Acute and Chronic Mesenteric Ischemia

The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia

“…Although it is known that extravascular reasons like intestinal intussusception, volvulus, strangulated hernias and obstructions can cause intestinal gangrene, these are rarely the cause of AMI (1). The etiology of AMI can be evaluated in 4 sub-categories: superior mesenteric artery (SMA) embolism (45-50 %), thrombosis of SMA (25 %), superior mesenteric vein (SMV) thrombosis (5-10 %), and non-occlusive mesenteric ischemia (NOMI) (20 %) (4)(5)(6)(7). Despite the differences in its etiology, intestinal gangrene and necrosis is the fatal end of AMI (3,7).…”

“…Despite the improvements at diagnostic imaging methods, surgical techniques and perioperative intensive care support, the high mortality rate due to AMI did not change signifi cantly in the last seven decades (5,7). Reason of this are the ongoing diffi culties at establishing AMI diagnosis before bowel necrosis occurs (7).…”

“…Reason of this are the ongoing diffi culties at establishing AMI diagnosis before bowel necrosis occurs (7). In a review of Herbert et al, it is reported that only one third of the patients was diagnosed as AMI before the surgical exploration and death (5). In Swedish autopsy studies, it was shown that real mortality rate from mesenteric ischemia can be more than 90 %, and 22-32 % of these patients could be diagnosed before death (8,9).…”

“…It is known that delays at establishing the AMI diagnosis reduce the survival chance and morbidity (4). Patient presentation is usually non-spesifi c and normal physical examination of the abdomen can cause a dangerous safety feeling of the physician (4,5).…”

“…Even though Doppler ultrasonography is useful in complete obstruction of proximal SMA, it is suboptimal because it relies on the expertness of the practitioner (4). Selective mesenteric angiography is considered the golden standart of AMI diagnosis but it is not available at every hospital, it requires an interventional radiologist, it is an invasive and long procedure and it requires nephrotoxic agents (3)(4)(5).…”