 DOI: 10.1016/j.rcl.2008.05.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Intestinal ischemia and infarction are a heterogeneous group of diseases that have as their unifying theme hypoxia of the small bowel or colon. The incidence of bowel ischemia and infarction is on the rise for several reasons: the aging of the population, the ability of intensive care units to salvage critically ill patients, and heightened clinical awareness of these disorders. Improvements in diagnostic imaging techniques have greatly contributed to the earlier diagnosis of intestinal ischemia, which can have a positive influence on patient outcomes. In this article, role of radiology in the detection, differential diagnosis, and management of patients who have intestinal ischemia and infarction is discussed.
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Affiliation(s)
- Richard M Gore
- Department of Radiology, Evanston Northwestern Healthcare, Northwestern University Medical School, 2650 Ridge Avenue, Evanston, IL 60201, USA.
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Abstract
Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow. Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities, leading to multi-organ failure and death. Early diagnosis is difficult because the clinical presentation is subtle, and the biological and radiological diagnostic tools lack sensitivity and specificity. Therapeutic options vary from conservative resuscitation, medical treatment, endovascular techniques and surgical resection and revascularization. A high index of suspicion is required for diagnosis, and prompt treatment is the only hope of reducing the mortality rate. Studies are in progress to provide more accurate diagnostic tools for early diagnosis. AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB). Several factors contribute to the systemic hypo-perfusion state, which is the most frequent pathophysiologic event. In this particular setting, the clinical presentation of AMI can be misleading, while the laboratory and radiological diagnostic tests often produce inconclusive results. The management strategies are controversial, but early treatment is critical for saving lives. Based on the experience of our team, we consider prompt exploratory laparotomy, irrespective of the results of the diagnostic tests, is the only way to provide objective assessment and adequate treatment, leading to dramatic reduction in the mortality rate.
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Kalantarinia K, Okusa MD. Ultrasound Contrast Agents in the Study of Kidney Function in Health and Disease. DRUG DISCOVERY TODAY. DISEASE MECHANISMS 2007; 4:153-158. [PMID: 19112526 PMCID: PMC2610015 DOI: 10.1016/j.ddmec.2007.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ultrasound contrast agents are gas filled microbubbles that enhance the ultrasound image. They behave similarly to red blood cells and cross all capillary beds; making contrast enhanced ultrasonography (CEU) a suitable technique to study vasculature and tissue blood flow. Ultrasound contrast agents have been found to be safe after intravenous injection. CEU has been used extensively in the field of cardiology. Currently, study of renal vasculature and renal blood flow requires complicated, time consuming and expensive techniques, which are not commonly used in clinical settings. CEU potentially may serve as a relatively noninvasive and safe technique for studying renal hemodynamics in health and disease. In this article we have reviewed the literature on the use of CEU in the study of kidney disease.
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Affiliation(s)
- Kambiz Kalantarinia
- Department of Medicine and Center for Immunity, Inflammation and Regenerative Medicine, University of Virginia Health System, Charlottesville, Virginia
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