Mesenteric Ischemia Research Articles

Protective Effects of Trimetazidine and Dexmedetomidine on Liver Injury in a Mesenteric Artery Ischemia-Reperfusion Rat Model via Endoplasmic Reticulum Stress.

Acute mesenteric ischemia can lead to severe liver damage due to ischemia-reperfusion (I/R) injury. This study investigated the protective effects of trimetazidine (TMZ) and dexmedetomidine (DEX) against liver damage induced by mesenteric artery I/R via endoplasmic reticulum stress (ERS) mechanisms. Twenty-four rats were divided into four groups: control, I/R, I/R+TMZ, and I/R+DEX. TMZ (20 mg/kg) was administered orally for seven days, and DEX (100 µg/kg) was given intraper-itoneally 30 min before I/R induction. Liver tissues were analyzed for creatinine, alanine ami-notransferase (ALT), aspartate aminotransferase (AST), thiobarbituric acid reactive substances (TBARS), and total thiol (TT) levels. Compared with the control group, the I/R group presented significantly increased AST, ALT, TBARS, and TT levels. TMZ notably reduced creatinine levels. I/R caused significant liver necrosis, inflammation, and congestion. TMZ and DEX treatments reduced this histopathological damage, with DEX resulting in a more significant reduction in infiltrative areas and vascular congestion. The increase in the expression of caspase-3, Bax, 8-OHdG, C/EBP homologous protein (CHOP), and glucose-regulated protein 78 (GRP78) decreased with the TMZ and DEX treatments. In addition, Bcl-2 positivity decreased both in the TMZ and DEX treatments. Both TMZ and DEX have protective effects against liver damage. These effects are likely mediated through the reduction in ERS and apoptosis, with DEX showing slightly superior protective effects compared with TMZ.

Acute mesenteric ischemia secondary to complete AV block and acute systolic heart failure: a case report

BackgroundAcute mesenteric ischemia (AMI) usually presents with abrupt and severe abdominal pain associated with nausea and vomiting. This case is notable due to the occurrence of AMI secondary to acute systolic heart failure caused by new onset complete heart block.Case PresentationA 65-year-old male presented with sudden onset epigastric pain. ECG showed complete AV block and acute ischemia, and a subsequent CTA revealed complete occlusion of the mid superior mesenteric artery. His emergent left heart catheterization showed non-occlusive coronary artery disease. The patient underwent emergent laparotomy and SMA thrombectomy. Postoperative complications included worsening congestive heart failure and persistent bradycardia, requiring a permanent pacemaker. The patient was discharged to a skilled nursing facility in stable condition.ConclusionsThis case highlights the diagnostic challenges of AMI in the setting of acute heart failure and new onset AV block mimicking acute cardiac events and emphasizes the importance of a multidisciplinary approach in managing such complex cases.

Myointimal hyperplasia of the mesenteric veins mimicking inflammatory bowel disease in a 13‐year‐old patient

AbstractIdiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare entity reported in adults, frequently mimicking inflammatory bowel disease (IBD). We report the first case of intestinal ischemia secondary to IMHMV presenting as IBD in a pediatric patient with Down syndrome. Chronic intestinal ischemia is rare in children, and this case emphasizes the need to consider this in the differential, when histopathology is suggestive. Clinical findings and colonoscopy in these patients may mimic IBD. The mucosal biopsies do not show classic features of IBD. Instead, there can be variable extent of mucosal changes such as dilated small capillaries in the lamina propria, edema, and early fibrosis. These changes may in fact represent early chronic ischemia. These findings should alert for vascular imaging and a full‐thickness biopsy to assess submucosal and subserosal larger vessels since medium‐ and large‐caliber veins in the colonic wall and mesentery are affected in IMHMV.

Acute mesenteric ischemia with abdominal skin mottling

AbstractWe report a rare case of a 90‐year‐old woman with Stage IV lung cancer awaiting transfer to hospice care who developed sudden abdominal and knee skin mottling. Elevated inflammatory markers on blood tests and emergent computed tomography led to a diagnosis of acute mesenteric ischemia, and the patient passed away 7 h later. Skin mottling indicates decreased blood flow in the gastrointestinal tract and is observed during mesenteric ischemia. Abdominal skin mottling may serve as an important physical finding that is detected early and suggests circulatory failure and intestinal ischemia.

MiniMizer Gastric Ring displacement at 31 weeks of gestation as a life-threatening complication

This case report describes a pregnant woman who underwent a laparoscopic MiniMizer Gastric Ring procedure for clinically severe obesity only one month before conception. At 31 weeks of gestation, the patient as admitted to the hospital with postprandial vomiting and persistent left-sided colicky abdominal pain. Maternal abdominal MRI revealed an intestinal obstruction and elective surgery was recommended. Due to the considerable risk to the fetus, antenatal corticosteroids were immediately administered to promote lung maturation and magnesium sulfate was started for fetal neuroprotection. During an exploratory laparoscopy, significantly enlarged and ischemic intestinal loops were found, leading to the decision to perform an atraumatic “en caul” cesarean delivery. After a successful “en caul” delivery, the MiniMizer ring, which had dislodged downwards and led to mesenteric ischemia, was visualized. Intraoperative esophagogastroduodenoscopy revealed a 1cm defect in the stomach wall related to gastric ring, covered with purulent exudate. Further exploration, showed a herniation of the distal alimentary loop through the Petersen foramen. Successful management included ring removal and intestinal loop reduction from the Petersen’s space, without evidence of strangulation, as confirmed with indocyanine green (ICG) angiography. The postoperative course was uneventful. Women with obesity who have undergone bariatric surgery should to be informed of the increased likelihood of becoming pregnant after treatment. It is advised to notify the patient of the importance of maintaining a sufficient interval between bariatric surgery and conception. Additionally reports from the literature on various complications during pregnancy after bariatric surgery are presented.

Intraoperative indocyanine green fluorescence for precise resection of nonocclusive mesenteric ischemia: a case report and diagnostic considerations based on pathology findings

BackgroundNonocclusive mesenteric ischemia (NOMI) is characterized by intestinal ischemia caused by spasms in the peripheral intestinal vessels without organic obstruction in the main mesenteric vessels. NOMI can be fatal in case of delayed diagnosis and treatment. Although the use of indocyanine green (ICG) fluorescence in assessing intestinal viability during NOMI surgery is well recognized, there is a paucity of reported cases using this technique. Herein, we present a case of NOMI that was successfully managed through accurate diagnosis and resection of the ischemic intestines guided by ICG fluorescence.Case presentationAn 81-year-old man presented with abdominal pain. Contrast-enhanced computed tomography revealed intrahepatic portal vein gas, superior mesenteric vein gas, and terminal ileal edema. Considering these findings, the patient was diagnosed with NOMI and emergency surgery was performed. Intestinal edema was observed 30 cm upstream of the terminal ileum without serosal discoloration. ICG fluorescence revealed areas of normal perfusion as well as mild and moderate hypoperfusion. The small bowel, including the hypoperfusion area, was resected. As no clinical signs of residual bowel ischemia were observed during the postoperative course, a second-look operation was deemed unnecessary. Intraoperative ICG fluorescence and histopathological findings indicated mucosal edema in the mildly hypoperfused area and mucosal necrosis in the moderately hypoperfused area.ConclusionsThis case highlights the use of intraoperative ICG fluorescence in the disease. ICG fluorescence is invaluable in assessing the extent of bowel ischemia and guiding precise resection. Thus, future efforts should focus on identifying accumulation of cases and quantification of ICG fluorescence intensity to further improve diagnostic performance.

Balloon Angioplasty and Stenting of Superior Mesenteric Artery in Chronic Intestinal Ischemia Associated with Decompensated Chronic Heart Failure (Clinical Case Report)

INTRODUCTION: Chronic intestinal ischemic syndrome (CIIS) is a pathology associated with chronic circulatory insufficiency in the visceral branches of the abdominal aorta. Duplex ultrasound can be used as the first imaging method to identify mesenteric artery stenosis. In general clinical practice, the diagnosis of CIIS is relatively rare. Expansion of application of percutaneous endovascular angioplasty and stenting of mesenteric arteries in recent years has significantly increased the effectiveness of treating patients with atherosclerotic lesion of the visceral arteries and CIIS. AIM: To demonstrate a clinical case of use of X-ray endovascular technologies in CIIS in a patient of cardiology profile. A clinical case of a patient with CIIS and severe decompensated polymorbidity is presented. Due to severity of the condition and impossibility of full examination for this reason, the patient was not included in the waiting list for heart transplantation despite the existence of indications for it. He was admitted to hospital for urgent indications. Ultrasound data revealed stenosis of the superior mesenteric artery. Balloon angioplasty and stenting of the superior mesenteric artery were successful. After discharge, the patient’s condition was satisfactory. CONCLUSION: The case demonstrates that effective treatment of even one of many comorbid diseases in a severe polymorbidity patient can improve his general condition, reduce load on the cardiovascular system and reverse edematous-ascitic syndrome.

Long-term antithrombotic therapy practices in patients with short bowel syndrome following acute mesenteric ischemia: A survey

Long-term antithrombotic therapy practices in patients with short bowel syndrome following acute mesenteric ischemia: A survey

Chronic Ischemic Gastritis in a Patient With a History of Cancer and Atherosclerotic Disease

ABSTRACT Chronic mesenteric ischemia is an uncommon disease presenting with nonspecific symptoms. The large number of differential diagnoses may result in diagnostic delays and progression to acute mesenteric ischemia. A 74-year-old woman with a history of breast cancer and carotid atherosclerosis complained of postprandial abdominal pain, vomiting, and weight loss. Endoscopic examination showed active chronic gastritis Helicobacter pylori negative. Contrast-enhanced computed tomography revealed stenosis in the mesenteric arterial district. Chronic gastritis resistant to treatment in a patient complaining of postprandial abdominal pain and weight loss should be investigated for chronic mesenteric ischemia, although history of cancer could be a misleading factor.

Spontaneous Inferior Mesenteric Artery Occlusion after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm and its Impact on Clinical Outcomes

The incidence and related factors of spontaneous occlusion of a patent inferior mesenteric artery (IMA) after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) without pre-emptive embolisation remain unclear. This study aimed to elucidate the incidence, clinical implications and predictors of spontaneous IMA occlusion after EVAR. This was a single centre, retrospective cohort study. Patients who underwent elective EVAR between 2007 and 2022 were categorised into three groups (group 1, spontaneous IMA occlusion; group 2, patent IMA with no type II endoleak (T2EL) from IMA; group 3, T2EL from IMA). Endpoints were the incidence of spontaneous IMA occlusion, sac enlargement, freedom from re-intervention, and overall survival after EVAR. Of 372 cases of elective EVAR for AAA, 230 who had patent IMA pre-operatively were analysed, after excluding 127 with pre-occluded IMA and 15 who underwent pre-emptive IMA embolisation. Spontaneous IMA occlusion occurred in 101 patients (43.9%). Sac enlargement rate was lower in group 1 than in groups 2 and 3. Freedom from re-intervention rate was higher in group 1 than in group 3 but did not differ between groups 1 and 2. Multivariate analysis revealed the absence of antiplatelet therapy, pre-operative higher haematocrit, absence of concomitant iliac artery aneurysm, posterior thrombus in the sac, and use of Endurant as predictors associated with spontaneous IMA occlusion. Spontaneous IMA occlusion was observed in 7.1% and 77.5% of patients with zero and four or five predictors, respectively. Spontaneous IMA occlusion occurred in nearly half of cases and was associated with positive clinical outcomes. In patients with a high prediction of spontaneous IMA occlusion, pre-emptive IMA embolisation may be omitted.

S4929 Adrenal Insufficiency in Addison's Disease - A New Potential Pathway for Developing Nonocclusive Mesenteric Ischemia

S4929 Adrenal Insufficiency in Addison's Disease - A New Potential Pathway for Developing Nonocclusive Mesenteric Ischemia

S4393 A Case of Non-Occlusive Mesenteric Ischemia Following the Rupture of a Hepatocellular Carcinoma

S4393 A Case of Non-Occlusive Mesenteric Ischemia Following the Rupture of a Hepatocellular Carcinoma

The Relationship Between Peri-Operative Systemic Inflammation and Survival in Patients With Abdominal Aortic Aneurysm

An association between pre-operative markers of systemic inflammation and inferior mortality following AAA repair has been observed. The prognostic value of the post-operative inflammatory response remains unreported in patients with AAA. The present study aimed to describe the association between the peri-operative inflammatory response & mortality in patients undergoing endovascular aneurysm repair (EVAR) and open surgical repair (OSR) for infrarenal AAA. Consecutive patients undergoing either emergency (EVAR or OSR) or elective (OSR) intervention for infrarenal AAA were retrospectively recruited from 3 centres. Pre-operative systemic inflammation was assessed using the modified Glasgow Prognostic Score (mGPS). Post-operative day 3 CRP (≤ 300mg/L, > 300mg/L) was chosen as the covariate of interest. The primary outcome was thirty-day mortality in the emergency cohort and twelve-month mortality in the elective cohort. There were 167 emergency cases (120 (72%) OSR) and 207 elective (207 (100%) OSR) cases, with a median (IQR) follow-up of 85 (52) months in the emergency cohort and 63 (57) months in the elective cohort. There were 56% vs. 44% of patients in the emergency cohort day 3 CRP ≤300mg/l vs. >300mg/L compared with 82% vs. 18% of patients in the elective cohort (p < 0.001). On univariate binary logistic regression analyses in the emergency cohort, open repair (p < 0.05), pre-operative mGPS 2 (p < 0.05), post-operative mesenteric ischaemia (p < 0.01), and day 3 post-operative CRP > 300mg/L (p < 0.05) were associated with increased odds of thirty-day mortality. On multivariate binary logistic regression analyses, only pre-operative mGPS 2 (OR 2.11, 95% CI 1.12 - 3.98, p < 0.05) retained independent association with thirty-day mortality. In the elective cohort, mean (95% CI) survival in the day 3 CRP ≤300mg/l vs. >300mg/L was 112.0 (101.8 - 122.2) months vs. 67.2 (54.1 - 80.2) months (p < 0.001). On univariate binary logistic regression analyses in the elective cohort, age ≥ 75 (p < 0.05), ischaemic heart disease (p < 0.05), and day 3 post-operative CRP > 300mg/L (p < 0.001) were associated with increased odds of twelve-month mortality. On multivariate binary logistic regression analyses, both age ≥ 75 (OR 5.15, 95% CI 1.25 - 21.30, p < 0.05) and day 3 post-operative CRP > 300mg/L (OR 15.68, 95% CI 3.61 - 68.15, p < 0.001) retained independent association with twelve-month mortality. Pre- and post-operative markers of systemic inflammation were independently associated with inferior survival following emergency and elective repair of AAA respectively. Further investigation of the peri-operative systemic inflammatory response is warranted in this patient group, with a particular focus on identifying targets for intervention.

Intestinal ischemia: A rare and less common complication after laparoscopic cholecystectomy-A case report and literature review.

Patients with a history of persistent mesenteric ischemia should not undergo laparoscopy. Mesenteric ischemia must be kept in mind for patients who develop nonspecific abdominal symptoms following laparoscopic surgeries. During laparoscopic cholecystectomy (LC), the rise in Intra-Abdominal Pressure due to carbon dioxide insufflation can reduce blood flow through splanchnic vessels, potentially leading to intestinal ischemia. A 72-year-old woman with a history of diabetes, hypertension, ischemic heart disease, and hyperlipidemia underwent LC. She was discharged but readmitted 4 days later due to peritonitis. Ischemic jejunum loops were found during surgery.

Revascularization of superior mesenteric artery occlusion via the arc of Buhler: A case report and literature review.

To report revascularization of a superior mesenteric artery (SMA) ostial occlusion via the Arc of Buhler. A 62-year-old female presented with 2 months of recurrent abdominal distension and postprandial pain. Computed tomography angiography (CTA) revealed ostial occlusion of the SMA with distal perfusion via the Arc of Buhler (connecting the celiac trunk and SMA). Conventional endovascular techniques failed. A 0.014 guidewire was passed retrograde through the occlusion via the Arc of Buhler. The guidewire was captured from the femoral sheath and balloon angioplasty with stent placement was performed. The patient had complete symptom resolution post-procedure. Retrograde revascularization via the Arc of Buhler is an effective method for treating the initial segment occlusion of the SMA.

Mesenteric thrombosis: An unusual complication of severe acute pancreatitis—Report of two cases

AbstractThe incidence of acute pancreatitis is 34 per 100 000 people in the general population and is on the rise. Approximately 15% to 20% of all patients experience severe pancreatitis, with a mortality rate nearing 20%. This condition is often linked to vascular complications, although mesenteric thrombosis is a rare presentation. We present two cases of severe acute pancreatitis resulting in multiple organ failure. Histopathological examination revealed acute hemorrhagic pancreatitis with necrosis and mesenteric thrombosis in both cases. Mesenteric thrombosis, though uncommon, is a serious complication with atypical symptoms and high mortality rates. Vascular complications in severe acute pancreatitis should not be overlooked. This case report underscores the significance of recognizing such rare complications and the need for comprehensive consideration in clinical assessments.

Trash Feet and Mesenteric Ischemia as a Rare Manifestation of a Complicated Abdominal Aortic Aneurysm: A Case Report.

Abdominal aortic aneurysms and atheromatous plaques are well-established potential culprits in the development of cholesterol embolization. This embolic phenomenon can result in the occlusion of peripheral arteries in the forefoot or toes, commonly referred to as "trash foot". A 61-year old patient exhibited severe symptoms and signs of lower limb and mesenteric ischemia, represented clinically by abdominal pain, hematochezia, and bilateral plantar necrotic lesions, attributed to embolization from a previously unknown large infrarenal abdominal aortic aneurysm. Diagnosis was confirmed by performing angio-CT of the abdomen, an angiologic examination, as well as colonoscopy. The patient underwent open surgical repair of the aortic aneurysm and received intravenous prostanoids, resulting in a successful outcome with resolution of bowel ischemia and complete recovery of bilateral foot lesions with no tissue loss. Cholesterol embolization syndrome seldom manifests with its complete clinical spectrum. Identifying and addressing the underlying cause is crucial, with a focus on potential abdominal aortic aneurysms. A combined approach involving surgical repair and prostanoid therapy may offer a viable option for patients experiencing severe manifestations.

Association between PAI-1 4G/5G genotype and residual thrombus in acute mesenteric venous thrombosis

Association between PAI-1 4G/5G genotype and residual thrombus in acute mesenteric venous thrombosis

Clinico-Radiological Features of Acute and Chronic Superior Mesenteric Artery Occlusion (SMAO)

Clinico-Radiological Features of Acute and Chronic Superior Mesenteric Artery Occlusion (SMAO)

Development and internal validation of a clinical-radiomic nomogram for predicting bowel resection in acute superior mesenteric venous thrombosis.

Development and internal validation of a clinical-radiomic nomogram for predicting bowel resection in acute superior mesenteric venous thrombosis.