Acute mesenteric ischemia: A critical role for the radiologist

Copin, P.; Zins, Marc; Nuzzo, Alexandre; Purcell, Yvonne; Beranger-Gibert, S.; Maggiori, Léon; Corcos, Olivier; Vilgrain, Valérie; Ronot, Maxime

doi:10.1016/j.diii.2018.01.004

Cited by 48 publications

(24 citation statements)

References 65 publications

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“…CT and MRI are also used to predict or measure intestinal viability, and have certain diagnostic value for intestinal ischemia injury [22,23] . However, these imaging techniques usually produce motion artifacts due to the patient's heartbeat and respiration [24] . Most importantly, these devices cannot be used during surgery.…”

Section: Discussionmentioning

confidence: 99%

Photoacoustic Imaging in Evaluating Early Intestinal Ischemia and Reperfusion Injury with Rat Models

Wang¹,

Pan²,

Hua³

et al. 2020

Preprint

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Purpose: It is still a challenge to distinguish whether the damaged intestine is viable or not in the treatment of acute mesenteric ischemia. In this study, photoacoustic imaging (PAI) was used to observe the activity of intestinal tissue after ischemia and reperfusion injury in rats.Methods: With the approval of animal ethics committee our university, in vivo study was carried out. Forty male SD rats were randomly divided into four groups: sham operated (SO) group, 1 h ischemia group, 2 h ischemia group and ischemia-reperfusion (I/R) group. In the ischemia group, superior mesenteric artery (SMA) was isolated and clamped for 1 h (n = 10) and 2 h (n = 10), respectively. In I/R group, after ischemia for 1 hour, the clamp was removed and reperfused for 1 hour (n = 10). The same time interval of SMA was taken as SO group (n = 10). Immediately after the establishment of the animal model, PAI examination was performed. After PAI examination, the small intestine was collected for histopathology.Results: The PAI derived parameters of 2 h ischemia group were significantly different from those of SO group and I/R group (P < 0.05). The levels of Hb, HbR, map760 and map 840 were increased in different degrees in ischemia group, especially in 2 h ischemia group (compared with SO group, P < 0.01). With the prolongation of ischemia time, the injury was aggravated. In immunohistochemistry, compared with SO group, BAX increased significantly in 2 h ischemia group (P < 0.01). Similarly, Caspase-3 was significantly higher than the baseline level (P < 0.05). The level of HIF-1a increased in 2 h ischemia group and I/R group (P < 0.05). TUNEL staining showed that the number of apoptotic positive nuclei in 2 h ischemia group was significantly higher than that in SO group (P < 0.05). HE staining showed that ischemia for 2 hours was the most serious, with obvious mucosal damage, extensive epithelial injury and bleeding.Conclusions: PAI can be used as an effective tool to detect acute intestinal ischemia injury and quantitatively evaluate tissue viability.

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Section: Discussionmentioning

confidence: 99%

Photoacoustic Imaging in Evaluating Early Intestinal Ischemia and Reperfusion Injury with Rat Models

Wang¹,

Pan²,

Hua³

et al. 2020

Preprint

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“…The abdominal-pelvic CT, performed without and with injection of contrast medium at arterial and portal times, is the only necessary and sufficient examination, urgently recommended for the positive diagnosis of acute mesenteric ischemia (AMI). 6,11,12 It must be carried out without delay, even in the presence of renal failure, as the risk of ignoring an AMI far exceeds that of the injection of the contrast agent. 6,11,13 It allows to characterize as well as possible the nature and morphology of vascular occlusion.…”

Section: Discussionmentioning

confidence: 99%

Acute mesenteric ischemia revealing cirrhosis: about a clinical case

Kpossou¹,

Cnm²,

Mm³

et al. 2020

GHOA

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Acute mesenteric ischemia (AMI) is a rare and serious medical and surgical emergency, the prognosis of which depends on the early diagnosis and appropriate treatment. It is caused by acute or chronic interruption of splanchno-mesenteric blood flow. This interruption may be due to embolism, thrombosis or intestinal hypoperfusion. We report a case of acute mesenteric ischemia in a young subject in a National Hospital and University Center of Benin. He was a 23-year-old man with no history of admitting a diffuse abdominal pain, excruciating, sudden onset of torsion and associated vomiting and stopping of materials and gases. Emergency laparotomy revealed acute mesenteric ischemia with ileal necrosis. Ileal resection with endo-ileal endo-ileal anastomosis was performed. Etiological research has revealed cirrhosis of undetermined cause. The postoperative course was marked by short bowel syndrome and ascitic decompensation of cirrhosis. Under symptomatic treatment, vitamin and iron supplementation and diuretic evolution was favorable.

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“…At the contrastenhancement computed tomography scan, IC was identified as large bowel wall thinning ("paper-thin-wall"), or any large bowel wall thickening and/or abnormal wall enhancement. Porto-mesenteric venous gas, pneumatosis, free intraperitoneal air, and mesenteric arterial or venous thrombus may also be present [5,13,28,29]. Colonoscopy findings were classified according to Favier's classification [30].…”

Section: Study Populationmentioning

confidence: 99%

Predictors of mortality following emergency open colectomy for ischemic colitis: a single-center experience

et al. 2020

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Background: Ischemic colitis (IC) is a severe emergency in gastrointestinal surgery. The aim of the present study was to identify the predictors of postoperative mortality after emergent open colectomy for IC treatment. Additionally, we compared postoperative outcomes of patients undergoing emergent colectomy due to aortic surgery-related IC (AS-IC group) vs. other IC etiologies (Other-IC group). Methods: We analyzed records of consecutive patients who underwent emergency open colectomy for IC between 2008 and 2019. Logistic regression analysis was performed to identify clinical and operative parameters associated with postoperative mortality. The AS-IC and Other-IC groups were compared for mortality, morbidity, ICU stay, hospital stay, and survival. Results: During the study period, 94 patients (mean age, 67.4 ± 13.7 years) underwent emergent open colectomy for IC. In the majority of cases, IC involved the entire colon (53.2%) and vasopressor agents were required preoperatively (63.8%) and/or intraoperatively (78.8%). Thirty-four patients underwent surgery due to AS-IC, whereas 60 due to Other-IC causes. In the AS-IC group, 9 patients had undergone endovascular aortic repair and 25 open aortic surgery; 61.8% of patients needed aortic surgery for ruptured abdominal aortic aneurism (AAA). Overall, 66 patients (70.2%) died within 90 days from surgery. The AS-IC and Other-IC groups showed similar operative outcomes and postoperative complication rates. However, the duration of the ICU stay (19 days vs. 11 days; p = 0.003) and of the total hospital stay (22 days vs. 16 days; p = 0.016) was significantly longer for the AS-IC group than for the Other-IC group. The rate of intestinal continuity restoration at 1 year after surgery was higher for the Other-IC group than for the AS-IC group (58.8% vs. 22.2%; p = 0.05). In the multivariate model, preoperative increased lactate levels, a delay between signs/symptoms' onset and surgery > 12 h, and the occurrence of postoperative acute kidney injury were statistically associated with postoperative mortality. Neither IC etiology (aortic surgery vs. other etiology) nor ruptured AAA was associated with postoperative mortality. Conclusion: Emergency open colectomy for IC is associated with high postoperative mortality, which appears to be unrelated to the IC etiology. Preoperative lactate levels, > 12-h delay to surgery, and postoperative acute kidney injury are independent predictors of postoperative mortality.

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Acute mesenteric ischemia: A critical role for the radiologist

Cited by 48 publications

References 65 publications

Photoacoustic Imaging in Evaluating Early Intestinal Ischemia and Reperfusion Injury with Rat Models

Photoacoustic Imaging in Evaluating Early Intestinal Ischemia and Reperfusion Injury with Rat Models

Acute mesenteric ischemia revealing cirrhosis: about a clinical case

Predictors of mortality following emergency open colectomy for ischemic colitis: a single-center experience

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