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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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Challenges in diagnosing mesenteric ischemia 被引量:34
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作者 Teun C van den Heijkant Bart AC Aerts +2 位作者 Joep A Teijink Wim A Buurman Misha DP Luyer 《World Journal of Gastroenterology》 SCIE CAS 2013年第9期1338-1341,共4页
Early identification of acute mesenteric ischemia (AMI) is challenging. The wide variability in clinical presentation challenges providers to make an early accurate diagnosis. Despite major diagnostic and treatment ad... Early identification of acute mesenteric ischemia (AMI) is challenging. The wide variability in clinical presentation challenges providers to make an early accurate diagnosis. Despite major diagnostic and treatment advances over the past decades, mortality remains high. Arterial embolus and superior mesenteric artery thrombosis are common causes of AMI. Non-occlusive causes are less common, but vasculitis may be important, especially in younger people. Because of the unclear clinical presentation and non-specific laboratory findings, low clinical suspicion may lead to loss of valuable time. During this diagnostic delay, progression of ischemia to transmural bowel infarction with peritonitis and septicemia may further worsen patient outcomes. Several diagnostic modalities are used to assess possible AMI. Multi-detector row computed tomographic angiography is the current gold standard. Although computed tomographic angiography leads to an accurate diagnosis in many cases, early detection is a persistent problem. Because early diagnosis is vital to commence treatment, new diagnostic strategies are needed. A non-invasive simple biochemical test would be ideal to increase clinical suspicion of AMI and would improve patient selection for radiographic evaluation. Thus, AMI could be diagnosed earlier with follow-up computed tomographic angiography or high spatial magnetic resonance imaging. Experimental in vitro and in vivo studies show promise for alpha glutathione S transferase and intestinal fatty acid binding protein as markers for AMI. Future research must confirm the clinical utility of these biochemical markers in the diagnosis of mesenteric ischemia. 展开更多
关键词 Acute mesenteric ischemia Diagnosis Biological markers INTESTINAL FATTY acid binding protein Alpha-glutathione S TRANSFERASE
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Computed tomography findings of pneumatosis and portomesenteric venous gas in acute bowel ischemia 被引量:15
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作者 Marco Milone Matteo Nicola Dario Di Minno +4 位作者 Mario Musella Paola Maietta Vittorio Iaccarino Giovanni Barone Francesco Milone 《World Journal of Gastroenterology》 SCIE CAS 2013年第39期6579-6584,共6页
AIM:To use more representative sample size to evaluate whether computed tomography(CT)scan evidence of the concomitant presence of pneumatosis and portomesenteric venous gas is a predictor of transmural bowel necrosis... AIM:To use more representative sample size to evaluate whether computed tomography(CT)scan evidence of the concomitant presence of pneumatosis and portomesenteric venous gas is a predictor of transmural bowel necrosis.METHODS:Data from 208 patients who were referred for a diagnosis of bowel ischemia were retrospectively reviewed.Only patients who underwent a surgical intervention following a diagnosis of bowel ischemia who also had a post-operative histological confirmation of such a diagnosis were included.Patients were split into two groups according to the presence of histological evidence of transmural bowel ischemia(case group)or partial bowel ischemia(control group).CT images were reviewed for findings of ischemia,including mural thickening,pneumatosis,bowel distension,portomesenteric venous gas and arterial or venous thrombi.RESULTS:A total of 248 subjects who underwent surgery for bowel ischemia were identified.Among the208 subjects enrolled in our study,transmural bowel necrosis was identified in 121 subjects(case group),and partial bowel necrosis was identified in 87 subjects(control group).Based on CT findings,including mural thickening,bowel distension,pneumatosis,pneumatosis plus portomesenteric venous gas and presence of thrombi or emboli,there were no significant differences between the case and control groups.The concomitant presence of pneumatosis and porto-mesenteric venous gas showed an odds ratio of 1.95(95%CI:0.491-7.775,P=0.342)for the presence of transmural necrosis.The presence of pneumatosis plus porto-mesenteric venous gas exhibited good specificity(83%)but low sensitivity(17%)in the identification of transmural bowel infarction.Accordingly,the positive and negative predictive values were 60% and 17%,respectively.CONCLUSION:Although pneumatosis plus porto-mesenteric venous gas is associated with bowel ischemia,we have demonstrated that their co-occurrence cannot be used as diagnostic signs of transmural necrosis. 展开更多
关键词 BOWEL ischemia PNEUMATOSIS mesenteric VENOUS GAS COMPUTED tomography
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Mesenteric ischemia:Pathogenesis and challengingdiagnostic and therapeutic modalities 被引量:24
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作者 Aikaterini Mastoraki Sotiria Mastoraki +5 位作者 Evgenia Tziava Stavroula Touloumi Nikolaos Krinos Nikolaos Danias Andreas Lazaris Nikolaos Arkadopoulos 《World Journal of Gastrointestinal Pathophysiology》 CAS 2016年第1期125-130,共6页
Mesenteric ischemia(MI) is an uncommon medical condition with high mortality rates. ΜΙ includes inadequate blood supply, inflammatory injury and eventually necrosis of the bowel wall. The disease can be divided into... Mesenteric ischemia(MI) is an uncommon medical condition with high mortality rates. ΜΙ includes inadequate blood supply, inflammatory injury and eventually necrosis of the bowel wall. The disease can be divided into acute and chronic MI(CMI), with the first being subdivided into four categories. Therefore, acute MI(AMI) can occur as a result of arterial embolism, arterial thrombosis, mesenteric venous thrombosis and nonocclusive causes. Bowel damage is in proportion to the mesenteric blood flow decrease and may vary from minimum lesions, due to reversible ischemia, to transmural injury, with subsequent necrosis and perforation. CMI is associated to diffuse atherosclerotic disease in more than 95% of cases, with all major mesenteric arteries presenting stenosis or occlusion. Because of a lack of specific signs or due to its sometime quiet presentation, this condition is frequently diagnosed only at an advanced stage. Computed tomography(CT) imaging and CT angiography contribute to differential diagnosis and management of AMI. Angiography is also the criterion standard for CMI, with mesenteric duplex ultrasonography and magnetic resonance angiography also being of great importance. Therapeutic approach of MI includes both medical and surgical treatment. Surgical procedures include restoration of the blood flow with arteriotomy, endarterectomy or anterograde bypass, while resection of necrotic bowel is always implemented. The aim of this review was to evaluate the results of surgical treatment for MI and to present the recent literature in order to provide an update on the current concepts of surgical management of the disease. Mesh words selected include MI, diagnostic approach and therapeutic management. 展开更多
关键词 Acute mesenteric ischemia mesentericischemia CHRONIC DIAGNOSTIC approach Therapeuticmanagement SURGICAL strategy
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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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Acute arterial mesenteric ischemia and reperfusion:Macroscopic and MRI findings, preliminary report 被引量:5
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作者 Luca Saba Daniela Berritto +6 位作者 Francesca Iacobellis Mariano Scaglione Sigismondo Castaldo Santolo Cozzolino Maria Antonietta Mazzei Veronica Di Mizio Roberto Grassi 《World Journal of Gastroenterology》 SCIE CAS 2013年第40期6825-6833,共9页
AIM:To explore the physiopathology and magnetic resonance imaging(MRI)findings in an animal model of acute arterial mesenteric ischemia(AAMI)with and without reperfusion.METHODS:In this study,8 adult Sprague-Dawley ra... AIM:To explore the physiopathology and magnetic resonance imaging(MRI)findings in an animal model of acute arterial mesenteric ischemia(AAMI)with and without reperfusion.METHODS:In this study,8 adult Sprague-Dawley rats underwent superior mesenteric artery(SMA)ligation and were then randomly divided in two groups of 4.In groupⅠ,the ischemia was maintained for 8 h.In groupⅡ,1-h after SMA occlusion,the ligation was removed by cutting the thread fixed on the back of the animal,and reperfusion was monitored for 8 h.MRI was performed using a 7-T system.RESULTS:We found that,in the case of AAMI without reperfusion,spastic reflex ileus,hypotonic reflex ileus,free abdominal fluid and bowel wall thinning are present from the second hour,and bowel wall hyperintensity in T2-W sequences are present from the fourth hour.The reperfusion model shows the presence of early bowel wall hyperintensity in T2-W sequences after 1 h and bowel wall thickening from the second hour.CONCLUSION:Our study has shown that MRI can assess pathological changes that occur in the small bowel and distinguish between the presence and absence of reperfusion after induced acute arterial ischemia. 展开更多
关键词 ACUTE ARTERIAL mesenteric ischemia REPERFUSION Magnetic resonance imaging Animal model Superior mesenteric artery BOWEL ischemia
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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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Chronic mesenteric ischemia: Time to remember open revascularization 被引量:6
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作者 Michael Keese Thomas Schmitz-Rixen Thomas Schmandra 《World Journal of Gastroenterology》 SCIE CAS 2013年第9期1333-1337,共5页
Chronic mesenteric ischemia is caused by stenosis or occlusion of one or more visceral arteries. It represents a therapeutic challenge and diagnosis and treatment require close interdisciplinary cooperation between ga... Chronic mesenteric ischemia is caused by stenosis or occlusion of one or more visceral arteries. It represents a therapeutic challenge and diagnosis and treatment require close interdisciplinary cooperation between gastroenterologist, vascular surgeon and radiologist. Although endovascular treatment modalities have been developed, the number of restenoses ultimately resulting in treatment failure is high. In patients fit for open surgery, the visceral arteries should be revascularized conventionally. These patients will then experience long term relief from the symptoms, a better quality of life and a better overall survival. 展开更多
关键词 Chronic mesenteric ischemia STENT Vascular surgery RESTENOSIS Prognosis
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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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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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Polyarteritis nodosa clinically mimicking nonocclusive mesenteric ischemia 被引量:1
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作者 Tsuyoshi Shirai Hiroshi Fujii +7 位作者 Shinichiro Saito Tomonori Ishii Hideyuki Yamaya Shigehito Miyagi Satoshi Sekiguchi Naoki Kawagishi Masato Nose Hideo Harigae 《World Journal of Gastroenterology》 SCIE CAS 2013年第23期3693-3698,共6页
Here, we present the case of a 74-year-old Japanese man with segmental intestinal necrosis, which developed after treatment with pulsed methylprednisolone for mononeuritis multiplex. The patient was weakly positive fo... Here, we present the case of a 74-year-old Japanese man with segmental intestinal necrosis, which developed after treatment with pulsed methylprednisolone for mononeuritis multiplex. The patient was weakly positive for myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibody (ANCA). Computed tomography and surgical findings were compatible with nonocclusive mesenteric ischemia (NOMI). He underwent small intestinal resection by emergency surgery and an intestinal fistula was made. Pathologically, necrotizing vasculitis with fibrinoid necrosis was present in medium to small-sized arteries, which was equivalent to Arkin's classification Ⅱ-Ⅳ. Most of the arteries had fibrous intimal thickening, which was considered to obstruct the arteries and thus cause segmental intestinal necrosis. A diagnosis of polyarteritis nodosa (PAN) was made, and intravenous cyclophosphamide pulse therapy was added to the therapeutic regimen. This patient was successfully treated with these multidisciplinary therapies and his stoma was finally closed. This is a very rare and indicative case of PAN weakly positive for MPO-ANCA and clinically mimicking NOMI, which occurred even after treatment with pulsed methylprednisolone. 展开更多
关键词 Anti-neutrophil CYTOPLASMIC antibody Intestinal NECROSIS MYELOPEROXIDASE Nonocclusive mesenteric ischemia Polyarteritis nodosa
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Mesenteric Ischemia:An unusual presentation of fistula between superior mesenteric artery and common hepatic artery 被引量:1
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作者 Ertugrul Kayacetin Serdar Karakse +1 位作者 Aydin Karabacakoglu Dilek Emlik 《World Journal of Gastroenterology》 SCIE CAS CSCD 2004年第17期2605-2606,共2页
Chronic mesenteric ischemia is an uncommon condition associated with a high morbidity and mortality.We reported a 36-year old women with postprandial abdominal pain due to chronic mesenteric ischemia caused by a fistu... Chronic mesenteric ischemia is an uncommon condition associated with a high morbidity and mortality.We reported a 36-year old women with postprandial abdominal pain due to chronic mesenteric ischemia caused by a fistula between superior mesenteric and common hepatic artery. 展开更多
关键词 ADULT ANGIOGRAPHY Arterio-Arterial Fistula FEMALE Hepatic Artery Humans ischemia mesenteric Artery Superior
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Acute Mesenteric Ischemia: A Challenging Diagnostic Disease—Four Cases Reports and Literature Review (AMI)
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作者 Danilo Coco Silvana Leanza 《Advances in Molecular Imaging》 2018年第4期59-68,共10页
Acute Mesenteric Ischemia (A.M.I.) is a potentially life-threatening condition syndrome due to inadequate or completely absent blood supply through superior or inferior mesenteric artery. The etiologies are various. E... Acute Mesenteric Ischemia (A.M.I.) is a potentially life-threatening condition syndrome due to inadequate or completely absent blood supply through superior or inferior mesenteric artery. The etiologies are various. Early diagnosis is essential to improve the clinical outcome. Despite advances in knowledge of pathophysiology, laboratory diagnosis and imaging techniques, acute intestinal ischemia is still associated with mortality rates. 展开更多
关键词 Acute mesenteric ischemia ANATOMY ETIOLOGY Treatment
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A Case Study of Mesenteric Ischemia by Low Flow CT Imaging
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作者 Zacharia Traore Pierlesky Elion Ossibi +7 位作者 Asmae Zeroual Seydou Ly Imane Kamaoui Youssef Lamrani Meryem Boubbou Moustapha Maaroufi Khalid Mazaz Siham Tizniti 《Open Journal of Radiology》 2015年第1期34-38,共5页
Acute mesenteric ischemia is a serious disease whose prognosis depends on early diagnosis and therapeutic management. Recent imaging technics play a fundamental role in its diagnosis. There are many forms of mesenteri... Acute mesenteric ischemia is a serious disease whose prognosis depends on early diagnosis and therapeutic management. Recent imaging technics play a fundamental role in its diagnosis. There are many forms of mesenteric ischemia including the non-occlusive form which is rare among others. We report the case of a non-occlusive mesenteric ischemia by low flow in a patient with terminal renal disease placed on hemodialysis. 展开更多
关键词 mesenteric ischemia LOW FLOW
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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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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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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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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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Surgical management of peritonitis secondary to acute superior mesenteric artery occlusion 被引量:16
20
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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