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Update in management of mesenteric ischemia 被引量:38
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作者 Robert W Chang John B Chang Walter E Longo 《World Journal of Gastroenterology》 SCIE CAS CSCD 2006年第20期3243-3247,共5页
Mesenteric ischemia disorders are precipitated by a circulation insufficiency event that deprives one or several abdominal organs of adequate respiration to meet metabolic demands. Although mesenteric ischemia occurs ... Mesenteric ischemia disorders are precipitated by a circulation insufficiency event that deprives one or several abdominal organs of adequate respiration to meet metabolic demands. Although mesenteric ischemia occurs infrequently, the mortality rate is from 60% to 100%, depending on the source of obstruction. The successful outcome is dependent upon a high index of suspicion and prompt management. We briefly review the pathophysiology and presentation of the various ischemic entities and review the current state of the art in diagnosis and treatment. Despite advances in both diagnosis and treatment, prompt diagnosis and supportive care remain critical for successful outcome. New imaging techniques, endovascular therapy and emerging research may improve our approach to this deadly condition. 展开更多
关键词 mesenteric ischemia Duplex ultrasonography Plasma D-dimer Computed tomography
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Planned second-look laparoscopy in the management of acute mesenteric ischemia 被引量:11
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作者 Hakan Yanar Korhan Taviloglu +4 位作者 Cemalettin Ertekin Beyza Ozcinar Fatih Yanar Recep Guloglu Mehmet Kurtoglu 《World Journal of Gastroenterology》 SCIE CAS CSCD 2007年第24期3350-3353,共4页
AIM: To investigate the role of second-look laparoscopy in patients with acute mesenteric ischemia (AMI). METHODS: Between January 2000 and November 2005, 71 patients were operated for the treatment of AMI. The in... AIM: To investigate the role of second-look laparoscopy in patients with acute mesenteric ischemia (AMI). METHODS: Between January 2000 and November 2005, 71 patients were operated for the treatment of AMI. The indications for a second-look were low flow state, bowel resection and anastomosis or mesenteric thromboembolectomy performed during the first operation. Regardless of the clinical course of patients, the second-look laparoscopic examination was performed 72 h post-operatively at the bed side in the ICU or operating room. RESULTS: The average time of admission to the hospital after the initation of syrnptoms was 3 d (range, 5 h-9 d). In 14 patients, laparotomy was performed. In 11 patients, small and/or large bowel necrosis was detected and initial resection and anastomosis were conducted. A low flow state was observed in two patients and superior mesenteric artery thromboembolectomy with small bowel resection was performed in one patient. In 13 patients, a second-look laparoscopic examination revealed normal bowel viability, but in one patient, intestinal necrosis was detected. In two of the patients, a third operation was necessary to correct anastomotic leakage. The overall complication rate was 42.8%, and in-hospital mortality rate was 57.1% (n = 6). CONCLUSION: Second-look laparoscopy is a minimally invasive, technically simple procedure that is performed for diagnostic as well as therapeutic purposes. The simplicity and ease of this method may encourage wider application to benefit more patients. However, the timing of a second-look procedure is unclear particularly in a patient with anastomosis. 展开更多
关键词 Acute mesenteric ischemia Second-look laparoscopy Minimally invasive PLANNED Low flow state
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Acute mesenteric ischemia after cardio-pulmonary bypass surgery 被引量:9
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作者 Bassam Abboud Ronald Daher Joe Boujaoude 《World Journal of Gastroenterology》 SCIE CAS CSCD 2008年第35期5361-5370,共10页
Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow... Acute mesenteric ischemia (AMI) is a highly-lethal surgical emergency. Several pathophysiologic events (arterial obstruction, venous thrombosis and diffuse vasospasm) lead to a sudden decrease in mesenteric blood flow. Ischemia/reperfusion syndrome of the intestine is responsible for systemic abnormalities, leading to multi-organ failure and death. Early diagnosis is difficult because the clinical presentation is subtle, and the biological and radiological diagnostic tools lack sensitivity and specificity. Therapeutic options vary from conservative resuscitation, medical treatment, endovascular techniques and surgical resection and revascularization. A high index of suspicion is required for diagnosis, and prompt treatment is the only hope of reducing the mortality rate. Studies are in progress to provide more accurate diagnostic tools for early diagnosis. AMI can complicate the post-operative course of patients following cardio-pulmonary bypass (CPB). Several factors contribute to the systemic hypo-perfusion state, which is the most frequent pathophysiologic event. In this particular setting, the clinical presentation of AMI can be misleading, while the laboratory and radiological diagnostic tests often produce inconclusive results. The management strategies are controversial, but early treatment is critical for saving lives. Based on the experience of our team, we consider prompt exploratory laparotomy, irrespective of the results of the diagnostic tests, isthe only way to provide objective assessment and adequate treatment, leading to dramatic reduction in the mortality rate. 展开更多
关键词 Acute mesenteric ischemia Non-occlusive Cardio-pulmonary bypass LAPAROTOMY PROGNOSIS MORTALITY
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Multidisciplinary management of acute mesenteric ischemia:Surgery and endovascular intervention 被引量:7
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作者 Takashi Sakamoto Tadao Kubota +1 位作者 Hiraku Funakoshi Alan Kawarai Lefor 《World Journal of Gastrointestinal Surgery》 SCIE 2021年第8期806-813,共8页
Acute mesenteric ischemia(AMI)is a rare cause of the“acute abdomen”,characterized by impaired blood flow to the intestine.The principle of treatment is restoration of perfusion to ischemic bowel and resection of any... Acute mesenteric ischemia(AMI)is a rare cause of the“acute abdomen”,characterized by impaired blood flow to the intestine.The principle of treatment is restoration of perfusion to ischemic bowel and resection of any necrotic intestine.Surgery and endovascular intervention are two complementary approaches to mesenteric ischemia.Endovascular intervention is not an alternative to the surgical approach,but it has the potential to improve the prognosis of patients with AMI when judiciously combined with a surgical approach.Due to the need for emergent treatment of patients with acute mesenteric ischemia,the treatment strategy needs to be modified for each facility.This review aims to highlight cutting-edge studies and provide reasonable treatment strategies for patients with acute mesenteric ischemia based on available evidence. 展开更多
关键词 Acute mesenteric ischemia Endovascular intervention Acute mesenteric arterial embolism Acute mesenteric arterial thrombosis
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Diagnostic value of plasminogen activity level in acute mesenteric ischemia 被引量:3
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作者 Yusuf Gunerhan Neset Koksal +2 位作者 Munire Kayahan Yavuz Eryavuz Hilal Sekban 《World Journal of Gastroenterology》 SCIE CAS CSCD 2008年第16期2540-2543,共4页
AIM: To investigate the changes in plasminogen activity level during mesenteric ischemia. METHODS: We performed laparotomy in 90 female Wistar-Albino rats (average weight 230 g). In sham groups (SL) (GroupsⅠand Ⅱ) t... AIM: To investigate the changes in plasminogen activity level during mesenteric ischemia. METHODS: We performed laparotomy in 90 female Wistar-Albino rats (average weight 230 g). In sham groups (SL) (GroupsⅠand Ⅱ) the superior mesenteric artery (SMA) and vein (SMV) were explored, but not tied. In SMA groups (Groups Ⅲ and Ⅳ) the SMA was ligated, and in SMV groups (Groups Ⅴ and Ⅵ) the SMV was ligated. On re-laparatomy 2 mL of blood was drawn at 1 h in groupsⅠ, Ⅲ and Ⅴ, and at 3 h in groups Ⅱ, Ⅳ and Ⅵ. Plasminogen levels were assessed and comparisons were made between groups and within each group. RESULTS: The mean plasminogen activity in the SL group was significantly higher than SMA (25.1 ± 10.8 vs 11.8 ± 4.6, P < 0.001) or SMV (25.1 ± 10.8 vs 13.7 ± 4.4, P < 0.001) groups both at 1 h and at 3 h (29.8 ± 8.9 vs 15.1 ± 5.7, P < 0.0001; 29.8 ± 8.9 vs 14.2 ± 2.9, P < 0.0001). There were no significant differences between the values of SMA and SMV groups at 1 h (P = 0.28) and at 3 h (P = 0.71). In each group, plasminogen activity levels did not change significantly between the two measurements performed at 1 h and 3 h. CONCLUSION: We conclude that blood plasminogen activities decrease during early phases of both arterial and venous mesenteric ischemia which may be a useful marker for early diagnosis. 展开更多
关键词 mesenteric ischemia NECROSIS Activity level
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Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence 被引量:2
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作者 Simon Bourcier Julian Klug Lee S Nguyen 《World Journal of Gastroenterology》 SCIE CAS 2021年第26期4088-4103,共16页
Acute mesenteric ischemia(AMI)is a severe condition associated with poor prognosis,ultimately leading to death due to multiorgan failure.Several mechanisms may lead to AMI,and non-occlusive mesenteric ischemia(NOMI)re... Acute mesenteric ischemia(AMI)is a severe condition associated with poor prognosis,ultimately leading to death due to multiorgan failure.Several mechanisms may lead to AMI,and non-occlusive mesenteric ischemia(NOMI)represents a particular form of AMI.NOMI is prevalent in intensive care units in critically ill patients.In NOMI management,promptness and accuracy of diagnosis are paramount to achieve decisive treatment,but the last decades have been marked by failure to improve NOMI prognosis,due to lack of tools to detect this condition.While real-life diagnostic management relies on a combination of physical examination,several biomarkers,imaging,and endoscopy to detect the possibility of several grades of NOMI,research studies only focus on a few elements at a time.In the era of artificial intelligence(AI),which can aggregate thousands of variables in complex longitudinal models,the prospect of achieving accurate diagnosis through machine-learning-based algorithms may be sought.In the following work,we bring you a state-of-the-art literature review regarding NOMI,its presentation,its mechanics,and the pitfalls of routine work-up diagnostic exams including biomarkers,imaging,and endoscopy,we raise the perspectives of new biomarker exams,and finally we discuss what AI may add to the field,after summarizing what this technique encompasses. 展开更多
关键词 mesenteric ischemia Biomarkers Critically ill Machine learning Artificial intelligence
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Mesenteric ischemia in COVID-19 patients:A review of current literature
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作者 Asad Ali Kerawala Bhagwan Das Ahda Solangi 《World Journal of Clinical Cases》 SCIE 2021年第18期4700-4708,共9页
BACKGROUND Coronavirus disease 2019(COVID-19)virus has affected all the systems of the body,defying all impressions of it being a respiratory virus only.AIM To see the association of mesenteric ischemia with COVID-19.... BACKGROUND Coronavirus disease 2019(COVID-19)virus has affected all the systems of the body,defying all impressions of it being a respiratory virus only.AIM To see the association of mesenteric ischemia with COVID-19.METHODS After initial screening and filtering of the titles on PubMed and Google Scholar,124 articles were selected.Articles were read in full,and the references were skimmed for relevance.Twenty-six articles(case reports and case series)were found to eligible for inclusion.References of these 26 articles were checked for any additional cases.Two more publications were found,and a total of 28 articles(22 case reports and 6 case series)have been included for review in this manuscript.RESULTS A total of 41 cases of acute mesenteric ischemia in COVID-19 patients have been reported in the literature since the outbreak of this pandemic.Most of them include patients with comorbidities.CONCLUSION In conclusion,based on this literature review and precise published knowledge regarding acute mesenteric ischemia in patients with COVID-19,it is essential to understand its relevance in all patients with gastrointestinal symptoms.The threshold for the diagnostic investigations should also be kept low for the timely diagnosis and management of this disorder. 展开更多
关键词 mesenteric ischemia COVID-19 SARS-CoV-2 INFLUENZA Severe acute respiratory syndrome Acute abdomen
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Acute mesenteric ischemia due to percutaneous coronary intervention:A case report
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作者 Peng Ding Yuan Zhou +2 位作者 Kun-Lan Long Song Zhang Pei-Yang Gao 《World Journal of Clinical Cases》 SCIE 2022年第28期10244-10251,共8页
BACKGROUND Percutaneous coronary intervention(PCI) is extensively used to treat acute coronary syndromes(ACS).Acute mesenteric ischemia is a life-threatening disease if untreated.CASE SUMMARY An 81-year-old female pre... BACKGROUND Percutaneous coronary intervention(PCI) is extensively used to treat acute coronary syndromes(ACS).Acute mesenteric ischemia is a life-threatening disease if untreated.CASE SUMMARY An 81-year-old female presented with 3 d of lethargy and 1 d of dyspnea.On November 16,2021,the patient developed a coma.Her oxygen saturation dropped to 70%-80%,the patient was admitted to the intensive care unit for further treatment.Chest computed tomography(CT) showed chronic bronchitis,emphysema,and multiple lung infections.Abdominal CT scan showed no obvious abnormalities,but have severely calcified abdominal vessels.The patient received assisted ventilation,and vasoactive,and anti-infection drugs.Troponin level was elevated.Since the patient was in a coma,it could not be determined whether she had chest pain.The cardiologist assumed that the patient had developed ACS;therefore,the patient underwent PCI via the left femoral artery approach,and no obvious abnormalities were found in the left and right coronary arteries.On the second postoperative day,the patient presented with abdominal distension and decreased bowel sounds;constipation was considered and a glycerin enema was administered.On day 4,the patient suddenly lost consciousness,and had decreased blood pressure,abdominal wall swelling with increased tension,and absence of bowel sounds.An urgent abdominal CT scan revealed gas in her hepatic portal system with extensive bowel wall necrosis.The patient died on day 5 due to intractable shock.CONCLUSION The potential serious complications in patients undergoing PCI,especially the patients who are hemodynamically unstable and have severely calcified abdominal vessels,should all be considered. 展开更多
关键词 Percutaneous coronary intervention Acute mesenteric ischemia Acute coronary syndrome Vascular calcification Case report
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Concealed mesenteric ischemia after total knee arthroplasty:A case report
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作者 Sheng-Yang Zhang Bang-Jian He +4 位作者 Hui-Hui Xu Miao-Miao Xiao Jing-Jing Zhang Pei-Jian Tong Qiang Mao 《World Journal of Clinical Cases》 SCIE 2021年第22期6515-6521,共7页
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 c... 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. 展开更多
关键词 Concealed mesenteric ischemia Total knee arthroplasty COMPLICATION Case report
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Identifying survival protective factors for chronic dialysis patients with surgically confirmed acute mesenteric ischemia
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作者 Shuh-Kuan Liau George Kuo +6 位作者 Chao-Yu Chen Yueh-An Lu Yu-Jr Lin Cheng-Chia Lee Cheng-Chieh Hung Ya-Chung Tian Hsiang-Hao Hsu 《World Journal of Gastrointestinal Surgery》 SCIE 2022年第8期809-820,共12页
BACKGROUND Mesenteric ischemia is significantly more common in end-stage kidney disease patients undergoing chronic dialysis than in the general population and is associated with high morbidity and mortality. However,... BACKGROUND Mesenteric ischemia is significantly more common in end-stage kidney disease patients undergoing chronic dialysis than in the general population and is associated with high morbidity and mortality. However, reports on prognostic factors in this population are limited.AIM To elucidate the in-hospital outcomes of acute mesenteric ischemia in chronic dialysis patients and to analyze protective factors for survival.METHODS The case data of 426 chronic dialysis patients who were hospitalized in a tertiary medical center for acute mesenteric ischemia over a 14-year period were retrospectively reviewed. Of these cases, 103 were surgically confirmed, and the patients were enrolled in this study. A Cox regression analysis was used to evaluate the protective factors for survival.RESULTS The in-hospital mortality rate among the 103 enrolled patients was 46.6%.Univariate analysis was performed to compare factors in survivors and nonsurvivors, with better in-hospital outcomes associated with a surgery delay(defined as the time from onset of signs and symptoms to operation) < 4.5 d, no shock, a higher potassium level on day 1 of hospitalization, no resection of the colon, and a total bowel resection length < 110 cm. After 1 wk of hospitalization, patients with lower white blood cell count and neutrophil counts, higher lymphocyte counts, and lower C-reactive protein levels had better in-hospital outcomes. Following multivariate adjustment, a higher potassium level on day 1 of hospitalization(HR 1.71, 95%CI 1.19 to 2.46;P = 0.004), a lower neutrophil count(HR 0.91, 95%CI 0.84 to 0.99;P = 0.037) at 1 wk after admission, resection not involving the colon(HR 2.70, 95%CI 1.05 to 7.14;P = 0.039), and a total bowel resection length < 110 cm(HR 4.55,95%CI 1.43 to 14.29;P = 0.010) were significantly associated with survival.CONCLUSION A surgery delay < 4.5 d, no shock, no resection of the colon, and a total bowel resection length <110 cm predicted better outcomes in chronic dialysis patients with acute mesenteric ischemia. 展开更多
关键词 mesenteric ischemia Chronic dialysis End-stage kidney disease SURGERY Protective factors SURVIVAL
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A hybrid technique: intra-arterial catheter-directed thrombolysis following the recanalization of superior mesenteric artery in acute mesenteric ischemia 被引量:6
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作者 ZHU Jie-chang DAI Xiang-chen FAN Hai-lun FENG Zhou ZHANG Yi-wei LUO Yu-dong 《Chinese Medical Journal》 SCIE CAS CSCD 2013年第7期1381-1383,共3页
Acute mesenteric ischemia is a deadly process withoverall mortality rate of 40%. Acute thrombosis of an atherosclerotic lesion with previous partial occlusion isone of the common causes. Peri-operative mortality ofsu... Acute mesenteric ischemia is a deadly process withoverall mortality rate of 40%. Acute thrombosis of an atherosclerotic lesion with previous partial occlusion isone of the common causes. Peri-operative mortality ofsuperior mesenteric artery (SMA) thrombosis is higherbecause of the difficulty in diagnosis, 展开更多
关键词 superior mesenteric artery mesenteric ischemia THROMBOSIS EMBOLECTOMY ANGIOPLASTY intra-arterial catheter-directed thrombolysis
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Should we perform decompressive laparotomy during severe acute pancreatitis with intra-abdominal hypertension below 25 mmHg:Only the gut knows
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作者 Thibault Vieille Melissa Crotet +3 位作者 Celia Turco Paul Monasterolo Hadrien Winiszewski Gael Piton 《World Journal of Gastrointestinal Surgery》 SCIE 2024年第5期1470-1473,共4页
We suggest that during severe acute pancreatitis(SAP)with intra-abdominal hypertension,practitioners should consider decompressive laparotomy,even with intra-abdominal pressure(IAP)below 25 mmHg.Indeed,in this setting... We suggest that during severe acute pancreatitis(SAP)with intra-abdominal hypertension,practitioners should consider decompressive laparotomy,even with intra-abdominal pressure(IAP)below 25 mmHg.Indeed,in this setting,non-occlusive mesenteric ischemia(NOMI)may occur even with IAP below this cutoff and lead to transmural necrosis if abdominal perfusion pressure is not promptly restored.We report our experience of 18 critically ill patients with SAP having undergone decompressive laparotomy of which one third had NOMI while IAP was mostly below 25 mmHg. 展开更多
关键词 Acute pancreatitis Abdominal compartment syndrome Decompressive laparotomy mesenteric ischemia Intra-abdominal pressure Abdominal perfusion pressure
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Surgical management of peritonitis secondary to acute superior mesenteric artery occlusion 被引量:17
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作者 Stefan Acosta 《World Journal of Gastroenterology》 SCIE CAS 2014年第29期9936-9941,共6页
Diagnosis of acute arterial mesenteric ischemia in the early stages is now possible using modern computed tomography with intravenous contrast enhancement and imaging in the arterial and/or portal phase.Most patients ... Diagnosis of acute arterial mesenteric ischemia in the early stages is now possible using modern computed tomography with intravenous contrast enhancement and imaging in the arterial and/or portal phase.Most patients have acute superior mesenteric artery(SMA)occlusion,and a large proportion of these patients will develop peritonitis prior to mesenteric revascularization,and explorative laparotomy will therefore be necessary to evaluate the extent and severity of intestinal ischemia,and to perform bowel resections.The establishment of a hybrid operating room in vascular units in hospitals is most important to be able to perform successful intestinal revascularization.This review outlines current frontline surgical strategies to improve survival and minimize bowel morbidity in patients with peritonitis secondary to acute SMA occlusion.Explorative laparotomy needs to be performed first.Curative treatment is based upon intestinal revascularization followed by bowel resection.If no vascular imaging has been carried out,SMA angiography is performed.In case of embolic occlusion of the SMA,open embolectomy is performed followed by angiography.In case of thrombotic occlusion,the occlusive lesion can be recanalized retrograde from an exposed SMA,the guidewire snared from either the femoral or brachial artery,and stented with standard devices from these access sites.Bowel resections and sometimes gall bladder removal due to transmural infarctions are performed at initial laparotomy,leaving definitive bowel reconstructions to a planned second look laparotomy,according to the principles of damage control surgery.Patients with peritonitis secondary to acute SMA occlusion should be managed by both the general and vascular surgeon,and a hybrid revascularization approach is of utmost importance to improve outcomes. 展开更多
关键词 Acute mesenteric ischemia PERITONITIS Explorative laparotomy Endovascular treatment Hybrid revascularization Superior mesenteric artery occlusion
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Nomogram for predicting transmural bowel infarction in patients with acute superior mesenteric venous thrombosis 被引量:6
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作者 Meng Jiang Chang-Li Li +4 位作者 Chun-Qiu Pan Wen-Zhi Lv Yu-Fei Ren Xin-Wu Cui Christoph F Dietrich 《World Journal of Gastroenterology》 SCIE CAS 2020年第26期3800-3813,共14页
BACKGROUND The prognosis of acute mesenteric ischemia(AMI)caused by superior mesenteric venous thrombosis(SMVT)remains undetermined and early detection of transmural bowel infarction(TBI)is crucial.The predisposition ... BACKGROUND The prognosis of acute mesenteric ischemia(AMI)caused by superior mesenteric venous thrombosis(SMVT)remains undetermined and early detection of transmural bowel infarction(TBI)is crucial.The predisposition to develop TBI is of clinical concern,which can lead to fatal sepsis with hemodynamic instability and multi-organ failure.Early resection of necrotic bowel could improve the prognosis of AMI,however,accurate prediction of TBI remains a challenge for clinicians.When determining the eligibility for explorative laparotomy,the underlying risk factors for bowel infarction should be fully evaluated.AIM To develop and externally validate a nomogram for prediction of TBI in patients with acute SMVT.METHODS Consecutive data from 207 acute SMVT patients at the Wuhan Tongji Hospital and 89 patients at the Guangzhou Nanfang Hospital between July 2005 and December 2018 were included in this study.They were grouped as training and external validation cohort.The 207 cases(training cohort)from Tongji Hospital were divided into TBI and reversible intestinal ischemia groups based on the final therapeutic outcomes.Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for TBI using the training data,and a nomogram was subsequently developed.The performance of the nomogram was evaluated with respect to discrimination,calibration,and clinical usefulness in the training and external validation cohort.RESULTS Univariate and multivariate logistic regression analyses identified the following independent prognostic factors associated with TBI in the training cohort:The decreased bowel wall enhancement(OR=6.37,P<0.001),rebound tenderness(OR=7.14,P<0.001),serum lactate levels>2 mmol/L(OR=3.14,P=0.009)and previous history of deep venous thrombosis(OR=6.37,P<0.001).Incorporating these four factors,the nomogram achieved good calibration in the training set[area under the receiver operator characteristic curve(AUC)0.860;95%CI:0.771-0.925]and the external validation set(AUC 0.851;95%CI:0.796-0.897).The positive and negative predictive values(95%CIs)of the nomogram were calculated,resulting in positive predictive values of 54.55%(40.07%-68.29%)and 53.85%(43.66%-63.72%)and negative predictive values of 93.33%(82.14%-97.71%)and 92.24%(85.91%-95.86%)for the training and validation cohorts,respectively.Based on the nomogram,patients who had a Nomo-score of more than 90 were considered to have high risk for TBI.Decision curve analysis indicated that the nomogram was clinically useful.CONCLUSION The nomogram achieved an optimal prediction of TBI in patients with AMI.Using the model,the risk for an individual patient inclined to TBI can be assessed,thus providing a rational therapeutic choice. 展开更多
关键词 Superior mesenteric venous thrombosis Acute mesenteric ischemia Transmural bowel infarction Reversible intestinal ischemia PREDICTORS NOMOGRAM
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Diagnosis and management of splanchnic ischemia 被引量:2
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作者 Jeroen J Kolkman Marloes Bargeman +1 位作者 Ad B Huisman Robert H Geelkerken 《World Journal of Gastroenterology》 SCIE CAS CSCD 2008年第48期7309-7320,共12页
Splanchnic or gastrointestinal ischemia is rare and randomized studies are absent. This review focuses on new developments in clinical presentation, diagnostic approaches, and treatments. Splanchnic ischemia can be ca... Splanchnic or gastrointestinal ischemia is rare and randomized studies are absent. This review focuses on new developments in clinical presentation, diagnostic approaches, and treatments. Splanchnic ischemia can be caused by occlusions of arteries or veins and by physiological vasoconstriction during low-flow states. The prevalence of significant splanchnic arterial stenoses is high, but it remains mostly asymptomatic due to abundant collateral circulation. This is known as chronic splanchnic disease (CSD). Chronic splanchnic syndrome (CSS) occurs when ischemic symptoms develop. Ischemic symptoms are characterized by postprandial pain, fear of eating and weight loss. CSS is diagnosed by a test for actual ischemia. Recently, gastro-intestinal tonometry has been validated as a diagnostic test to detect splanchnic ischemia and to guide treatment. In single- vessel CSD, the complication rate is very low, but some patients have ischemic complaints, and can be treated successfully. In multi-vessel stenoses, the complication rate is considerable, while most have CSS and treatment should be strongly considered. CT and MR-based angiographic reconstruction techniques have emerged as alternatives for digital subtraction angiography for imaging of splanchnic vessels. Duplex ultrasound is still the first choice for screening purposes. The strengths and weaknesses of each modality will be discussed. CSS may be treated by minimally invasive endoscopic treatment of the celiac axis compression syndrome, endovascular antegrade stenting, or laparotomy-assisted retrograde endovascular recanalization and stenting.The treatment plan is highly individualized and is mainly based on precise vessel anatomy, body weight, co- morbidity and severity of ischemia. 展开更多
关键词 Splanchnic ischemia mesenteric ischemia TONOMETRY Blood flow Chronic splanchnic syndrome Chronic splanchnic disease Chronic mesenteric isch-emia Celiac artery compression syndrome Ischemiccolitis
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Superior mesenteric vein thrombosis induced by influenza infection:A case report 被引量:1
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作者 Gyu Man Oh Kyoungwon Jung +4 位作者 Jae Hyun Kim Sung Eun Kim Won Moon Moo In Park Seun Ja Park 《World Journal of Clinical Cases》 SCIE 2020年第18期4193-4199,共7页
BACKGROUND Among the various types and causes of mesenteric ischemia,superior mesenteric vein(SMV)thrombosis is a rare and ambiguous disease.If a patient presents with SMV thrombosis,past medical history should be rev... BACKGROUND Among the various types and causes of mesenteric ischemia,superior mesenteric vein(SMV)thrombosis is a rare and ambiguous disease.If a patient presents with SMV thrombosis,past medical history should be reviewed,and the patient should be screened for underlying disease.SMV thrombosis may also occur due to systemic infection.In this report,we describe a case of SMV thrombosis complicated by influenza B infection.CASE SUMMARY A 64-year-old male visited the hospital with general weakness,muscle aches,fever,and abdominal pain.The patient underwent computed tomography(CT)and was diagnosed with SMV thrombosis.Since the patient’s muscle pain and fever could not be explained by the SMV thrombosis,the clinician performed a test for influenza,which produced a positive result for influenza B.The patient had a thrombus in the SMV only,with no invasion of the portal or splenic veins,and was clinically stable.Anticoagulation treatment was prescribed without surgery or other procedures.The follow-up CT scan showed improvement,and the patient was subsequently discharged with continued oral anticoagulant treatment.CONCLUSION This case provides evidence that influenza may be a possible risk factor for SMV thrombosis.If unexplained abdominal pain is accompanied by an influenza infection,examination of an abdominal CT scan may be necessary to screen for possible SMV thrombosis. 展开更多
关键词 Influenza B virus mesenteric ischemia Venous thrombosis mesenteric vascular occlusion INFLUENZA HUMAN Case reports
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Ischemic bowel disease in 2021 被引量:22
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作者 Monjur Ahmed 《World Journal of Gastroenterology》 SCIE CAS 2021年第29期4746-4762,共17页
Ischemic bowel disease(ISBODI)includes colon ischemia,acute mesenteric ischemia(AMI)and chronic mesenteric ischemia(CMI).Epidemiologically,colon ischemia is the most common type followed by AMI and CMI.There are vario... Ischemic bowel disease(ISBODI)includes colon ischemia,acute mesenteric ischemia(AMI)and chronic mesenteric ischemia(CMI).Epidemiologically,colon ischemia is the most common type followed by AMI and CMI.There are various risk factors for the development of ISBODI.Abdominal pain is the common presenting symptom of each type.High clinical suspicion is essential in ordering appropriate tests.Imaging studies and colonoscopy with biopsy are the main diagnostic tests.Treatment varies from conservative measures to surgical resection and revascularization.Involvement of multidisciplinary team is essential in managing ISBODI.Although open surgery with revascularization plays an important role,recently there is an increasing interest in percutaneous endovascular treatment. 展开更多
关键词 Colon ischemia Ischemic colitis Acute mesenteric ischemia Chronic mesenteric ischemia Endovascular treatment of acute and chronic mesenteric ischemia
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Prognostic significance of red blood cell distribution width in gastrointestinal disorders 被引量:21
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作者 Hemant Goyal Giuseppe Lippi +3 位作者 Altin Gjymishka Bijo John Rajiv Chhabra Elizabeth May 《World Journal of Gastroenterology》 SCIE CAS 2017年第27期4879-4891,共13页
The red blood cell distribution width(RDW) is a routinely measured and automatically reported blood parameter,which reflects the degree of anisocytosis. Recently,the baseline RDW was found to have clinical significanc... The red blood cell distribution width(RDW) is a routinely measured and automatically reported blood parameter,which reflects the degree of anisocytosis. Recently,the baseline RDW was found to have clinical significance for assessing clinical outcome and severity of various pathological conditions including cardiovascular diseases,sepsis,cancers,leukemia,renal dysfunction and respiratory diseases. A myriad of factors,most of which ill-defined,have an impact on the red cell population dynamics(i.e.,production,maturation and turnover). A delay in the red blood cell clearance in pathological conditions represents one of the leading determinants of increased anisocytosis. Further study of RDW may reveal new insight into inflammation mechanisms. In this review,we specifically discuss the current literature about the association of RDW in various disease conditions involving the gastrointestinal and hepatobiliary systems. We also present some of the related measurements for their value in predicting clinical outcomes in such conditions. According to our data,RDW was found to be a valuable prognostic index in gastrointestinal disorders along with additional inflammatory biomarkers(i.e.,C reactive protein,erythrocyte sedimentation rate,and platelet count) and current disease severity indices used in clinical practice. 展开更多
关键词 Red blood cell distribution width HEPATITIS PANCREATITIS Inflammatory bowel diseases Crohn’s disease Ulcerative colitis Colon cancer Hepatocellular carcinoma Acute mesenteric ischemia Gastrointestinal diseases
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Ischemic colitis and large bowel infarction:A case report 被引量:1
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作者 Eugen Florin Georgescu Doina Carstea +2 位作者 Daniela Dumitrescu Ramona Teodorescu Andrei Carstea 《World Journal of Gastroenterology》 SCIE CAS CSCD 2012年第39期5640-5644,共5页
Ischemic bowel disease results from an acute or chronic drop in the blood supply to the bowel and may have various clinical presentations, such as intestinal angina, ischemic colitis or intestinal infarction. Elderly ... Ischemic bowel disease results from an acute or chronic drop in the blood supply to the bowel and may have various clinical presentations, such as intestinal angina, ischemic colitis or intestinal infarction. Elderly patients with systemic atherosclerosis who are symptomatic for the disease in two or more vascular beds have multiple comorbidities and are particularly at risk. The clinical evolution and outcome of this disease are difficult to predict because of its pleomorphic aspects and the general lack of statistical data. In this paper, we present the case of a patient who was monitored in our unit for six years. For this patient, we encountered iterative changes in the clinical pattern, beginning with chronic "intestinal angina" and finishing with signs of acute mesenteric ischemia after an episode of ischemic colitis. This evolution is particularly rare in clinical practice, and the case is instructive because it raises discussions about the natural history of the condition and the thera-peutic decisions that should be made at every stage of the disease. An important lesson is that ischemic bowel disease should always be considered in patients who have multiple risk factors for atherosclerosis and have experienced recurrent "indistinct" abdominal symptoms.In these cases, aggressive investigation and therapeutic decisions must be taken whenever possible. Despite an absence of standardized protocols, angiographic evaluation and revascularization procedures have beneficial outcomes. Current advances in endovascular therapy, such as percutaneous transluminal angioplasty with stenting, should be increasingly used in patients with chronic mesenteric ischemia. Such therapy can avoid the risks that are associated with open repair. However, technical difficulties, especially in severe stenotic lesions, frequently occur. 展开更多
关键词 Ischemic colitis Intestinal infarction Mes-enteric thrombosis Acute mesenteric ischemia Intes-tinal angina mesenteric atherosclerosis
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Severe Klebsiella pneumoniae pneumonia complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism:A case report 被引量:1
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作者 Xiao-Li Bao Nan Tang Yang-Zhong Wang 《World Journal of Clinical Cases》 SCIE 2022年第30期11101-11110,共10页
BACKGROUND Klebsiella pneumoniae(K.pneumoniae)is a clinically common Gram-negative bacillus that can cause community-and hospital-acquired infections and lead to pneumonia,liver abscesses,bloodstream infections,and ot... BACKGROUND Klebsiella pneumoniae(K.pneumoniae)is a clinically common Gram-negative bacillus that can cause community-and hospital-acquired infections and lead to pneumonia,liver abscesses,bloodstream infections,and other infectious diseases;however,severe pneumonia caused by hypervirulent K.pneumoniae(hv Kp)complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism is rarely seen in the clinical setting and has not been reported in the literature.CASE SUMMARY A 51-year-old man was hospitalized with fever and dyspnea.Persistent mild pain in the middle and upper abdomen began at dawn on the 3rd day following admission and developed into persistent severe pain in the left upper abdomen 8h later.Based on chest computed tomography(CT),bronchoscopy,bronchoalveolar lavage fluid metagenomic next-generation sequencing,abdominal aortic CT angiography(CTA),and culture of the superior mesenteric artery embolus,adult community-acquired severe hv Kp pneumonia complicated by acute intraabdominal multiple arterial thrombosis and bacterial embolism was diagnosed.Notably,he recovered and was discharged from the hospital after receiving effective meropenem anti-infection,endovascular contact thrombolytic,and systemic anticoagulant therapies and undergoing percutaneous thrombus aspiration.Ten days later,the patient returned to the hospital for abdominal CTA examination,which indicated blocked initial common pathway of the celiac trunk and superior mesenteric artery,and local stenosis.Therefore,celiac trunk artery stenting was performed in Chongqing Hospital,and postoperative recovery was good.CONCLUSION We report a case of hv Kp severe pneumonia complicated by acute intra-abdominal multiple arterial thrombosis and bacterial embolism and suggest that clinicians should consider the possibility of a Gram-negative bacillus infection and conduct effective pathogen detection in a timely fashion when managing patients with severe community-acquired pneumonia before obtaining bacteriologic and drug sensitivity results.At the same time,when patients have severe pulmonary infection complicated by severe abdominal pain,an acute mesenteric artery embolism should be considered to avoid delays in treatment. 展开更多
关键词 Klebsiella pneumoniae Severe pneumonia Acute mesenteric ischemia Superior mesenteric artery embolism Case report
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