Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy

Trompeter, M.; Brazda, Thurid; Remy, Christopher T.; Vestring, T; Reimer, Peter

doi:10.1007/s00330-001-1220-2

Cited by 315 publications

(296 citation statements)

References 30 publications

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“…For example, various forms of shock, septicemia, dehydration and hypotension following dialysis and heart or major abdominal surgery have been reported (1). In the present case, the septicemia seemed to induce the NOMI.…”

Section: Discussionsupporting

confidence: 45%

“…It is commonly caused by a decreased cardiac output resulting in splanchnic hypoperfusion, with a mortality rate of approximately 70% (1). NOMI generally affects elderly and weakened patients suffering from myocardial infarction, congestive heart failure, sepsis and renal or hepatic disease.…”

Section: Introductionmentioning

confidence: 99%

“…NOMI generally affects elderly and weakened patients suffering from myocardial infarction, congestive heart failure, sepsis and renal or hepatic disease. This condition also accounts for 20-30% of all cases of acute mesenteric ischemia (1).…”

Section: Introductionmentioning

confidence: 99%

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Non-occlusive Mesenteric Ischemia after Splenic Metastasectomy for Small-Cell Lung Cancer

et al. 2015

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A 68-year-old man presented with severe abdominal pain. Seven months earlier, he had received systemic chemotherapy for small-cell lung cancer with solitary metastasis to the spleen, followed by splenectomy. Abdominal computed tomography and abdominal arterial angiography showed diffuse ischemia of the mesenteric artery without apparent occlusion. The patient also suffered from septicemia caused by Enterococcus faecium. Therefore, a diagnosis of non-occlusive mesenteric ischemia (NOMI) induced by septicemia was supposed. Although treatment with antibiotics and papaverine hydrochloride was administered and the necrotic tissue in the intestinal tract was resected, the patient died.Physicians should be aware that patients undergoing splenectomy are likely to be affected by septicemia, which may subsequently induce NOMI.

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Section: Discussionsupporting

confidence: 45%

Section: Introductionmentioning

confidence: 99%

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Non-occlusive Mesenteric Ischemia after Splenic Metastasectomy for Small-Cell Lung Cancer

et al. 2015

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“…It develops secondary to cardiogenic shock following cardiac infarction, hypovolemia and hemorrhage, congestive heart failure, arrhythmia, aortic insufficiency, or ingestion of drugs leading to vasoconstriction such as cardiotonics and amphetamines (17,18). Catheter angiography is considered as the gold standard for the diagnosis of non-occlusive mesenteric ischemia.…”

Section: Mdct Features Of Acute Mesenteric Ischemiamentioning

confidence: 99%

Utility of MDCT in emergency setting of acute mesenteric ischemia

Türkbey

Akpınar²,

Çil³

et al. 2008

Diagn Interv Radiol

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A cute mesenteric ischemia (AMI), which is a consequence of impaired blood flow to the gastrointestinal tract, is a life-threatening entity with an estimated mortality rate ranging between 60% and 90% (1-3). Among major etiologies of AMI are superior mesenteric artery (SMA) embolus, SMA thrombus, superior mesenteric vein (SMV) thrombosis and non-occlusive vasoconstriction (1). Minor causes of AMI include aortic dissection, intestinal volvulus, internal hernia, and adhesion band related extrinsic compression of the mesenteric vessels (4, 5). Although it is relatively rare (around 1% of all acute abdomen referrals), prompt diagnosis and treatment of AMI is important since early management of this clinical entity increases survival (6). Diagnosis of acute mesenteric ischemiaDiagnosis of AMI requires strong suspicion since the clinical features are usually non-specific such as abdominal pain, nausea, vomiting, or even diarrhea (7). Until late 1960s, surgical exploration or autopsy was used for diagnosis; then imaging modalities came into use as new diagnostic tools (8). Plain radiography and ultrasound are generally initial modalities used in patients presenting with acute abdomen in an emergency room, but their role is limited in the demonstration of primary and secondary signs of AMI. On plain radiographs, dilated bowel segments with air-fluid levels, pneumatosis and portal venous gas can be seen, whereas ultrasound can demonstrate mesenteric thrombus via Doppler mode but the presence of extensive gas within bowel segments and incompliance of patients may limit the accuracy of this imaging modality (6,8,9).Digital subtraction angiography (DSA) has been regarded as the gold standard imaging method in the setting of AMI. It not only enables direct visualization of the mesenteric vasculature but also provides prompt endovascular intervention opportunity (10). On the other hand, DSA is invasive, expensive, needs experience and, unfortunately, not readily available (10).Computed tomography (CT) became a powerful tool in the management of AMI with the introduction of multidetector technology, as it provides direct visualization of the mesenteric vasculature, intestines and mesentery (7). With its high spatial resolution and volumetric 3 dimensional reconstructions, multidetector CT angiography (MDCTA) allows direct non-invasive visualization of the etiology of AMI and its insults on the intestines, and associated findings/pathologies through a great anatomical detail window (6, 11).Magnetic resonance (MR) angiography is another non-invasive tool for the detection of AMI by determining mesenteric flow. It can be used as a second choice in children but its power is by far limited in the demonstration of calcified plaques (12, 13). ABDOMINAL IMAGING PICTORIAL ESSAY Utility of multidetector CT in an emergency setting in acute mesenteric ischemiaBarış Türkbey, Erhan Akpınar, Barbaros Çil, Muşturay Karçaaltıncaba, Okan Akhan ABSTRACT Prompt diagnosis of acute mesenteric ischemia is a dilemma which is unfortunately generally m...

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“…The lead point is a jejunal melanoma metastasis (curved arrow). Note the additional sub-diaphragmatic metastasis (arrow) and spread-out segmental arteries due to distension of bowel loops [60], are sometimes difficult to depict on CT angiography. Typical CT findings of bowel ischaemia in the setting of normally perfused mesenteric vessels then may facilitate the diagnosis of NOMI.…”

Section: Ischaemic Bowel Diseasementioning

confidence: 99%

Multidetector computed tomography of acute abdomen

et al. 2006

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Acute abdominal pain is one of the most common causes for referrals to the emergency department. The sudden onset of severe abdominal pain characterising the "acute abdomen" requires rapid and accurate identification of a potentially lifethreatening abdominal pathology to provide a timely referral to the appropriate physician. While the physical examination and laboratory investigations are often non-specific, computed tomography (CT) has evolved as the first-line imaging modality in patients with an acute abdomen. Because the new multi-detector CT (MDCT) scanner generations provide increased speed, greater volume coverage and thinner slices, the acceptance of CT for abdominal imaging has increased rapidly. The goal of this article is to discuss the role of MDCT in the diagnostic work-up of acute abdominal pain.

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Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy

Cited by 315 publications

References 30 publications

Non-occlusive Mesenteric Ischemia after Splenic Metastasectomy for Small-Cell Lung Cancer

Non-occlusive Mesenteric Ischemia after Splenic Metastasectomy for Small-Cell Lung Cancer

Utility of MDCT in emergency setting of acute mesenteric ischemia

Multidetector computed tomography of acute abdomen

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