Acute Mesenteric Ischemia: A Challenge for the Acute Care Surgeon

Kärkkäinen, Jussi M.

doi:10.1177/14574969211007590

Cited by 35 publications

(29 citation statements)

References 33 publications

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“…Although laboratory results are not definitive, they may help to corroborate clinical suspicion. More than 90% of patients will have an abnormally elevated leukocyte count [ 48 ]. The second most commonly encountered abnormal finding is metabolic acidosis with elevated lactate level, which occurs in 88% [ 49 ].…”

Section: Pathophysiology and Epidemiologymentioning

confidence: 99%

Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery

et al. 2022

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Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process may progress to life-threatening intestinal necrosis. The incidence is low, estimated at 0.09–0.2% of all acute surgical admissions, but increases with age. Although the entity is an uncommon cause of abdominal pain, diligence is required because if untreated, mortality remains in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques is evolving and provides new treatment options. Lastly, a focused multidisciplinary approach based on early diagnosis and individualized treatment is essential. Thus, we believe that updated guidelines from World Society of Emergency Surgery are warranted, in order to provide the most recent and practical recommendations for diagnosis and treatment of AMI.

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Section: Pathophysiology and Epidemiologymentioning

confidence: 99%

Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery

et al. 2022

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“…Acute mesenteric ischemia (AMI) is characterized by an abrupt interruption or reduction of the intestinal blood supply, either temporarily or permanently, and is a medicalsurgical emergency that requires immediate attention. Despite advances in medical imaging techniques, the evolution of clinical knowledge, and the development of biotechnology beyond the adoption of less invasive treatments, AMI still represents a major diagnostic and therapeutic challenge, largely due to the absence of specific markers related to the severity of the condition [1][2][3]. The clinical course of the disease is correlated with a high mortality rate (70%) in patients with AMI admitted to the emergency room [4].…”

Section: Introductionmentioning

confidence: 99%

“…It can be caused by an embolus or thrombus within the vascular lumen, but also by phenomena that directly affect the intestinal wall such as volvulus (loop twist), intestinal invagination, incarcerated hernia, or extrinsic compression (caused by tumors or adhesions among Metabolites 2021, 11, 802 2 of 14 others). In addition to a mechanical obstruction, an intestinal transplant, blood pressure variations (hypovolemic, cardiogenic, or neurogenic shock), and non-occlusive phenomena (e.g., due to the use of drugs) represent other reported causal events [3].…”

Section: Introductionmentioning

confidence: 99%

Translational Application of Fluorescent Molecular Probes for the Detection of Reactive Oxygen and Nitrogen Species Associated with Intestinal Reperfusion Injury

et al. 2021

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Acute mesenteric ischemia, caused by an abrupt interruption of blood flow in the mesenteric vessels, is associated with high mortality. When treated with surgical interventions or drugs to re-open the vascular lumen, the reperfusion process itself can inflict damage to the intestinal wall. Ischemia and reperfusion injury comprise complex mechanisms involving disarrangement of the splanchnic microcirculatory flow and impairment of the mitochondrial respiratory chain due to initial hypoxemia and subsequent oxidative stress during the reperfusion phase. This pathophysiologic process results in the production of large amounts of reactive oxygen (ROS) and nitrogen (RNS) species, which damage deoxyribonucleic acid, protein, lipids, and carbohydrates by autophagy, mitoptosis, necrosis, necroptosis, and apoptosis. Fluorescence-based systems using molecular probes have emerged as highly effective tools to monitor the concentrations and locations of these often short-lived ROS and RNS. The timely and accurate detection of both ROS and RNS by such an approach would help to identify early injury events associated with ischemia and reperfusion and increase overall clinical diagnostic sensitivity. This abstract describes the pathophysiology of intestinal ischemia and reperfusion and the early biological laboratory diagnosis using fluorescent molecular probes anticipating clinical decisions in the face of an extremely morbid disease.

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“…There are four distinct etiological subtypes of AMI that must be recognized because of their treatment and prognostic differences [5]. These include embolism of the superior mesenteric artery, thrombosis of the SMA due to atherosclerosis, nonocclusive mesenteric ischemia, and venous mesenteric ischemia.…”

Section: Introductionmentioning

confidence: 99%

The Utility of Biomarkers in Diagnosing and Predicting Outcomes in Acute Mesenteric Ischemia

Pirvu

Bratosin

Nica

et al. 2021

Surgery

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Background: Acute intestinal ischemia stands as the most lethal acute condition encountered by general surgeons and one of the deadliest pathologies in medicine triggered by thromboembolic events. The patients’ survival decreases dramatically to a lower than 30% rate when diagnosed after 24 hours, thus early diagnosis with proper surgical or vascular intervention is mandatory. This study aims to determine the utility of biomarkers and routine blood tests in assessing the severity and mortality risk for patients with acute mesenteric ischemia. Methods: The study was developed on a prospective cross-sectional design over a period of five years, finding a total of 147 patients who underwent emergency surgery after a high suspicion of acute mesenteric ischemia. The available biomarkers used in our Clinic comprised a complete blood count, total bilirubin, CK, CK-MB, LDH, AST, ALT, amylase, and cholinesterase. Results: The leukocyte count (OR=1.105), hemoglobin (OR=3.912), LDH (OR=1.144), NLR (OR=1.154), and LLR (OR=1.286) were all independent and significant risk factors for AMI diagnosis. These covariates proved a good and reliable tool for diagnosing AMI with a 75.3% predicted probability. Conclusion: The prediction tool proved reliable, although it should only be considered in the clinical context where the surgeon suspects a case of acute mesenteric ischemia. The proposed model should be further investigated and validated in larger studies.

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Acute Mesenteric Ischemia: A Challenge for the Acute Care Surgeon

Cited by 35 publications

References 33 publications

Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery

Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery

Translational Application of Fluorescent Molecular Probes for the Detection of Reactive Oxygen and Nitrogen Species Associated with Intestinal Reperfusion Injury

The Utility of Biomarkers in Diagnosing and Predicting Outcomes in Acute Mesenteric Ischemia

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