Acute superior mesenteric ischaemia

Wilson, C; Gupta, Ravi; Gilmour, D. G.; Imrie, C. W.

doi:10.1002/bjs.1800740417

Cited by 115 publications

(57 citation statements)

References 8 publications

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“…Even limited resection resulted in complications in 42% of patients and death in 12%. In any series the overall morbidity and mortality rates reflect the number of massive resections performed which are associated with a greater risk of complications and deaths both in the present study and other reports [2,3], Massive resection was more than twice as likely to result in postoperative complications and over three times as likely to result in a postoperative death than a limited resection. Massive resections were nearly always done on emergency and frequently (48%) resulted in loss of intestinal continuity, most likely because they were performed on ischemic, unprepared intestine in an emergency setting.…”

Section: Discussionsupporting

confidence: 71%

Intestinal Resection in Adults: Causes and Consequences

1989

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We reviewed the records of 160 adult patients undergoing intestinal resection to determine the outcome of this surgical procedure. Twenty-three patients (14%) underwent massive ( > 50%) resection and 18 developed the short bowel syndrome. Mesenteric vascular disease was the indication for resection in 16 (70%) of these patients. The most frequent indications for resection in the 137 patients (86%) undergoing less extensive resection were: obstruction (26%); tumor (23%); Crohn’s disease (22%), and trauma (10%). Previous resection had been performed in 22 of these patients and the short bowel syndrome resulted in 6 patients. The morbidity and mortality rates of massive intestinal resection were significantly greater than for lesser resection (87 vs. 42 and 43 vs. 12%, respectively, p < 0.05). Massive resection was also more frequently an emergency procedure (87 vs. 40%, p < 0.05) and more likely to necessitate ostomy formation (48 vs. 15 %, p < 0.005). Seventeen of the 24 patients with the short bowel syndrome survived and 14 required total parenteral nutrition (TPN) at home. Eleven patients remain alive on TPN with follow-up of 13–64 months. Intestinal resection is associated with greater morbidity than generally appreciated. The short bowel syndrome occurred in 15 % of patients and while it most often resulted from massive resection (75%), it also frequently followed sequential lesser resections (25%). Home TPN has made long-term survival possible for many patients (70%) with the short bowel syndrome.

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Section: Discussionsupporting

confidence: 71%

Intestinal Resection in Adults: Causes and Consequences

1989

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“…AMI represents 10%-67% of these complications [129,133,134] , and is the most lethal, with a case-fatality rate of 70% to 100% [129,131,132,135,136] . Pathophysiology AMI occurring after CPB, is due to NOMI in the vast majority of cases [137][138][139] . The various contributory factors are: low cardiac output (frequent in this category of patients), use of vasopressors and underlying atherosclerotic disease.…”

Section: Ami After Cpbmentioning

confidence: 99%

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Abboud¹,

Daher²,

Boujaoude³

2008

WJG

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Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow. Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities, leading to multi-organ failure and death. Early diagnosis is difficult because the clinical presentation is subtle, and the biological and radiological diagnostic tools lack sensitivity and specificity. Therapeutic options vary from conservative resuscitation, medical treatment, endovascular techniques and surgical resection and revascularization. A high index of suspicion is required for diagnosis, and prompt treatment is the only hope of reducing the mortality rate. Studies are in progress to provide more accurate diagnostic tools for early diagnosis. AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB). Several factors contribute to the systemic hypo-perfusion state, which is the most frequent pathophysiologic event. In this particular setting, the clinical presentation of AMI can be misleading, while the laboratory and radiological diagnostic tests often produce inconclusive results. The management strategies are controversial, but early treatment is critical for saving lives. Based on the experience of our team, we consider prompt exploratory laparotomy, irrespective of the results of the diagnostic tests, is the only way to provide objective assessment and adequate treatment, leading to dramatic reduction in the mortality rate.

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“…2,14,15 In present study patients appeared later had increase mortality rates (50%-100%) similarly to the studies done by others in which they reported increased mortality (up to 90% to 100%) in bowel ischemia patients due to undue delay in presentation, the shorter the duration of symptoms the more likely was the chance of patient to survive after surgery. 16,17 Forty eight percent of patients of bowel ischemia group had no significant X ray abdomen findings. These finding were similar to the findings of the study done by others in which they had reported approximately 50% patients had no significant X ray abdomen findings.…”

Section: Discussionmentioning

confidence: 97%

Role of serum lactic dehydrogenase, glutamic oxaloacetic transaminase, creatine phosphokinase, alkaline phospatase, serum phosphorus in the cases of bowel ischemia in acute abdomen

et al. 2017

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Background: Bowel ischemia is a life-threatening condition which may arise from a number of causes affecting the arterial and venous compartments of the mesenteric circulation. The rapid onset of acute mesenteric ischemia and the potential rapidity with which bowel infarction may occur explain the lethality of this disease. The aim of this study was to evaluate the role of serum lactic dehydrogenase (LDH), glutamic oxaloacetic transaminase (SGOT), creatine phosphokinase (CPK), alkaline phospatase, serum phosphorus in the cases of bowel ischemia in acute abdomen.Methods: Above mentioned serum enzymes were measured preoperatively in the fifty patients of acute abdomen. Biomarker levels were compared in patients between equal two groups on the basis intra operative findings of bowel ischemia and non-bowel ischemia.Results: Preoperative estimated serum levels of all described enzymes found to be significantly elevated in patients of group A (with bowel ischemia) in comparison with group B (with no bowel ischemia). Sensitivity and specificity for elevated levels of S. LDH were 88% and 68%, for SGOT 68% and 80%, for S. ALP 72% and 68%, for S. CPK-MB 76% and 84%, and for S. phosphorus 76% and 68% respectively.Conclusions: Preoperative estimated serum levels of all described enzymes found to be significantly elevated in patients of group A (with bowel ischemia) in comparison with group B (with no bowel ischemia). Sensitivity and specificity for elevated levels of S. LDH were 88% and 68%, for SGOT 68% and 80%, for S. ALP 72% and 68%, for S. CPK-MB 76% and 84%, and for S. phosphorus 76% and 68% respectively.

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Acute superior mesenteric ischaemia

Cited by 115 publications

References 8 publications

Intestinal Resection in Adults: Causes and Consequences

Intestinal Resection in Adults: Causes and Consequences

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

Role of serum lactic dehydrogenase, glutamic oxaloacetic transaminase, creatine phosphokinase, alkaline phospatase, serum phosphorus in the cases of bowel ischemia in acute abdomen

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