Long-term results after surgery for acute mesenteric ischemia

Klempnauer, Jürgen; Grothues, Frank; Bektaş, H.; Pichlmayr, R.

doi:10.1016/s0039-6060(97)90351-2

Cited by 116 publications

(71 citation statements)

References 8 publications

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“…8,9 Also, though less common, SBS can occur in adults because of multiple resections in the setting of Crohn's disease, or with mesenteric ischemia secondary to vascular disease. 10,11 Because SBS patients cannot maintain sufficient nutrition with enteral intake, they may require long-term total parenteral nutrition, which itself can be complicated in children by liver failure and cirrhosis. 12 SBS patients therefore endure significant healthcare costs, recently estimated to be on the order of $1.6 million per patient over 5 years.…”

Section: Discussionmentioning

confidence: 99%

Tissue Engineering of the Intestine in a Murine Model

Barthel

Speer

Levin

et al. 2012

JoVE

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Tissue-engineered small intestine (TESI) has successfully been used to rescue Lewis rats after massive small bowel resection, resulting in return to preoperative weights within 40 days.1 In humans, massive small bowel resection can result in short bowel syndrome, a functional malabsorptive state that confers significant morbidity, mortality, and healthcare costs including parenteral nutrition dependence, liver failure and cirrhosis, and the need for multivisceral organ transplantation. 2 In this paper, we describe and document our protocol for creating tissueengineered intestine in a mouse model with a multicellular organoid units-on-scaffold approach. Organoid units are multicellular aggregates derived from the intestine that contain both mucosal and mesenchymal elements, 3 the relationship between which preserves the intestinal stem cell niche. 4 In ongoing and future research, the transition of our technique into the mouse will allow for investigation of the processes involved during TESI formation by utilizing the transgenic tools available in this species. 5The availability of immunocompromised mouse strains will also permit us to apply the technique to human intestinal tissue and optimize the formation of human TESI as a mouse xenograft before its transition into humans. Our method employs good manufacturing practice (GMP) reagents and materials that have already been approved for use in human patients, and therefore offers a significant advantage over approaches that rely upon decellularized animal tissues. The ultimate goal of this method is its translation to humans as a regenerative medicine therapeutic strategy for short bowel syndrome. Video LinkThe video component of this article can be found at

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Section: Discussionmentioning

confidence: 99%

Tissue Engineering of the Intestine in a Murine Model

Barthel

Speer

Levin

et al. 2012

JoVE

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“…It is estimated that nearly 1% of patients presenting with acute abdominal pain have ischemic intestinal disease, 1-3 and it may be responsible for 0.1% of all hospital The lethality of the disease is well documented, with some series reporting mortality rates exceeding 60%. [4][5][6][7] A critical factor for survival of acute mesenteric ischemia is early diagnosis and intervention. In cases of superior mesenteric artery (SMA) embolism in which surgery is performed once the bowel is infarcted, the mortality rate nearly doubles from 35% to 68%.…”

Section: Introductionmentioning

confidence: 99%

Imaging of Acute Mesenteric Ischemia Using Multidetector CT and CT Angiography in a Porcine Model

Rosow

Sahani

Strobel

et al. 2005

Journal of Gastrointestinal Surgery

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Acute mesenteric ischemia, a frequently lethal disease, requires prompt diagnosis and intervention for favorable clinical outcomes. This goal remains elusive due, in part, to lack of a noninvasive and accurate imaging study. Traditional angiography is the diagnostic gold standard but is invasive and costly. Computed tomography (CT) is readily available and noninvasive but has shown variable success in diagnosing this disease. The faster scanning time of multidetector row CT (M.D.CT) greatly facilitates the use of CT angiography (CTA) in the clinical setting. We sought to determine whether M.D.CT-CTA could accurately demonstrate vascular anatomy and capture the earliest stages of mesenteric ischemia in a porcine model. Pigs underwent embolization of branches of the superior mesenteric artery, then imaging by M.D.CT-CTA with three-dimensional reconstruction protocols. After scanning, diseased bowel segments were surgically resected and pathologically examined. Multidetector row CT and CT angiography reliably defined normal and occluded mesenteric vessels in the pig. It detected early changes of ischemia including poor arterial enhancement and venous dilatation, which were seen in all ischemic animals. The radiographic findings-compared with pathologic diagnoses-predicted ischemia, with a positive predictive value of 92%. These results indicate that M.D.CT-CTA holds great promise for the early detection necessary for successful treatment of acute mesenteric ischemia. KeywordsMesenteric ischemia; computed tomography; angiography; animal model Acute mesenteric ischemia, the process of insufficient blood supply to the bowel, carries consequences ranging from a transient, totally reversible insult to a lethal event. The prevalence of mesenteric ischemia is increasing in the United States as the population ages. It is estimated that nearly 1% of patients presenting with acute abdominal pain have ischemic intestinal disease, 1-3 and it may be responsible for 0.1% of all hospital The lethality of the disease is well documented, with some series reporting mortality rates exceeding 60%. [4][5][6][7] A critical factor for survival of acute mesenteric ischemia is early diagnosis and intervention. In cases of superior mesenteric artery (SMA) embolism in which surgery is performed once the bowel is infarcted, the mortality rate nearly doubles from 35% to 68%. 8 The mean duration of ischemia preceding surgery for noninfarcted bowel is 13 hours, compared with 21 hours for those with infarction. 9 Thus, the window of opportunity for intervention is narrow and prompt diagnosis is crucial for patient survival. Nevertheless, this goal remains elusive, due in part to the lack of an accurate diagnostic imaging tool. NIH Public AccessAlthough angiography is considered the standard of reference for the diagnosis of mesenteric ischemia, it is not widely used because it is invasive, time-consuming, and costly. Computed tomography has been historically used with variable success for evaluating small bowel ischemia. It can help dete...

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“…During the perioperative period, a Swan-Ganz catheter should be used to monitor fluid and cardiac function. Finally, when cross-clamping the supraceliac aorta, the anesthesiologist should be notified to use myocardial protective maneuvers and reduction of after load to maximize cardiac output (Klempnauer et al 1997). Acute renal failure in the immediate postoperative period can be prevented by keeping the patient well hydrated and administering mannitol before the aorta is crossclamped.…”

Section: Complicationsmentioning

confidence: 99%

“…Patients who have had total small intestine resection need lifelong intravenous hyperalimentation (Chang et al 2006). However, with rapid treatment, the mortality rate can be reduced considerably, and p a t i e n t s m a y b e s p a r e d b o w e l r e s e c t i o n (Klempnauer et al 1997). When more than half of the bowel is removed, mortality rates of up to 80% have been reported (Ward et al 1995).…”

Section: Prognosismentioning

confidence: 99%

Mesenteric Ischemia: Still a Deadly Puzzle for the Medical Community

Stamatakos

Stefanaki

Mastrokalos

et al. 2008

Tohoku J. Exp. Med.

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The main goal of this article is to update etiology, epidemiology, diagnosis, treatment and outcome of the various causes of mesenteric ischemia in order to elucidate its labyrinthine clinical riddle, by reviewing the current English medical literature. Mesenteric ischemia is a quite uncommon disorder, observed in the emergency department. It is a lifethreatening vascular emergency that requires early diagnosis and intervention to restore mesenteric blood flow and to prevent bowel necrosis and patient death. Consequently, it is a vital diagnosis to make because of its high mortality rate and its thorny complications. The underlying causes vary, and the prognosis depends on the specific findings during clinical examination. Vague and nonspecific clinical findings and limitations of diagnostic studies make the diagnosis a significant challenge. The prognosis of acute mesenteric ischemia of any type is grave. The complications following this medical jigsaw puzzle are also severe. Patients in whom the diagnosis is missed until infarction occurs have a mortality rate of 90%. Even with good treatment, up to 50-80% of patients die. Survivors of extensive bowel resection face lifelong disability. Despite the progress in understanding the pathogenesis of mesenteric ischemia and the development of treatment modalities, the entity remains a diagnostic challenge for clinicians. Delay in diagnosis contributes to a high mortality rate. Early diagnosis and adequate treatment can improve the clinical outcome. Even if diagnostic modalities have improved since the first successful attempts to confront effectively this clinical entity, mesenteric ischemia still remains a lethal diagnostic enigma for the medical community.Mesenteric Ischemia; thrombosis; bowel infarction; atherosclerosis; mesenteric venous thrombosis; mesenteric thromboendarterectomy.Tohoku

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Long-term results after surgery for acute mesenteric ischemia

Cited by 116 publications

References 8 publications

Tissue Engineering of the Intestine in a Murine Model

Tissue Engineering of the Intestine in a Murine Model

Imaging of Acute Mesenteric Ischemia Using Multidetector CT and CT Angiography in a Porcine Model

Mesenteric Ischemia: Still a Deadly Puzzle for the Medical Community

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