Cause Of Acute Mesenteric Ischemia Research Articles

CT angiography in the diagnosis of acute mesenteric thrombosis: a case report

Acute mesenteric ischemia (AMI) is a rare vascular disease characterized by a high mortality rate with untimely diagnosis and treatment. The overall incidence is low, estimated at 0.09–0.2 % of all hospital admissions to emergency departments. One of the causes of acute mesenteric ischemia is acute arterial thrombosis, which is most common in the elderly.The problem of early diagnosis of acute mesenteric thrombosis is still relevant due to a non-specific clinical features. Computed tomography angiography (CT angiography) of the abdominal aorta and its branches is characterized by high sensitivity (85–98 %) and specificity (91–100 %). Computed tomography angiography is the gold standard for the diagnosis of acute mesenteric ischemia.The article discusses the use of computed tomography angiography (CT angiography) for visualization of acute mesenteric thrombosis.

MIRACULUS OUTCOME OF NON-OCCLUSIVE MESENTRIC ISCHAEMIA (NOMI) IN CARDIOGENIC SHOCK- A CASE REPORT

Introduction: Non-occlusive mesenteric ischemia (NOMI) is an acute mesenteric circulatory disorder which includes all types of mesenteric ischemia without any blockage of blood vessels. It is usually seen in elderly age group with risk factors of previous myocardial infarction, congestive cardiac failure and post-cardiac surgery, renal disease, vasopressor use, aortic insufciency. NOMI is an infrequent cause of acute mesenteric ischemia with atypical symptoms & constitutes 20-30% cases of acute mesenteric ischemia (AMI). The mortality rate is generally high, at least 50%, being the deadliest type of acute mesenteric ischemia (AMI). A high index of suspicion is required. Treatment is based on correction of the underlying cause, supportive therapy, vasodilation and surgery. Presenting a challenging case of an elderly patient with Diabetes Mellitus for 15 years in cardiogenic shock with NOMI. Colonoscopy was diagnostic of ischemic colitis. Patient was managed conservatively with successful outcome NOMI is a rare disease with a difcult d Conclusion: iagnosis because of the unspecic symptomatology. Early recognition with high suspicion of index is necessary. Case highlights the challenges in the diagnosis and the multiple difculties during management. Treatment with supportive therapy, vasodilator drugs and surgery if needed can signicantly improve prognosis & lower mortality

Treatment of Acute Mesenteric Ischemia: Individual Challenges for Interventional Radiologists and Abdominal Surgeons.

Acute mesenteric ischemia (AMI) is a life-threatening condition resulting from occlusion of the mesenteric arterial vessels. AMI requires immediate treatment with revascularization of the occluded vessels. to evaluate the technical success, clinical outcomes and survival of patients receiving endovascular treatment for AMI followed by surgery. A search of our institution's database for AMI revealed 149 potential patients between 08/2016 and 08/2021, of which 91 were excluded due to incomplete clinical data, insufficient imaging or missing follow-up laparoscopy. The final cohort included 58 consecutive patients [(median age 73.5 years [range: 43-96 years], 55% female), median BMI 26.2 kg/m2 (range:16.0-39.2 kg/m2)]. Periinterventional imaging regarding the cause of AMI (acute-embolic or acute-on-chronic) was evaluated by two radiologists in consensus. The extent of AMI and the degree of technical success was graded according to a modified TICI (Thrombolysis in Cerebral Infarction scale) score (TICI-AMI) classification (0: no perfusion; 1: minimal; 2a < 50% filling; 2b > 50%; 2c: near complete or slow; 3: complete). Lab data and clinical data were collected, including the results of follow-up laparoscopy. Non-parametric statistics were used. All interventions were considered technically successful. The most common causes of AMI were emboli (51.7%) and acute-on-chronic thrombotic occlusions (37.9%). Initial imaging showed a TICI-AMI score of 0, 1 or 2a in 87.9% (n = 51) of patients. Post-therapeutic TICI-AMI scores improved significantly with 87.9% of patients grade 2b and better. Median lactate levels reduced from 2.7 (IQR 2.0-3.7) mg/dL (1-18) to 1.45 (IQR 0.99-1.90). Intestinal ischemia was documented in 79.1% of cases with resection of the infarcted intestinal loops. In total, 22/58 (37.9%) patients died during the first 30 days after intervention and surgery. According to CIRSE criteria, we did not observe any SAE scores of grade 2 or higher. AMI is a serious disease with high lethality within the first 30 days despite optimal treatment. However, interventional revascularization before surgery with resection of the infarcted bowel can save two out of three of critically ill patients.

Radiological predictive factors of transmural intestinal necrosis in acute mesenteric ischemia: systematic review and meta-analysis.

Transmural intestinal necrosis (TIN) is related to high mortality in patients with acute mesenteric ischemia (AMI). Radiological predictive factors of TIN in AMI remains controversial. This study aimed to identify the CT-based predictive factors of TIN in AMI. EMBASE and PUBMED were searched for publications predicting TIN using radiological features. Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess the methodological quality of individual studies. Data were presented in terms of diagnostic odds ratio (DOR), sensitivity, specificity, and 95% confidence interval (CI). The random-effects models were used for the meta-analysis. Eleven studies including 1037 cases with AMI were considered. The meta-analysis showed that bowel wall thinning (DOR = 13.10; 95% CI: 3.71, 46.25), decreased or absent bowel wall enhancement (DOR = 5.77; 95% CI: 2.95, 11.30), bowel dilation (DOR = 3.23; 95% CI: 2.03, 5.15), pneumatosis intestinalis (DOR = 5.78; 95% CI: 2.24, 14.95), porto-mesenteric venous gas (DOR = 5.36; 95% CI: 2.14, 13.40), and arterial occlusive AMI (DOR = 2.66; 95% CI: 1.53, 4.63) were risk factors for predicting TIN. Bowel wall thinning and porto-mesenteric venous gas displayed high specificity to diagnose TIN (98%, 95%, respectively). The subgroup analysis showed that decreased or absent bowel wall enhancement (DOR = 8.23; 95% CI: 4.67, 14.51) and bowel dilation (DOR = 3.14; 95% CI: 1.55, 6.39) were predictors of TIN in venous occlusive AMI, which were not related to TIN in arterial-origin AMI. For predicting TIN, there are specific radiological features. The radiological predictors of TIN may differ according to the various causes of AMI. Future primary studies should further evaluate the relationships between radiological signs and TIN based on different etiologies. • Bowel wall thinning, decreased or absent bowel wall enhancement, bowel dilation, pneumatosis intestinalis, porto-mesenteric venous gas, and arterial occlusive AMI were risk factors for predicting TIN. • Decreased or absent bowel wall enhancement and bowel dilation were predictors of TIN in venous occlusive AMI, which were not related to TIN in arterial-origin AMI.

Acute superior mesenteric arterial thromboembolic occlusion-catheter directed thrombolysis-be on time, still be cautious!

Acute mesenteric ischemia (AMI) is one of the major life-threatening emergencies which require immediate attention and treatment. The most common cause of AMI is superior mesenteric artery (SMA) occlusion secondary to an embolic phenomenon. We present a 55-year-old gentleman with acute SMA thromboembolism, treated by catheter directed thrombolysis (CDT) that helped in avoiding a major surgery. A 55-year-old male, with known diabetes, hypertension and atrial fibrillation, presented with acute abdominal pain and found to have SMA thromboembolism on contrast computed tomography (CT) abdomen. As there were no evidences of bowel ischemia clinically and on the CT imaging, endovascular CDT was performed following which the patient improved and discharged after 10 days of hospital stay. Timely endovascular intervention in appropriate patient population with acute mesenteric arterial thromboembolic occlusion can help avoid major surgeries, reduce the extent of non-viable bowel and decrease the resultant significant morbidity.

54-Year-Old Woman With Altered Mental Status and Abdominal Pain

54-Year-Old Woman With Altered Mental Status and Abdominal Pain

Acute Mesentric Venous Thrombosis with a History Recurrent DVT in Young Age : A Case Report

Acute mesenteric ischemia (AMI) may be defined as a sudden interruption of the blood supply to a segment of the small intestine, leading to ischemia, cellular damage, intestinal necrosis, and eventually patient death if left untreated. Mesenteric venous thrombosis (MVT) is an emergency condition that is rarely found as a cause of AMI compared to arterial thrombosis, and accounts for only 16% of all mesenteric ischemia cases. The overall incidence is low (0.09-0.2% of all acute admissions to emergency department), prompt diagnostic and intervention are essential in order to reduce the high mortality rate (50-80%).

Reliability of Multi-Detector CT in the Assessment of Mesenteric Ischemia Using Basic Images

Abstract Background: Mesenteric ischemia is caused by drop of blood flow in intestinal vasculature to a degree that compromise the viability of target part and according to the time and amount of reduction, it can be classified into acute mesenteric ischemia and chronic mesenteric ischemia. Aim of Study: To assess the value of Multidetector CT (MDCT) and CT Angiography (CTA) in the diagnosis of different causes of mesenteric ischemia using the source images and routine reformat. Material and Methods: This prospective study included 58 consecutive patients (30 males and 28 females), with age range (52-77 years) during the period from October 2017 to Dec. 2018. They were referred for CT angiography of the mesenteric vessels with clinical suspicious of (acute or chronic) mesenteric ischemia. Four patients were exclude due to contraindication to IV contrast, so finally the study was conducted for 54 patients, all underwent CT angiography and the results of CT angiography were collected and tabulated. Results: Twenty four subjects had CTA findings of me-senteric ischemia (acute=14 and chronic=10). Thickening of bowel wall was the commonest finding in Acute Mesenteric Ischemia (AMI) in 85.7%. Bowel wall non-enhancement was noted in 11 patients of 14 with AMI (78.57%). CTA pointed out the cause of AMI in 14 patients (dominant cause was arterial thromboembolism, (n=10 (71.4 %)), the most frequent site was Superior Mesenteric Artery (SMA). CTA diagnosed and found out the reason of pain in Chronic Mesenteric Ischemia (CMI) patients (atherosclerosis of the splanchnic arteries with significant stenosis or occlusion was the dominant reason (n=7, 70%). Among the 24 patients with mesenteric ischemia, MDCT and CTA provided the reason for mesenteric ischemia in all patients which represents accuracy, sensitivity and specificity of 100%. Conclusion: MDCT and CTA are noninvasive tools that can be the optimum choice in imaging of cases with suspicious mesenteric ischemia.

Review: Acute superior mesenteric artery embolism: A vascular emergency cannot be ignored by physicians.

Background:Acute mesenteric ischemia (AMI) is a life-threatening medical condition that occurs when a sudden decreased perfusion to the intestines which leads to bowel infarction, and acute superior mesenteric artery embolism (ASMAE) is the main cause of AMI. Unfortunately, with the improvement of diagnosis and treatment technology, the mortality remains high due to less frequent clinical suspicion resulted from the unclear clinical manifestation and non-specific laboratory findings.Methods:Relevant studies published were identified by searching the PubMed, Embase and Cochrane Library databases. This review presented the literatures to introduce the research progress of ASMAE in recent years.Results:Patients with the history of atrial fibrillation, heart valve disease and atherosclerosis should be considered as ASMAE. Laboratory findings are insensitive and unspecific, however, angiography and Computed tomography angiography (CTA) can provide a clear diagnosis sensitively and specifically. Endovascular approaches have been increasingly reported in multiple case series. The key to successful treatment of AMI involves early clinical recognition and early intervention to move the embolus, which can reduce the rate of misdiagnosis and save the precious time and lives of patients.Conclusions:Loss of time eventually leads to progression of ischemia to transmural bowel necrosis with peritonitis and septicemia, which may further worsen patients’ outcomes. It is important for physicians to make a timely and accurate diagnosis, which can save precious time and reduce the mortality.

Mesenteric ischemia: can multidetector computed tomography angiography be a one-stop diagnostic solution?

Background Mesenteric ischemia is a medical condition in which inflammation and injury of the small intestine result from inadequate blood supply. Mesenteric ischemia is caused by a reduction in intestinal blood flow and is classified as acute (sudden onset of intestinal hypoperfusion) or chronic depending on the time course of symptoms. Multi Detector Computed Tomography MDCT has high sensitivity and specificity for diagnosing acute primary mesenteric ischemia. Aim and objectives Our objective was to evaluate the role of MDCT angiography in evaluation of patients with suspected mesenteric ischemia as regards vascular and intestinal abnormalities. Patients and methods This prospective study was performed on 60 patients clinically suspected of having mesenteric ischemia, referred to the radiology department of Cairo University hospitals from the emergency hospital and the out-patient clinics and in-patient departments of general surgery and of Endemic Infectious diseases and Hepatogastroenterology. Patients suspected clinically to have mesenteric ischemia were initially examined by Doppler and if showed mesenteric vascular suspicious findings by Doppler, they were referred to CT angiography examination. Results In our study we found that 40 patients (66.7%) out of 60 patients showed abnormal MDCT findings which explained the cause of mesenteric ischemia in these patients. The most prevalent CT findings in 40 patients with positive CT angiographic findings in acute mesenteric ischemia (AMI) were bowel wall thickening in 12 patients (30%), bowel distension in 8 patients (20%) and lack of mural enhancement in 10 patients (25%). Computed tomography angiography (CTA) detected accurately the cause of AMI where arterial thrombo-embolism was common cause of AMI (62.5%) and the SMA was the most frequent site in patients with AMI than mesenteric venous thrombosis with AMI (37.5%). 50% of patients with AMI showed pneumatosis intestinalis and surgical exploration revealed bowel infarction and resection anastomosis was done. Conclusion MDCT is fast, safe, accurate and non-invasive imaging modality of choice in patients with suspected mesenteric ischemia which is able to evaluate not only mesenteric vascular structures but also evaluate bowel wall changes and adjacent mesentery, thus detecting the primary cause of mesenteric ischemia that can lead to earlier diagnosis and intervention, also confirmation or exclusion of various other differential diagnoses of acute abdominal conditions.

Acute Portomesenteric Venous Thrombosis: Diagnosis and Treatment

AbstractAcute portomesenteric venous thrombosis (PMVT) is an unusual cause of acute mesenteric ischemia. Because of its rarity and nonspecific presentation, radiologic imaging plays a key role in the diagnosis of acute PMVT. Medical management with anticoagulation is the mainstay of therapy, with surgery reserved for patients suspected of having peritonitis or bowel infarction. However, endovascular therapy has an evolving role and may serve as an important adjunct to anticoagulation in selected patients with acute PMVT.

Predictive Factors for Intestinal Transmural Necrosis in Patients with Acute Mesenteric Ischemia.

Acute mesenteric ischemia (AMI) is a serious and potentially fatal condition. No definite parameter can predict transmural bowel necrosis in patients with AMI to justify early surgical intervention. The current study aimed to identify the clinical, laboratory, and radiologic parameters that can successfully predict the onset of intestinal transmural necrosis in patients with AMI. Records of patients with AMI in the period of January 2013 to October 2017 were reviewed. Clinical parameters as patients' symptoms, vital signs, and signs of peritonitis along with the results of laboratory and radiologic investigations were analyzed to identify predictive factors for intestinal transmural necrosis using binary logistic regression analysis. One hundred and one patients (70 males) with mean age of 55years were included. Venous occlusion was the cause of AMI in 78 (77.3%) patients and arterial occlusion in 23 (22.7%) patients. Twenty-two patients completed conservative treatment successfully, whereas 79 patients required exploratory laparotomy. On laparotomy, six patients were found to have viable bowel. Overall, 28 patients had viable bowel and 73 had bowel necrosis. The significant independent predictors for transmural bowel necrosis were mesenteric arterial occlusion (OR: 26.5, p=0.02), leukocytosis (OR: 1.3, p<0.0001), acidosis (OR: 3.8, p=0.04), free intraperitoneal fluid (OR: 4.21, p=0.005), and combined portal vein and SMV thrombosis in CT scan (OR: 3.4, p=0.026). The independent predictors for transmural bowel necrosis were mesenteric arterial occlusion, leukocytosis, acidosis, free intraperitoneal fluid, and combined portal vein and SMV thrombosis in CT scan.

Acute mesenteric ischemia with tuberculous mesenteric lymphadenitis in a young female

We present the case of an 18 year old female with tuberculous mesenteric lymphadenopathy who came to hospital with peritonitis and acute mesenteric ischemia. An emergency exploratory laparotomy with resection of gangrenous small bowel and right colon with end-to-end anastomosis was performed. Subsequent evaluation for etiology of bowel gangrene was essentially normal. By exclusion, the most likely cause of acute mesenteric ischemia in this patient was of unknown etiology which is indeed rare. However, tuberculosis as a cause of mesenteric vasculitis and bowel gangrene needs to be explored.

PREDICTING OUTCOMES IN PATIENTS WITH ATRIAL FIBRILLATION AND ACUTE MESENTERIC ISCHEMIA

Acute mesenteric ischemia (AMsI) is an infrequent but catastrophic condition associated with high mortality and morbidity. Thromboembolism due to atrial fibrillation (AF) is one of the causes of AMsI, but the overall effect of AF and anticoagulation on outcomes in these patients is not known. The

Rare Case of Isolated Mesenteric Vein Thrombosis Triggered by Acute Pancreatitis

Introduction: Mesenteric vein thrombosis(MVT) is an uncommon cause of acute mesenteric ischemia accounting for 5 % of cases. Acute pancreatitis is associated with thrombosis of the splenic or portal vein but rarely with SMV in isolation, especially in the absence of necrosis.We describe an unusual case of isolated SMVT triggered by an episode of acute pancreatitis, found to have underlying antiphospholipid syndrome (APS). Case: 68 y/o lady w/PMH of HTN,HLP presented with diffuse intermittent abdominal pain, 7 days duration associated with multiple episodes of vomiting. She denied any fever or chills, her BMs were soft and regular without blood. On exam, vitals were stable, epigastrium was tender without rebound and BS were reduced. CBC, CMP were normal. Lipase was mildly elevated. CT abdomen showed inflammatory changes along pancreatic head & around SMV with thrombosis, concentric wall thickening along jejunum and ileum corresponding to the distribution of SMV. On review of history, her two sisters had DVT and she had h/o 2 spontaneous abortions. Anticoagulation was started with heparin and she was managed conservatively with serial abdominal exams. EGD revealed normal mucosa till mid jejunum. Hypercoagulable work up revealed elevated B2 glycoprotein IgM and positive ANA. Factor V leiden mutation and Jak 2 v617f mutation was negative. Diagnosis of antiphospholipid syndrome was made and she was discharged on oral warfarin with INR 2.0-3.0. Discussion: MVT is a rare cause of intestinal ischemia however has better prognosis than the other causes.Abdominal pain is the most common presenting symptom.Local inflammatory conditions (acute pancreatitis etc), inherited or acquired thrombophilias are predisposing factors. Diagnosis is made with demonstration of occlusion on imaging (CT or MRI).Our case is unique as isolated MVT was precipitated by acute pancreatitis; very rare in the absence of necrosis.In such cases, testing for inherited or acquired thrombophilias should be done.In our case, we found e/o elevated anti-B2 microglobulin IgMAb (persisted after 12 weeks) consistent with APS.Treatment is conservative with anticoagulation. Surgical exploration is reserved for cases with bowel infarction. Conclusion: In conclusion, our case demonstrates the need for high index of suspicion to diagnose MVT as delay in treatment is associated with poor prognosis. It also stresses the need to test for inherited or acquired thrombophilias, as it changes long term management.Figure 1

The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia.

Acute mesenteric ischemia (AMI) is an abdominal-vascular emergency which is rare and has high mortality rates (60-80 %) due to late diagnosis (1-3). Although it is known that extravascular reasons like intestinal intussusception, volvulus, strangulated hernias and obstructions can cause intestinal gangrene, these are rarely the cause of AMI (1). In this study, we used male Wistar-Albino rats weighing 250-300 grams obtained from Pamukkale University Experimental Research Laboratory. Animals were exposed to light-dark cycles for 12 hours and had free access to food and water. They were kept in cages for 7 days to stabilise their intestinal flora. In animals of group I, nothing was made other than taking 0.5 ml blood intracardially. In other animals, abdomen was reached with midline laparotomy and superior mesenteric artery (SMA) was located. In group II (operative control group), SMA was isolated and manipulated but was not ligated. In Group III (intestinal ischemia group), SMAwas isolated and ligated with 3/0 silk tie distally to the aorta. After this process, intestinal ischemia was achieved which was confirmed by paleness and pulselessness of intestines, caecum and right colon. Later on, abdomen was closed with double 3/0 polyglactin sutures. At postoperative 1st, 4th and 6th hours 0.5 ml blood was taken intracardially from the animals in groups II and III in order to quantify D-dimer and L-lactate levels. D-dimer: Blood samples which were put into tubes containing sodium citrate, were seperated from plasma with centrifugation at 4000 rpm for 7 minutes.L-lactate: Blood L-lactate levels were determined from blood taken into capillary tubes with the help of immobilised enzyme electrode technology using YSI 1500 Sport portative lactate analyzer (Yellow Springs Instruments Inc., Ohio-USA). Two cm long intestinal samples were taken from animals in which SMA was ligated in order to achieve mesenteric ischemia and these samples were fixed in 10 % formol. As a result, in rats with SMA occlusion serum D-dimer levels were not increased significantly when compared either in the group or with the basal values of the control group and values in operative control group. Therefore, it is concluded that D-dimer is not a useful marker for early diagnosis of AMI. On the other hand, it is revealed that blood L-lactate levels began to increase significantly following 4th hour of mesenteric ischemia and it is shown that this increase continued at the 6th hour. In addition, considering the utmost importance of the early diagnosis in patients with the clinical suspicion of AMI, L-lactate seems to be a suitable marker to use in emergency departments because it is achieved with a portable device that gives fast and accurate results. Nevertheless, our results are need to be supported by clinical studies with larger patient series (Tab. 2, Fig. 11, Ref. 39).

The length of necrosis and renal insufficiency predict the outcome of acute mesenteric ischemia

Acute mesenteric ischemia (AMI) is a potentially life-threatening condition because of its diagnostic difficulty, operative challenges, and comorbidities a patient may have. The aim of this study was to identify factors associated with adverse outcomes in patients with AMI. The hospital records and clinical data of all patients with AMI were reviewed for a recent 4-year period. Clinical outcomes and factors influencing mortality were analyzed. Included in the study were 104 patients (46 females and 58 males) with an overall mean age of 66 ± 13.4 years. The cause of AMI was arterial pathology in 74 (71%) patients, venous thrombosis in 15 (14%) patients, and nonocclusive ischemia in 12 (12%) patients. Abdominal pain was the most common presenting symptom (97% of patients). The 30-day mortality rate was 66%. Univariate analysis showed that mortality was associated with renal insufficiency (p = 0.004), an age greater than 70 years (p = 0.02), the presence of comorbidities (p = 0.001), a leukocyte count greater than 18,000/mL (p = 0.04), and small bowel necrosis of more than 100 cm (p < 0.0001). Logistic regression analysis showed that independent predictors of mortality were small bowel necrosis of more than 100 cm (p = 0.002) and a serum creatinine level greater than 2 mg/dL (p = 0.04). The length of the necrosis and renal insufficiency are the primary factors that result in a poor outcome in AMI patients. Prompt diagnostic evaluation and early therapeutic interventions may help to prevent the development of these fatal predictors.

Challenges in diagnosing mesenteric ischemia

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.

Time dependent response in ghrelin levels in mesenteric ischemia in rat

The objective of this study was to determine the value of time-dependent ischemia-modified ghrelin in mesenteric ischemia. The authors investigated whether or not there is changes in plasma ghrelin levels in the acute period in a rat model of mesenteric ischemia were time-related. 42 mature male rats were divided into seven groups: one control and six ischemia groups. In the ischemia groups, following laparotomy the superior mesenteric artery (SMA) was ligated using a 2/0 silk suture, and blood samples were taken at 30, 60, 90, 120, 150 and 180 min. Plasma ghrelin levels in all the ischemia groups were significantly higher compared to the control group. In addition, the highest level of ghrelin was observed at 180 min. In our current study we have shown a direct increase in ghrelin in cases of acute mesenteric ischemia (AMI). This is a result of ghrelin’s protective effect against ischema/reperfusion (I/R) damage on the intestines, as in most of the other organs. With these characteristics, ghrelin can be easily applied in AMI and appears to be a prognosis parameter that can be used in clinics and needs no technological equipment or experience. Key words: Ischemia, superior mesenteric arteria, ghrelin, rat. INTRODUCTION Acute mesenteric ischemia (AMI) is one of many abdominal emergencies. It refers to a sudden onset of intestinal hypoperfusion, which can be due to an occlusive or a nonocclusive obstruction of arterial or venous blood flow (Stamatakos et al., 2008). AMI is caused by mesenteric occlusive vascular disease and is more common in adult patients who have additional cardiovascular problems, with a mortality rate of 30 to 90%. The causes of AMI in the pediatric age group include mesenteric vascular occlusion due to invasive aortic monitoring devices, neonatal aortic thrombosis,

A study on 107 patients with acute mesenteric ischemia over 30 years

Acute mesenteric ischemia (AMI) is a life threatening cause of acute abdomen. The purpose of this study is to define risk factors that predict the adverse outcome of AMI and to present our experience in the last 30 years. Hospital records and clinical data of 107 patients undergoing surgical intervention for AMI during the last 30 year period were reviewed and clinical outcomes as well as factors influencing mortality were analyzed. Mesenteric arterial thrombosis, arterial embolism and nonocclusive mesenteric ischemia (NOMI) were the cause of AMI in 68 (63.6%), 28 (26%), and 11 patients (10.2%), respectively. Abdominal pain was the most common presenting symptom (90.6%). Peritonitis was observed in 96 patients (89.7%) and 24 patients (22.4%) were in shock. Abdominal ultrasonography was performed in 46 patients (42%), abdominal CT angiography in 36 patients (33%) and mesenteric angiography in 12 patients (10.5%). All patients were operated and 11 (10%) patients underwent a second-look operation. Bowel resection was necessary in 101 patients (93.4%) during the initial operation and in seven patients (6.5%) during the second-look operation. The hospital mortality was 55.1%. Mortality was mainly due to multiorgan failure (43%). Diabetes mellitus, use of digoxine and antiplatelet drugs, duration of the symptoms until before surgery, existence of shock, low levels of the pH and bicarbonate and re-laparotomy were found to be negative predictors of the perioperative mortality. The use of total parenteral nutrition and CT angiography was found to be a protective factor against mortality. A high index of suspicion with prompt diagnostic evaluation with CT angiography may reduce time prior to surgical intervention which may lead to improved patient survival.