Acute mesenteric ischemia: A review of the main imaging techniques and signs

Navas-Campo, Raquel; Moreno-Caballero, L.; Ezponda, Ana; Muñoz, David Ibáñez

doi:10.1016/j.rxeng.2020.02.004

Cited by 9 publications

(14 citation statements)

References 67 publications

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“…Acute mesenteric ischemia (AMI) is a life-threatening emergency with associated high mortality rates. Since rapid diagnosis of AMI is the most important predictor of outcome, prompt diagnosis and intervention are essential in order to reduce mortality in patients with AMI [41,42]. The finding of HPVG alone is not an indication for emergency surgery since surgical intervention is recommended only when intestinal infarction due to superior mesenteric arterial thrombosis is present.…”

Section: Discussionmentioning

confidence: 99%

Gas in the Portal Vein: An Emergency or Just Hot Air?

et al. 2021

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We report the case of a 87-year-old woman admitted to our Emergency Department for mild abdominal pain associated with vomiting. An abdominal X-ray showed gas present in the portal venules of the left hepatic lobe, a finding associated with numerous surgical and medical conditions. The patient was successfully managed with conservative treatment. Isolated intrahepatic gas is a rare radiologic finding; emergency surgery should be performed only when there are signs of associated acute intestinal infarction. KeywordsHepatic portal venous gas (HPVG) • Intrahepatic pneumatosis • Emergency surgery • Intestinal ischemia • Superior mesenteric artery embolism Abbreviations WBC White blood cell Hgb Haemoglobin CRP C-reactive protein HPVG Hepatic portal venous gas AMI Acute mesenteric ischemia ED Emergency Department Case Report and EvolutionA 87-year-old woman was admitted to the ED in "Ospedale Civile Umberto I" in Lugo (Ravenna) for a single vomiting episode associated with mild abdominal pain, without fever or diarrhea. Despite her age, the patient was autonomous in her daily activities; her primary medical comorbidity was chronic atrial fibrillation treated with oral anticoagulants. On initial presentation, the patient appeared in minimal distress; abdominal examination was unremarkable. Laboratory tests showed normal WBC count and Hgb with mildly increased CRP (34 mg/dL; N.V. ≤ 10 mg/dL). An abdominal X-ray showed gas present in the portal venules of the left hepatic lobe (Fig. 1), confirmed by CT scan (Fig. 2) with * N. Zorzetti

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Section: Discussionmentioning

confidence: 99%

Gas in the Portal Vein: An Emergency or Just Hot Air?

et al. 2021

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“…All of them give a rich net of collateral branches: the pancreaticoduodenal artery between the celiac trunk and SMA, through the common hepatic artery; Riolan arc, and Drummond marginal artery between SMA and IMA. Watershed territories among these three districts are at higher risk of ischemia, particularly in hypoafflux conditions (Figure 1): the ileocaecal junction, the splenic flexure (Griffith's point), and the rectosigmoid junction (Sudeck's point) [33]. SMA is the dominant artery involved in acute intestinal ischemia.…”

Section: Intestinal Vascular Supplymentioning

confidence: 99%

“…The embolic disease is usually a manifestation of underlying cardiovascular disease [36] (atrial fibrillation, endocarditis) or, less frequently, from aortic or mesenteric plaques, and it usually involves the high flow SMA due to the narrow take-off angle from the aorta [2]. Topography and extension of the involved segment depend on embolus location (Figure 2): the inflow to the proximal jejunum is preserved if the embolus is located near the takeoff of the middle colic artery with sparing of inferior pancreaticoduodenal branches or almost complete ischemia of the small bowel of the embolus is located close to the SMA orefice [2,33,37,38]. Involved vascular beds are usually healthy and show poor collateralization, so clinical presentation and evolution to transmural necrosis occur earlier, moreover, concurrent emboli can involve other splanchnic arteries, particularly renal and splenic ones, determining parenchymal infarcts (Figure 3).…”

Section: • Acute Arterial Mesenteric Ischemiamentioning

confidence: 99%

Diagnostic Role of MDCT in Acute Mesenteric Ischemia

Ronza,

Di Gennaro,

Buzzo

et al. 2024

Preprint

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Mesenteric ischemia diagnosis is challenging with an overall mortality in up to 50% of cases despite advances in treatment. The main problem that affects the outcome is the delayed diagnosis because of non-specific clinical presentation. Multi Detector CT Angiography (MDCTA) is the first line investigation for the suspected diagnosis of vascular abdominal pathologies and is the diagnostic test of choice in suspected mesenteric bowel ischemia. MDCTA can accurately detect the presence of arterial and venous thrombosis, determine the extension and the gastrointestinal tract involved, and provide detailed information determining the subtype and the stage progression of the diseases helping clinicians and surgeons for the proper management. CT can differentiate forms that are still susceptible to pharmacological or interventional treatment (NOM= non-operative management) from advanced disease with transmural necrosis in which a surgical approach is required. Knowledge of CT imaging patterns and corresponding vascular pathways is mandatory in Emergency settings to reach a prompt and accurate diagnosis. The aims of this paper are 1. to provide technical information about the optimal CTA protocol; 2. To empathize the CTA arterial and venous supply to gastrointestinal tract and relative ischemic pattern; 3. To describe vascular, bowel and extraintestinal CT findings for the diagnosis of acute mesenteric ischemia.

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“…Radiation therapy: In some cases, rectosigmoid ischemia can develop as a complication of pelvic radiation therapy. Radiation can lead to the formation of fibrosis and scarring in the blood vessels, resulting in compromised blood supply [ [3] , [4] , [5] , [6] ].…”

Section: Introductionmentioning

confidence: 99%

“…However, colonoscopy is more accurate and necessary to establish a definite diagnosis [ 16 ]. The treatment approach for rectosigmoid ischemia can range from conservative to surgical, depending on the severity of the injury [ 5 , 7 ]. In this case report, we presented a patient with transmural rectosigmoid ischemia who had not undergone any significant interventions and had no underlying diseases prior to symptom onset.…”

Section: Introductionmentioning

confidence: 99%

A case report of transmural rectosigmoid ischemia in an elderly patient

Ebrahimi,

Arabi,

Dabiri

et al. 2023

International Journal of Surgery Case Reports

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Acute mesenteric ischemia: A review of the main imaging techniques and signs

Cited by 9 publications

References 67 publications

Gas in the Portal Vein: An Emergency or Just Hot Air?

Gas in the Portal Vein: An Emergency or Just Hot Air?

Diagnostic Role of MDCT in Acute Mesenteric Ischemia

A case report of transmural rectosigmoid ischemia in an elderly patient

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