Predictors and risk factors for intestinal necrosis in patients with mesenteric ischemia

Zhao, Hongwei; Meng, Yiting; Zhang, Peng; Zhang, Qian; Wang, Feng

doi:10.21037/atm-20-8154

Cited by 6 publications

(4 citation statements)

References 27 publications

(37 reference statements)

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“…Mesenteric artery embolism is a severe acute abdominal disease in clinic, characterized by rapid development and high mortality. 11 Early diagnosis is the key to the treatment of mesenteric artery embolism. 12 It has been shown that 13 the mortality of acute intestinal ischemia caused by mesenteric artery embolism is as high as 50%-90%.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of mesenteric CTA combined with D-dimer level and inflammatory factor changes in severity of mesenteric artery embolism

Yiru¹,

Li²,

Liang³

et al. 2023

Pak J Med Sci

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Objective: To investigate the value of mesenteric CTA combined with D-dimer (DD) level and inflammatory factor changes in evaluating the severity of mesenteric artery embolism. Methods: This is a retrospective study. The imaging data of mesenteric CTA and the levels of plasma DD and inflammatory factors in 120 patients with mesenteric artery embolism confirmed by DSA or surgery in Baoding No.1 Central Hospital were analyzed retrospectively from January 2021 to December 2022. The coincidence rate of CTA alone and CTA combined with DD and inflammatory factors with the results of surgery or DSA was compared and analyzed. The specificity, sensitivity and accuracy of CTA alone and CTA combined with DD and inflammatory factors in diagnosing superior mesenteric artery embolism were compared. The correlations of different severity of mesenteric artery embolism with DD and inflammatory factor levels were compared and analyzed. Results: There was a significant difference in the coincidence rate between CTA diagnosis and CTA combined with DD and inflammatory factors diagnosis (p= 0.01). And the sensitivity and accuracy of the latter were significantly higher than those of the former (sensitivity, p= 0.01; accuracy, p= 0.00). The levels of plasma DD, TNF-a, CRP and IL-6 in the intestinal wall thinning group were significantly higher than those in the thickening group (p= 0.00). The above indexes increased significantly in the decreased intestinal wall enhancement group compared with the increased intestinal wall enhancement group (p= 0.00). DD, TNF-α, CRP and IL-6 levels increased with the increase in stenosis severity. Conclusion: Mesenteric CTA combined with plasma DD and inflammatory factor levels can effectively determine the severity of mesenteric arterial embolism, and provide a scientific basis for early clinical diagnosis and treatment. doi: https://doi.org/10.12669/pjms.39.5.6719 How to cite this: Zhang Y, Li Z, Liang J, Bai S, Zhang Z. Diagnostic value of mesenteric CTA combined with D-dimer level and inflammatory factor changes in severity of mesenteric artery embolism. Pak J Med Sci. 2023;39(5):---------. doi: https://doi.org/10.12669/pjms.39.5.6719 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 99%

Diagnostic value of mesenteric CTA combined with D-dimer level and inflammatory factor changes in severity of mesenteric artery embolism

Yiru¹,

Li²,

Liang³

et al. 2023

Pak J Med Sci

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“…Taking into context the clinical presentation of the patients, PI and pneumoperitoneum or portal venous gas should not be used as an indication by themselves for an exploratory laparotomy. Additional criteria, including higher C-reactive protein concentrations, higher white blood cell counts, higher lactate levels, and ascites, may be required to indicate inflammatory syndrome and the likelihood of intestinal necrosis from mesenteric ischemia [ 7 , 47 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

Pneumatosis Intestinalis Induced by Alpha-Glucosidase Inhibitors in Patients with Diabetes Mellitus

McKinley

Santiago

Pak

et al. 2022

JCM

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Alpha-glucosidase inhibitor (αGIs)-induced pneumatosis intestinalis (PI) has been narrated in case reports but never systematically investigated. This study aimed to investigate the concurrency of PI and αGIs. A literature search was performed in PubMed, Google Scholar, WorldCat, and the Directory of Open-Access Journals (DOAJ) by using the keywords “pneumatosis intestinalis”, “alpha-glucosidase inhibitors”, and “diabetes”. In total, 29 cases of αGIs-induced PI in 28 articles were included. There were 11 men, 17 women, and one undefined sex, with a median age of 67. The most used αGI was voglibose (44.8%), followed by acarbose (41.4%) and miglitol (6.8%). Nine (31%) patients reported concomitant use of prednisone/prednisolone with or without immunosuppressants. The main symptoms were abdominal pain (54.5%) and distention (50%). The ascending colon (55.2%) and the ileum (34.5%) were the most affected. Nineteen (65.5%) patients had comorbidities. Patients with comorbidities had higher rates of air in body cavities, the portal vein, extraintestinal tissues, and the wall of the small intestine. Only one patient was found to have non-occlusive mesenteric ischemia. Twenty-five patients were treated with conservative therapy alone, and two patients received surgical intervention. All patients recovered. In conclusion, comorbidities, glucocorticoids, and immunosuppressants aggravate αGIs-induced PI. Conservative therapy is recommended when treating αGIs-induced PI.

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“…In this case, the patient’s only early sign was fever. Considering that the patient had a history of heart valve replacement and abnormal coagulation function, there was a possibility of thromboembolism, and previous studies have shown that an elevated WBC count is a risk factor for MI progression[ 11 , 12 ]. After excluding blood flow disorders in the lower extremities and heart, MI is one of the complications after major surgery that needs to be considered.…”

Section: Discussionmentioning

confidence: 99%

Concealed mesenteric ischemia after total knee arthroplasty: A case report

Zhang

et al. 2021

WJCC

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BACKGROUND In critical care medicine, mesenteric ischemia (MI) is a life-threatening disease that can be present in both critically ill patients and those undergoing major surgery. For the first time, we report a case of concealed MI with a long course after knee arthroplasty. CASE SUMMARY A male patient underwent left total knee arthroplasty for gouty arthritis and developed a persistent fever and persistently high levels of serum infection markers after surgery. He was considered to have a periprosthetic site infection and treated with antibiotics and colchicine, periprosthetic debridement was performed, and the spacer was replaced, but no improvement was seen. At 54 d after arthroplasty, the patient developed gastrointestinal symptoms of nausea and vomiting, abdominal distention, and subsequently, cloudiness of consciousness, and hypotensive shock. Finally, the patient was diagnosed with ascending colonic mesentery ischemia with necrosis after laparotomy, which improved after right hemicolectomy. CONCLUSION Concealed MI without gastrointestinal symptoms after major surgery is rare and easily misdiagnosed. Orthopedic surgeons need to be aware of this complication.

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Predictors and risk factors for intestinal necrosis in patients with mesenteric ischemia

Cited by 6 publications

References 27 publications

Diagnostic value of mesenteric CTA combined with D-dimer level and inflammatory factor changes in severity of mesenteric artery embolism

Diagnostic value of mesenteric CTA combined with D-dimer level and inflammatory factor changes in severity of mesenteric artery embolism

Pneumatosis Intestinalis Induced by Alpha-Glucosidase Inhibitors in Patients with Diabetes Mellitus

Concealed mesenteric ischemia after total knee arthroplasty: A case report

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