The Unusual Suspect: A Case of Non-occlusive Mesenteric Ischemia in a Patient With Cirrhosis

Bawany, Muhammad; Nawras, Ali; Youssef, Wael; Sodeman, Thomas

doi:10.4021/gr226w

Cited by 5 publications

(8 citation statements)

References 6 publications

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“…2 Multiple case reports and small case series described the occurrence of NOMI after cardiac surgery, [3][4][5][6][7][8] heart failure, 4,9 and a variety of heterogeneous acute critical illnesses. [9][10][11][12][13][14][15][16][17][18][19][20][21][22] Risk factors for NOMI appear to be older age as well as cardiovascular and/or chronic kidney disease (CKD) and it occurs especially in situations after major surgery, sepsis, and shock requiring vasopressor therapy. 23,24 Nonocclusive mesenteric ischemia is often only diagnosed in advanced stages of extensive intestinal necrosis, 24 leading to a devastating mortality rate up to 90% that has not changed over the past decades.…”

Section: Introductionmentioning

confidence: 99%

Nonocclusive Mesenteric Ischemia and Interventional Local Vasodilatory Therapy: A Meta-Analysis and Systematic Review of the Literature

Stahl

Rittgerodt

Busch

et al. 2019

J Intensive Care Med

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Background: Intensive care patients with nonocclusive mesenteric ischemia (NOMI) show mortality rates of 70% to 90%. Besides emergency surgery, different interventional local vasodilatory treatment (LVT) attempts have been described. We performed a systematic review and a meta-analysis to evaluate feasibility, efficacy, and tolerability of LVT in patients with life-threatening NOMI. Methods: Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed until February 2019. Measured outcomes included immediate technical success rates (as indicated by mesenteric vasodilation on angiography or clinical improvement) and adverse events (AEs). Therapeutic efficacy was measured by the assessment of overall mortality. Results: Twelve studies (335 patients, 245 received LVT) from 1977 to 2018 were included. All studies were retrospective (4 comparative and 8 noncomparative). Different intra-arterial vasodilators (4× papaverine, 6× prostaglandin E1, 1× tolazoline/heparin, 1× tolazoline + iloprost) were reported. Initial technical success rate was 75.9% (95% confidence interval [CI], 55.1%-89%, P = .017) with an AE rate of 2.9% (95% CI: 1.3%-6.6%; P = .983). Overall mortality in LVT patients was 40.3% (95% CI: 28.7%-53%, P = .134). In 4 studies, outcomes were compared between patients receiving LVT to those who received standard of care (odds ratio for death in LVT patients was 0.261 [95% CI: 0.095-0.712, P = .009]). Conclusions: Local vasodilatory treatment appears to be safe in patients with NOMI and might have the potential to at least partially reverse mesenteric vasoconstriction features in control angiographies. However, with no randomized and prospective studies available yet, the overall quality of published studies has to be considered as low; therefore, it is not possible to draw generalizable conclusions from the present data concerning clinical end points. Its application might hold promise as a rescue treatment strategy and deserves further evaluation in randomized controlled trials.

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Section: Introductionmentioning

confidence: 99%

Nonocclusive Mesenteric Ischemia and Interventional Local Vasodilatory Therapy: A Meta-Analysis and Systematic Review of the Literature

Stahl

Rittgerodt

Busch

et al. 2019

J Intensive Care Med

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“…27 Liver cirrhosis usually causes dilation of the splanchnic circulation, however previous case reports on cirrhotic patients have postulated that mesenteric ischemia in the absence of any other cardiovascular causes may be due to abnormal metabolism of neurohumoral mediators such as angiotensin and vasopressin. 45 Preoperative smoking status (current or ex-smoker) was insignificant for 12 studies; however, two studies found this to be significant. The first study was a retrospective analysis of autopsy reports the following death as a result of mesenteric ischemia postcardiac surgery with CPB.…”

Section: Preoperative Resultsmentioning

confidence: 96%

Predicting outcomes of mesenteric ischemia postcardiac surgery: A systematic review

Kayali

Sarodaya

Shah

et al. 2022

Journal of Cardiac Surgery

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Objective This systematic review aims to identify predictors of outcomes of mesenteric ischemia in patients following cardiac surgery. Methods A comprehensive literature search was done on EMBASE, PubMed, Ovid MEDLINE, and SCOPUS using keywords relating to bowel ischemia and cardiac surgery. Database search results were screened by at least two authors and 32 articles were selected for inclusion in this review. Results Data on 1907 patients were analyzed. The mean age was 70.0 ± 2.99 years and the prevalence of bowel ischemia was 1.74%. Advanced age was a significant risk factor. 63.16% of patients reported were men, and 58.4% of patients died in hospital. There was heterogeneity in the reported significance of the following preoperative risk factors: hypertension, smoking status, type 2 diabetes mellitus, end‐stage renal disease, preoperative left ventricular ejection fraction <35%. Cardiopulmonary bypass (CPB) time, preoperative/operative intra‐aortic balloon pump (IABP) support, and inotrope usage were significantly associated with the development of mesenteric ischemia; however, other intraoperative factors including the type of cardiac surgery and duration of aortic cross‐clamping had varying levels of reported significance. There were discrepancies in the reported significance of leukocytosis and metabolic acidosis (pH <7.3) as postoperative markers. Postoperative vasopressor use, prolonged ventilation time, and elevation in lactate, transaminases, creatinine, and intestinal fatty acid‐binding protein (IFABP) levels were found to be strongly associated with bowel ischemia. Conclusion This systematic review found the strongest associations of mesenteric ischemia postcardiac surgery to be advanced age, CPB time, rise in lactate, transaminases, creatinine, and IFABP. IABP support, vasopressor, and inotrope use as well as prolonged ventilation were strongly linked too.

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“…Зазвичай НОМІ діагностується завдяки використанню брижової ангіографії [19]. Ряд авторів надають абсолютну перевагу ангіографії, вважаючи її «золотим стандартом» діагностики [5,17]. Артеріографія показана пацієнтам із підозрою на НОМІ, стан яких не поліпшується у відповідь на лікування (рівень доказовості В).…”

Section: інструментальна діагностикаunclassified

“…Колоноскопічне обстеження може бути корисним у прогнозуванні клінічного перебігу. Обстеження безпечне при ранніх стадіях захворювання, але потребує обережного виконання у зв'язку з посиленням ризику розвитку ішемічних уражень при інсуфляції повітря [5]. Колоноскопічними критеріями у хворих з НОМІ є сегментарний характер уражень із чіткою межею здорових і уражених ділянок.…”

Section: інструментальна діагностикаunclassified

“…Селективне катетер-асоційоване введення вазодилататорів є пріоритетним. До основних вазодилататорів, застосовуваних у клінічній практиці, належать: папаверин, толазолін (альфаадрено блокатор), глюкагон, нітрогліцерин, нітропрусид, простагландин Е, феноксибензамін [5].…”

Section: лікуванняunclassified

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Nonoсclusive mesenteric ischemia (literature review)

Khomenko¹,

Perepelitsіa²,

Kuchynskyi³

et al. 2021

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Non-occlusive mesenteric ischemia is a relatively rare but extremely complex pathology in terms of diagnosis. A wide range of reasons for the development of non-occlusive impression dramatically complicates the diagnosis and differentiation with other abdominal pathology. The vast majority of publications in the domestic literature on acute disorders of mesenteric blood flow, mostly address the problems of diagnosis and treatment of occlusive types of mesenteric ischemia, while the topic of non-occlusive ischemia remains insufficiently covered. Given that in half of the cases NOMI is diagnosed at the stage of irreversible necrotic changes of the intestine – there is a real need to generalize the root causes and mechanisms of neoclustive mesenteric ischemia, modern methods of diagnosis and treatment. Purpose – to analyze of the causes, prevalence, classification, diagnosis and treatment of non-occlusive disorders of mesenteric blood flow. This research, based on literature review, showed that acute non-occlusive mesenteric ischemia (NOMI) is associated with poor prognosis due to the lack of accurate diagnostic measures. First of all, clarity regarding biochemical markers. Therefore, the research and development of the latter is seen as a priority. Contrast methods of examination (computed tomography, angiography) are the only possible diagnostic tools. Pharmacological correction is fundamental and presupposes the use of drugs with a vasodilating effect systemically or locally (catheter-associated). An important issue is the development of pharmacological agents that allow targeted action on the pathogenetic mechanisms of the development of NOMI. A multidisciplinary approach involving a specialized doctor, a surgeon, an X-ray endovascular surgeon and an intensive care physician in the treatment of a patient with suspected NOMI is the foundation for the success of therapy. The question of the use of laparoscopy remains controversial, given the invasiveness of the method and the difficulty of interpreting the changes detected in the early phase of the disease. No conflict of interests was declared by the authors. Key words: acute mesenteric ischemia, non-occlusive disorders of mesenteric blood flow.

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The Unusual Suspect: A Case of Non-occlusive Mesenteric Ischemia in a Patient With Cirrhosis

Cited by 5 publications

References 6 publications

Nonocclusive Mesenteric Ischemia and Interventional Local Vasodilatory Therapy: A Meta-Analysis and Systematic Review of the Literature

Nonocclusive Mesenteric Ischemia and Interventional Local Vasodilatory Therapy: A Meta-Analysis and Systematic Review of the Literature

Predicting outcomes of mesenteric ischemia postcardiac surgery: A systematic review

Nonoсclusive mesenteric ischemia (literature review)

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