An investigation of bedside laparoscopy in the ICU for cases of non-occlusive mesenteric ischemia

Abstract

BackgroundAcute mesenteric ischemia is a rare affection with high related mortality. NOMI presents the most important diagnostic problems and is related with the higher risk of white laparotomy. This study wants to give a contribution for the validation of laparoscopic approach in case of NOMI.MethodsThirty-two consecutive patients were admitted in last 10 years in ICU of Paolo Giaccone University Hospital of Palermo for AMI. Diagnosis was obtained by multislice CT and selective angiography was done if clinical conditions were permissive. If necrosis was already present or suspected, surgical approach was done. Endovascular or surgical embolectomy was performed when necessary. Twenty NOMI patients underwent medical treatment performing laparoscopy 24 h later to verify the evolution of AMI. A three-port technique was used. In all patients we performed a bed side procedure 48–72 h later in both non-resected and resected group.ResultsIn 14 up 20 case of NOMI the disease was extended throughout the splanchnic district, in 6 patients it involved the ileum and the colon; after a first look, only 6 patients underwent resection. One patient died 35 h after diagnosis of NOMI. The second look, 48 h later, demonstrated 4 infarction recurrences in the group of resected patients and onset signs of necrosis in 5 patients of non-resected group. A total of 15 resections were performed on 11 patients. Mortality rate was 6/20–30% but it was much higher in resected group (5/11–45,5%). Non-therapeutic laparotomy was avoided in 9/20 patients and in this group mortality rate was 1/9–11%. No morbidity was recorded related to laparoscopic procedure.ConclusionsLaparoscopy could be a feasible and safety surgical approach for management of patient with NOMI. Our retrospective study demonstrates that laparoscopy don’t increase morbidity, reduce mortality avoiding non-therapeutic laparotomy.

Neuroendocrine tumor of the common bile duct: case report

“…With the aim to prevent these complications and its fearful sequelae, the use of hemostatic patches, that could be helpful in other digestive anastomoses, has not been validated (12)(13)(14)(15) Complications such as intestinal ischemia or other abdominal complications have not been described (16)(17)(18)(19). The laparoscopic approach, although possible, is not validated yet (20,21).…”

A strategy for improving the prognosis of non‐occlusive mesenteric ischemia (NOMI): a single‐center observational study

“…The pathophysiology of NOMI is presumably related to prolonged vasospasm of the mesenteric arteries during circulatory shock. Although NOMI is common in dehydrated patients or those in shock, the cause has not been clarified and the treatment strategy has not been decided . Methods to improve the prognosis of patients treated for suspected NOMI are presently unclear.…”

Akute (arterielle und venöse) Mesenterialischämie

“…Die nicht okklusive Mesenterialischämie (NOMI, nonocclusive mesenteric ischemia) ist eine Ausschlussdiagnose, da der Nachweis eines Vasospasmus im Splanchnikusgebiet sehr schwierig zu belegen ist [7]. Sie tritt bevorzugt bei intensivpflichtigen, katecholaminbedürftigen Patienten unter schlechter, kardialer Pumpfunktion auf (▶ Tab.…”