Imaging in Intestinal Ischemic Disorders

Gore, Richard M.; Yaghmai, Vahid; Thakrar, Kiran H.; Berlin, Jonathan W.; Mehta, Uday K.; Newmark, Geraldine M.; Miller, Frank H.

doi:10.1016/j.rcl.2008.05.004

Cited by 58 publications

(103 citation statements)

References 72 publications

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“…AMI presents in 95% of all MI cases, and it predominantly affects the elderly, particularly those with cardiovascular conditions, such as cardiac arrhythmias, congestive heart failure, coronary artery disease, dyslipidemia, hypotensive episode, recent myocardial infarction, peripheral vascular disease, and valvular heart disease (6,8). Smoking (3,6) and obesity (3) are also strongly associated risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…As such, intestinal infarction is rare in CMI (8) and typically involves two of the three main vessels for symptoms to occur (11). Overall, females are affected more often than males by a ratio of 1-1.5:1 for AMI (3,4,12) and 3-4:1 for CMI (6,8).…”

Section: Discussionmentioning

confidence: 99%

“…AMI can be arterial or venous in origin and is classified into one of the four following categories: mesenteric arterial emboli (MAE) (found in 40-50% of all cases with AMI); mesenteric arterial thrombosis (MAT) (found in 20-30% of cases); nonocclusive mesenteric ischemia (NOMI) (found in 20-25% of cases); and mesenteric venous thrombosis (MVT) (found in 5-15% of cases) (4,11,13,14). MAE usually occurs in individuals with underlying cardiac disease, such as arrhythmias, valvular disorders, and cardiac or aortic thrombus (8,14), and most commonly affects the superior mesenteric artery due to its large caliber and narrow angle where it intersects with the abdominal aorta (6,15).…”

Section: Discussionmentioning

confidence: 99%

“…MAE usually occurs in individuals with underlying cardiac disease, such as arrhythmias, valvular disorders, and cardiac or aortic thrombus (8,14), and most commonly affects the superior mesenteric artery due to its large caliber and narrow angle where it intersects with the abdominal aorta (6,15). The emboli typically lodge distal to the origin of the middle colic artery (the first major branch of the superior mesenteric artery), which spares the duodenum and transverse colon from resulting pathologic lesion (7).…”

Section: Discussionmentioning

confidence: 99%

“…The emboli typically lodge distal to the origin of the middle colic artery (the first major branch of the superior mesenteric artery), which spares the duodenum and transverse colon from resulting pathologic lesion (7). Twenty percent of individuals with MAE may have synchronous emboli to other viscera, such as the spleen or kidneys (6).…”

Section: Discussionmentioning

confidence: 99%

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Fatal Acute Hemorrhagic Bowel Infarction Caused by Mesenteric Venous Thrombosis

Srettabunjong

2017

Journal of Forensic Sciences

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Acute mesenteric venous thrombosis (MVT) is a rare, but life-threatening medical phenomenon. MVT is normally characterized by insidious onset, with nonspecific signs and symptoms. A high index of clinical suspicion is required for diagnosis, and emergency surgery is necessary to optimize the chances of patient survival, especially in the people aged more than 70 years. Surprisingly, based on my review of the literature, no fatal acute MVT case has been reported in the forensic literature. All reported such cases have been documented in medical literature, and most of them have been associated with underlying risk factors for venous thrombosis, such as hypercoagulable state, certain cancers, and stasis of the blood flow. Here, I report the case of a sudden unexpected death due to extensive intestinal ischemia and infarction with massive abdominal hemorrhage caused by acute MVT in a 72-year-old man without known underlying risk factors.KEYWORDS: forensic science, forensic pathology, embolism, intestinal gangrene, vascular occlusion, medico-legal death, sudden unexpected death, thrombosis Mesenteric ischemia (MI) arises from a highly complex heterogeneous group of disorders that result in insufficient blood supply to the intestine, causing extensive irreversible bowel infarction and eventual death. Although a rarely occurring event, MI is a lifethreatening condition that is well understood among physicians who treat patients with acute abdominal disorders. A highly lethal condition that is difficult to diagnose, only one-third of patients with acute mesenteric ischemia (AMI) were correctly identified before surgical intervention or death (1,2). AMI requires emergency surgical treatment, with mortality rates that range from 60% to 80% (3,4). Avoiding delay in diagnosis and treatment remains the greatest challenge to reducing the high mortality rate associated with this condition (5). Surprisingly, based on my review of the literature, no such case has been reported in the forensic literature. All reported such cases have been documented in the medical literature, and most of them have been associated with underlying risk factors for venous thrombosis, such as hypercoagulable state, certain cancers, and stasis of the blood flow. Here, I report the case of a sudden unexpected death due to AMI with massive abdominal hemorrhage caused by acute mesenteric venous thrombosis in a 72-year-old man without known underlying risk factors. Case ReportA 72-year-old man was found dead lying on a sofa in his house by his wife and son who had returned home in the evening. According to information obtained from the deceased's relatives, the deceased was diagnosed with hypertension 5 years earlier and he irregularly complied with his prescribed antihypertensive therapy. Approximately 3 days before his death, he complained of intermittent abdominal discomfort and pain. He was not able to eat food as usual, and he had occasional nausea, vomiting, and diarrhea. He as well as his family, had no significant previous medical histo...

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Section: Discussionmentioning

confidence: 99%