Chronic Mesenteric Ischemia: A Rare Cause of Chronic Abdominal Pain

Barret, Maximilien; Martineau, Chloé; Rahmi, Gabriel; Pellerin, Olivier; Sapoval, Marc; Alsac, Jean-Marc; Fabiani, Jean‐Noël; Malamut, Georgia; Samaha, Elia; Cellier, Christophe

doi:10.1016/j.amjmed.2015.07.029

Cited by 25 publications

(26 citation statements)

References 16 publications

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“…Firstly, his symptoms consisted primarily of diarrhoea and nausea for the majority of his illness, with pain being a very late feature. This is unusual: in one retrospective review of 54 cases of mesenteric ischaemia, pain was present in 98% of patients, with diarrhoea only in 24.5% and nausea in 2% [ 4 ]. The clinicians therefore applied a ‘representativeness heuristic’, wherein the patient exhibited a cluster of symptoms or ‘illness script’ common to those with inflammatory bowel disease, rather than mesenteric ischaemia [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Also falsely reassuring was the absence of biochemical markers of malnutrition such as anaemia or hypoalbuminaemia; as well as frank lactataemia. However, serum lactate levels are rarely raised in chronic mesenteric ischaemia due to the capacity of the liver to metabolise lactate delivered via the portal vein [ 4 ]. As such, serum lactate is elevated only in cases of critical transmural ischaemia.…”

Section: Discussionmentioning

confidence: 99%

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A Delayed Diagnosis of Chronic Mesenteric Ischaemia: The Role of Clinicians’ Cognitive Errors

Yeoh¹

2016

Case Rep Gastroenterol

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Chronic diarrhoeal illnesses with nausea and weight loss are a common indication for gastroenterology review. While many such cases have intra-luminal aetiologies, such as inflammatory bowel disease, coeliac disease or other malabsorptive conditions, with many other cases due to functional gut disorders or systemic malignancy, clinicians must also keep vascular disorders in mind. Here we report a patient with a delayed diagnosis of chronic mesenteric ischaemia after 6 months of gastrointestinal symptoms strongly mimicking an alternative diagnosis such as inflammatory bowel disease due an atypical predominance of nausea and diarrhoea rather than pain. We briefly review the literature on treatment of this condition but also discuss with particular attention the sequence of cognitive errors made by clinicians that led to a diagnostic delay, inviting readers to thus reflect on how such errors can be minimised in their practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Delayed Diagnosis of Chronic Mesenteric Ischaemia: The Role of Clinicians’ Cognitive Errors

Yeoh¹

2016

Case Rep Gastroenterol

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“…In general, long-term patient survival does not seem to be influenced by the type of revascularization performed [19][20][21] . ET is associated with lower peri-procedural morbidity [22,23] . However, Zacharias et al [24] recently reported a higher 3-year patency rate using OT (OT 91%; ET 74%), and Arya et al [25] also found higher mid-and long-term patency rates for OT, while Cai et al [26] saw significantly higher symptom recurrence within 3 years with ET.…”

Section: Resultsmentioning

confidence: 99%

Chronic Mesenteric Ischemia: Patient Outcomes Using Open Surgical Revascularization

Wagenhäuser

Meyer-Janiszewski²,

Dueppers³

et al. 2017

Dig Surg

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Background: Chronic mesenteric ischemia (CMI) is a rare disease. Open treatment (OT) remains a valuable treatment option. We analyzed patient outcomes after OT and investigated health-related quality of life (HRQoL). Methods: Data were analyzed retrospectively. The investigation period was from January 1, 2001, to December 31, 2014. We investigated mortality and patency rates using Kaplan-Meier analysis. HRQoL was measured using a 36-item health survey. Various statistical methods were employed. Results: A total of 100 patients (celiac trunk [TC: n = 23], superior mesenteric artery [SMA: n = 26], or both [n = 51]) were included. Median follow-up was 5 ± 35 months. One-year survival rate for TC was 75 ± 11%, for SMA: 79 ± 10%, and for both: 96 ± 3%. TC 5-year survival was 75 ± 11% (SMA: 57 ± 16%: both: 80 ± 8%). Obesity and the length of hospital stay were independently associated with patient survival (p < 0.05). Primary 1-year patency rate was 60 ± 13% for TC (SMA: 86 ± 10%; both: 71 ± 8%) and secondary 1-year patency rate was 84 ± 9% for TC (SMA: 100%; both: 79 ± 7%). HRQoL was inferior compared to the German normative data (p < 0.05). Conclusion: CMI overlaps between gastrointestinal and vascular surgery. OT is safe, and simultaneous revascularization of the TC and the SMA does not affect mortality. Patients would not necessarily benefit from OT in terms of HRQoL.

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“…Computed tomography angiography was the key diagnostic tool for 60% of the patients. Endovascular and open surgical revascularization had similar early and late outcomes [13].…”

mentioning

confidence: 87%

“…Vascular reconstruction can be accomplished by Endarterectomy or aortomesenteric bypasses [12] of 54 patients with chronic mesenteric vascular ischemia, 43 patients were treated with endovascular revascularization and 11 patients with open surgical revascularization [13]. The symptoms were abdominal pain in 98% of the patients, weight loss in 53% of the patients, and diarrhea in 25% of the patients.…”

mentioning

confidence: 99%

Mesenteric Vascular Ischemia

Aronow¹

2015

Angiol

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Chronic Mesenteric Ischemia: A Rare Cause of Chronic Abdominal Pain

Cited by 25 publications

References 16 publications

A Delayed Diagnosis of Chronic Mesenteric Ischaemia: The Role of Clinicians’ Cognitive Errors

A Delayed Diagnosis of Chronic Mesenteric Ischaemia: The Role of Clinicians’ Cognitive Errors

Chronic Mesenteric Ischemia: Patient Outcomes Using Open Surgical Revascularization

Mesenteric Vascular Ischemia

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