Acute Nonocclusive Mesenteric Ischemia Research Articles

Acute non-occlusive mesenteric ischemia in patients with various types of comorbidities and postoperative complications: clinical case and observation.

Aim. To enhance the outcomes of treating patients with acute non-occlusive mesenteric ischemia (focal) following colostomy, aiming to gain a better understanding of the prevalent risk factors for complications and exploring ways of their reduction.Materials and methods. A clinical case detailing the treatment of a patient with acute non-occlusive mesenteric ischemia amidst abdominal sepsis and stoma necrosis, compounded by inflammatory disease of the spinal cord membranes, is presented. Additionally, the clinical observation of a patient experiencing postoperative complications, including coronavirus infection and bilateral hydrothorax, is provided.Results. In a patient presenting severe coronary pathology alongside a nuanced clinical manifestation of mesenteric ischemia in the delayed phase, a surgical intervention involving intestinal tract resection and subsequent stoma removal was conducted. Regrettably, stoma necrosis ensued, necessitating reconstructive surgery. The patient’s initial critical state, compounded by the requirement for repeated surgical intervention, precipitated a swift progression of multiple organ failure, culminating in mortality. Conversely, another patient, postoperatively diagnosed with coronavirus infection and bilateral hydrothorax, exhibited amelioration in clinical status following administered treatment, ultimately warranting hospital discharge.Conclusions. Early diagnosis and timely surgical intervention contribute to improving the prognosis of treatment. Early postoperative complications and repeated surgical interventions significantly worsen the prognosis.

Неоклюзивні порушення брижового кровотоку (огляд літератури)

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.

Problems of the Diagnosis and Treatment of Acute Mesenteric Ischemia: a SingleCenter Experience

Objective: To improve the diagnosis and treatment of acute mesenteric ischemia by using available methods of early diagnosis and modern methods of treatment. Summary Background Data: The number of patients with disorders of the mesenteric circulation is increasing all over the world. In comparison with the occlusion of the coronary, cerebral arteries and peripheral veins, acute obstruction of the mesenteric arteries and veins is diagnosed much later, which causes a high mortality rate from 53 to 100%. Methods: In this study the experience of treatment of 162 patients with acute mesenteric ischemia was analyzed. All patients underwent treatment in Institute of Urgent and Recovery Surgery (IURS NAMS, Donetsk, Ukraine) from 2002 to 2017. Results: From 162 patients: 112 patients were with acute occlusive and 50 patients with acute nonocclusive mesenteric ischemia. The intravital diagnosis was not confirmed in 26 patients (16 %). 119 of patients died, the level of mortality was 73, 5%. 104 patients were operated, 32 patients were discharged (30,8 %), 72 patients died, a mortality rate was 69,2 %. Operations with restore of blood flow were performed in 14 patients, 5 patients died, 9 patients left the hospital. Conservative therapy was performed in 22 patients, in 11 patients with good results (50 %). Conclusions: The early diagnosis of this pathology is crucial and it can reduce the high mortality rate of patients with AMI. Treatment of OAMI should be carried out in a community of general, vascular and endovascular surgeons. Restoration of blood flow through mesenteric vessels with the help of endovascular technology and implementation of thrombembolectomy during open surgical intervention in a number of cases allows to avoid intestinal resection.

CHOLESTEROL CRYSTAL EMBOLISM AS THE REASON OF ACUTE NON-OCCLUSIVE MESENTERIC ISCHEMIA AFTER INFRARENAL AORTIC ANEURISM REPAIR

OBJECTIVE. According to the analytical data, the acute non-occlusive mesenteric ischemia after infrarenal aortic aneurism repair occurs in 0.2–1 % of cases. This complication is difficult to diagnose and associated with unfavorable prognosis and high mortality. MATERIAL AND METHODS. The retrospective analysis included 112 case histories of patients with infrarenal aortic aneurism repair in the period from 2007 to 2017. RESULTS. During the early postoperative period, 2 patients (1.8 %) had an acute non-occlusive mesenteric ischemia with lethal outcome. In these cases, the complication developed with safety patency of main mesenteric arteries and was followed by developing early multiorgan failure and thrombocytopenia. The autopsy showed generalized atherosclerosis, infarctions of kidneys, spleen and liver, caused by cholesterol crystal embolism of microvascular bed, which was found after histological research. CONCLUSION. The clinical presentation of acute non-occlusive mesenteric ischemia after infrarenal aortic aneurism repair is low-specific. One of the etiological factors of this complication is cholesterol crystal embolism in microvascular bed of visceral arteries

Acute non-occlusive mesenteric ischemia of the small bowel in a patient started on hemodialysis: a case report

BackgroundNon-occlusive mesenteric ischemia is not uncommon in chronic hemodialysis patients and is the major cause of an acute abdomen in this population. Intensive ultrafiltration and intradialytic hypotension are usually the precipitation factors. A definite diagnosis is usually late and associated with high mortality. We present a rare case of a patient who developed abdominal symptoms during his first week on HD without having obvious hypotensive episodes.Case presentationA 76-year-old man was admitted with pulmonary edema and renal failure developed abdominal symptoms during his first week on hemodialysis without having obvious hypotensive episodes. Abdominal diagnostic procedures were all unrevealing. Mesenteric ischemia was diagnosed during laparoscopy done on the basis of physical findings and clinical suspicion. Ischemic small bowel of the distal ileum was resected and histopathology examination of the small bowel demonstrated transmural ischemic necrosis with hemorrhages and non-occluded mesenteric artery. Patient maid a steady recovery, and was discharged on the 11th post-operative day.ConclusionMesenteric ischemia should be systematically suspected in dialysis patients experiencing even mild and nonspecific abdominal symptoms with or without hemodialysis-induced hypotensive episodes. Identification of patients at risk and prevention of intradialytic hypotension may help to reduce the incidence of this potentially fatal complication in hemodialysis patients.

Uterine lipoleiomyoma in an elderly patient: a case report

Uterine lipoleiomyoma is a rare, fat-containing, benign tumor. The clinical features and optimal treatment of this tumor remain unclear. An 80-year-old woman with an extensive cardiac history was referred for assessment of a huge pelvic mass. Magnetic resonance imaging demonstrated a uterine tumor with inhomogeneously high signal intensity. A fat suppression technique showed heterogeneous suppression of the signal intensity, with areas of increased enhancement after Gd-DTPA administration. Hysteroscopy revealed no abnormal findings in the endometrium. She underwent a simple total abdominal hysterectomy, with a preoperative diagnosis of uterine liposarcoma. Histological examination revealed a uterine lipoleiomyoma. Ten days after surgery, she died due to acute non-occlusive mesenteric ischemia. In cases where the radiological appearance of a uterine tumor in an elderly patient is suspicious for liposarcoma, the possibility of a benign lipoleiomyoma should be considered. Careful consideration of the patient's preoperative condition and familiarity with uterine fat-containing tumors are essential for determining an optimal therapeutic approach.

Diagnosis and treatment of nonocclusive mesenteric ischemia after open heart surgery

Background. Acute nonocclusive mesenteric ischemia (NOMI) is a rare but often fatal event after cardiac surgery. Methods. Twenty patients with ongoing ileus after cardiac surgery despite maximal laxative treatment underwent selective mesenteric angiography. In cases of pathological radiographic findings, papaverine was continuously administered via an intraarterial perfusion catheter. Results. Severe NOMI was confirmed in seven patients (mean lactate: 6.9 ± 8.3 mg/dL), mild to moderate findings in another seven (mean lactate: 1.4 ± 1.1 mg/dL). One patient had thromboembolic occlusion of the superior mesenteric artery; five patients demonstrated normal imaging findings. In nine of fourteen patients (64%) treated with papaverine, symptoms improved within hours (defecation occurred after 4–29 hours, mean 13 ± 8.1 hours). No side effects or complications occurred in connection with the papaverine treatment. The clinical condition of five patients deteriorated. Four patients underwent laparotomy with creation of an ileostomy or colostomy, two of whom presented with severe intestinal ischemia and later died. One patient died prior to laparotomy. Conclusions. Selective mesenteric angiography with continuous papaverine administration is a simple, fast, and effective diagnostic and therapeutic tool to reduce the need for laparotomy for symptoms of ileus after open-heart surgery.

Comparison of an intravenous selective mesenteric vasodilator with intraarterial papaverine in experimental nonocclusive mesenteric ischemia

Acute nonocclusive mesenteric ischemia was produced in dogs anesthetized with pentobarbital by reversible pericardial tamponade, which reduced cardiac output and mesenteric blood flow by ~42% and 53%, respectively. Papaverine, infused into the cephalic (superior) mesenteric artery at an average dose of 100 μg/kg · min, was completely effective in restoring mesenteric blood flow and correcting altered intestinal oxygen kinetics. However, the same dose of papaverine given intravenously to other dogs was ineffective in correcting the deranged hemodynamics and oxygen kinetics. Larger doses of intravenous papaverine returned mesenteric blood flow toward control values but caused systemic arterial hypotension. In comparison, synthetic urotensin I, a highly selective mesenteric vasodilator peptide, produced results identical to those produced by intraarterial papaverine, even though it was given intravenously in small doses (average dose: 13 ng/kg · min). Moreover, it produced no systemic effects. These results suggest that intravenous urotensin I is as effective as intraarterial papaverine in a model of severe mesenteric ischemia, and that it should be examined for a possible clinical role in the treatment of acute mesenteric ischemia in humans.

Hemoconcentration in Acute Nonocclusive Mesenteric Ischemia

To the Editor.— In a recent report on acute nonocclusive mesenteric ischemia (NOMI) Vyden described the pathogenesis of this syndrome in two patients (226:776, 1973). Reduction in cardiac output was singled out as the cause of low flow in the mesenteric circulation. It is not apparent, however, why of the many patients in whom cardiac output is reduced only a small number develop mesenteric ischemia. Several other factors are thought to contribute to the etiology of this syndrome. Digitalis preparations have been shown to cause mesenteric vasoconstriction. Stenotic lesions without complete occlusion, or occlusive lesions of small vessels, have also been implicated. A possible inciting factor often overlooked is hemoconcentration. The report by Vyden does not even include this point. Though the hematocrit level may be high, secondary to infarction of the bowel, Fogarty and Fletcher (Am J Surg111:130, 1960) found an elevated hematocrit level was four times more