Acute abdomen in the hemodialysis patient population

Bender, Jeffrey S.; Ratner, Lloyd E.; Magnuson, Thomas; Zenilman, Michael E.

doi:10.1016/s0039-6060(05)80247-8

Cited by 41 publications

(40 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…23 As the incidences of cardiac and thromboembolic disease increase worldwide, we may expect the same for mesenteric ischemia. Despite the importance of early detection in preventing the high mortality associated with bowel infarction, it continues to pose a diagnostic challenge to clinicians.…”

Section: Discussionmentioning

confidence: 99%

Imaging of Acute Mesenteric Ischemia Using Multidetector CT and CT Angiography in a Porcine Model

Rosow

Sahani

Strobel

et al. 2005

Journal of Gastrointestinal Surgery

View full text Add to dashboard Cite

Acute mesenteric ischemia, a frequently lethal disease, requires prompt diagnosis and intervention for favorable clinical outcomes. This goal remains elusive due, in part, to lack of a noninvasive and accurate imaging study. Traditional angiography is the diagnostic gold standard but is invasive and costly. Computed tomography (CT) is readily available and noninvasive but has shown variable success in diagnosing this disease. The faster scanning time of multidetector row CT (M.D.CT) greatly facilitates the use of CT angiography (CTA) in the clinical setting. We sought to determine whether M.D.CT-CTA could accurately demonstrate vascular anatomy and capture the earliest stages of mesenteric ischemia in a porcine model. Pigs underwent embolization of branches of the superior mesenteric artery, then imaging by M.D.CT-CTA with three-dimensional reconstruction protocols. After scanning, diseased bowel segments were surgically resected and pathologically examined. Multidetector row CT and CT angiography reliably defined normal and occluded mesenteric vessels in the pig. It detected early changes of ischemia including poor arterial enhancement and venous dilatation, which were seen in all ischemic animals. The radiographic findings-compared with pathologic diagnoses-predicted ischemia, with a positive predictive value of 92%. These results indicate that M.D.CT-CTA holds great promise for the early detection necessary for successful treatment of acute mesenteric ischemia. KeywordsMesenteric ischemia; computed tomography; angiography; animal model Acute mesenteric ischemia, the process of insufficient blood supply to the bowel, carries consequences ranging from a transient, totally reversible insult to a lethal event. The prevalence of mesenteric ischemia is increasing in the United States as the population ages. It is estimated that nearly 1% of patients presenting with acute abdominal pain have ischemic intestinal disease, 1-3 and it may be responsible for 0.1% of all hospital The lethality of the disease is well documented, with some series reporting mortality rates exceeding 60%. [4][5][6][7] A critical factor for survival of acute mesenteric ischemia is early diagnosis and intervention. In cases of superior mesenteric artery (SMA) embolism in which surgery is performed once the bowel is infarcted, the mortality rate nearly doubles from 35% to 68%. 8 The mean duration of ischemia preceding surgery for noninfarcted bowel is 13 hours, compared with 21 hours for those with infarction. 9 Thus, the window of opportunity for intervention is narrow and prompt diagnosis is crucial for patient survival. Nevertheless, this goal remains elusive, due in part to the lack of an accurate diagnostic imaging tool. NIH Public AccessAlthough angiography is considered the standard of reference for the diagnosis of mesenteric ischemia, it is not widely used because it is invasive, time-consuming, and costly. Computed tomography has been historically used with variable success for evaluating small bowel ischemia. It can help dete...

show abstract

Section: Discussionmentioning

confidence: 99%

Imaging of Acute Mesenteric Ischemia Using Multidetector CT and CT Angiography in a Porcine Model

Rosow

Sahani

Strobel

et al. 2005

Journal of Gastrointestinal Surgery

View full text Add to dashboard Cite

show abstract

“…In recent years, non-occlusive mesenteric ischemia (NOMI) has become increasingly recognized as a highly dangerous complication in both hemodialysis [1,2,3,4,5,6,7,8,9,10,11,12] and peritoneal dialysis patients, young and old alike [13,14,15]. Undoubtedly, NOMI is seen far more often in hemodialysis patients, with intradialytic hypotension being the major precipitating factor behind the development of NOMI among these patients [1, 2,4,5,6, 11].…”

Section: Introductionmentioning

confidence: 99%

Non-Occlusive Mesenteric Ischemia in Chronically Dialyzed Patients: A Disease with Multiple Risk Factors

et al. 2005

View full text Add to dashboard Cite

Background: Non-occlusive mesenteric ischemia (NOMI) can be a fatal complication in dialysis patients. Intradialytic hypotension is usually the precipitating factor. The occurrence of 16 cases in 5 years (1998–2002), compared with only 4 in previous years, led us to investigate other risk factors contributing to NOMI. A control group of stable hemodialysis patients was used for comparison. Results: 20 patients were studied: 17 diagnosed surgically, and 3 clinically. The mean age was 70.8 ± 1.8 years, and the male:female ratio 7:13. Nineteen patients were on hemodialysis. Clinically overt atherosclerosis was present in 17 patients. Preceding dialysis-associated hypotension was identified in all patients studied and access thrombosis in 6 patients. In all patients, abdominal pain was the presenting symptom. Initial abdominal examination was unimpressive in 16 patients. The hemoconcentration, leukocytosis and metabolic acidosis were the most prominent laboratory findings. 5/11 abdominal sonograms showed intestinal pathology. 2/3 angiographies were diagnostic. Three patients responded to early fluid challenge and did not require surgery. Pathology was related to the area of the superior mesenteric artery in all 15 patients operated. Twelve (60%) patients died from the event. The 1-year mortality rate was 17/20 patients (85%). Possible contributing factors, other than dialysis-associated hypotension, included: high-dose recombinant human erythropoietin (rhEPO) therapy (179 ± 35 vs. 116 ± 10 U/kg/week in the control group, p < 0.05); metastatic calcifications (abdominal aorta 14/14, aortic valve 11/18; medial calcification of mesenteric arteries in 2/11 pathology specimens); digoxin, and hypoalbuminemia. Conclusions: The increased incidence of NOMI in dialysis patients may be related to overly aggressive rhEPO therapy and the unsuspected presence of mesenteric arterial medial calcifications. Identification of patients at risk, prevention of intradialytic hypotension and a controlled increase in dry weight may help to reduce the incidence of NOMI in chronically dialyzed patients.

show abstract

“…Clark and Gewertz (18) showed that histologic injury caused by two short 15-minute periods of low-flow reperfusion was more severe than a 30-minute period of reperfusion. Decreased volume accompanied by increased hematocrit may contribute to the low-flow state (19). Four of our cases were patients with CRF.…”

Section: Discussionmentioning

confidence: 86%

Isolated cecal necrosis: our surgical experience and a review of the literature

Çakar¹,

Ersöz²,

Bag³

et al. 2014

UCD

View full text Add to dashboard Cite

Objective: Isolated cecal necrosis is a rare cause of ischemic colitis. Ischemic colitis is further divided into two groups: occlusive mesenteric ischemia and non-occlusive mesenteric ischemia. The aim of this study was to investigate the cause of isolated cecal necrosis. Material and Methods:We operated on 3 male and 3 female patients with a mean age of 60.3±18.7 (38-85) years with a preliminary diagnosis of acute appendicitis between 2007 and 2012. Four of these patients were on hemodialysis, 1 patient had an aortofemoral bypass, and 1 patient had coronary artery disease with atrial fibrillation. Results:The diagnosis was made intraoperatively in all cases. Five patients died postoperatively. One patient survived. Conclusion:In the case of right lower quadrant pain, the possibility of isolated cecal necrosis should be kept in mind, especially in patients on hemodialysis, elderly patients with diabetes, and heart disease; surgical strategies should be planned accordingly, and it should be understood that a high mortality rate will be inevitable.

show abstract

Acute abdomen in the hemodialysis patient population

Cited by 41 publications

References 9 publications

Imaging of Acute Mesenteric Ischemia Using Multidetector CT and CT Angiography in a Porcine Model

Imaging of Acute Mesenteric Ischemia Using Multidetector CT and CT Angiography in a Porcine Model

Non-Occlusive Mesenteric Ischemia in Chronically Dialyzed Patients: A Disease with Multiple Risk Factors

Isolated cecal necrosis: our surgical experience and a review of the literature

Contact Info

Product

Resources

About