Occlusive Mesenteric Ischemia Research Articles

Safety, Efficacy and Outcome of Rotational Thrombectomy assisted Endovascular Revascularisation of the Superior Mesenteric Artery in Acute Thromboembolic Mesenteric Ischaemia.

To evaluate the efficacy and safety of percutaneous rotational thrombectomy-assisted endovascular revascularization of acute thromboembolic superior mesenteric artery occlusions in acute mesenteric ischemia. Fifteen cases of percutaneous rotational thrombectomy- assisted (Rotarex S, BD, USA) revascularization were retrospectively analyzed. The etiology was embolic in 40 % of cases and thrombotic in 60 %. A "Thrombectomy in Visceral Ischemia" (TIVI) 5-point score determined vessel patency at presentation, after percutaneous rotational thrombectomy, and after adjunctive technologies. TIVI 3 indicated nearly complete revascularization (minimal residual side branch thrombus). TIVI 4 indicated complete revascularization. Technical success was defined as successful device application and a final TIVI score of 3/4 after adjunctive technologies. Safety and outcome were also analyzed. Device application via femoral access was feasible in 100 % of cases and improved flow in 86.7 % of cases (1 × TIVI 0→1, 11 × TIVI 0→2, 1 × TIVI 1→2). There was no change in 13.3 % of cases (2 × TIVI 2→2). Additional devices resulted in further flow improvement in 93.3 % of cases (8 × TIVI 3, 6 × TIVI 4). One recanalization failed (TIVI 2→2→2). After adjunctive technologies (10 × manual aspiration, 11 × angioplasty, 9 × stenting), the technical success rate was 93.3 %. The mean procedure time was 40.5(± 14) minutes for embolism and 72.1(± 20) minutes for thrombosis. There was one device-related major complication (catheter tip fracture) resulting in a device-related safety rate of 93.3 %. The overall major complication rate was 20 %. Surgical exploration (13 ×), bowel resection (9 ×) and Fogarty embolectomy/bypass (3 ×) were also performed. The 30-day mortality rate was 40 %. Percutaneous rotational thrombectomy is an effective adjunct for rapid endovascular recanalization of acute thromboembolic superior mesenteric artery occlusions with an acceptable rate of major procedural complications. · Percutaneous rotational thrombectomy-assisted superior mesenteric artery revascularization in acute occlusive mesenteric ischemia is feasible and effective.. · Percutaneous rotational thrombectomy facilitates rapid flow restoration in native and stented superior mesenteric artery segments.. · Brachial access should be considered in the case of steep take-off angles of the superior mesenteric artery..

Factors that may affect the outcome of acute occlusive mesenteric ischemia. A single-center study

BackgroundAcute mesenteric ischemia is a rare but lethal disease. Acute occlusive mesenteric ischemia consists of mesenteric artery embolism, mesenteric artery thrombosis, and mesenteric vein thrombosis. This study aimed to investigate the factors that may affect the outcome of acute occlusive mesenteric ischemia.MethodsData from acute occlusive mesenteric ischemia patients admitted between May 2016 and May 2022 were reviewed retrospectively. Patients were divided into 2 groups according to whether complications(Clavien‒Dindo ≥ 2) occurred within 6 months of the first admission. Demographics, symptoms, signs, laboratory results, computed tomography angiography features, management and outcomes were analyzed.Results59 patients were enrolled in this study. Complications(Clavien‒Dindo ≥ 2) occurred within 6 months of the first admission in 17 patients. Transmural intestinal necrosis, peritonitis, white blood cell count, percentage of neutrophils, percentage of lymphocytes, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, creatine kinase isoenzyme, cardiac troponin I, laparoscopic exploration rate, open embolectomy rate, enterostomy rate, length of necrotic small bowel, length of healthy small bowel, surgical time and intraoperative blood loss differed significantly between groups. Creatine kinase isoenzyme (OR = 1.415, 95% CI: 1.060–1.888) and surgical time (OR = 1.014, 95% CI: 1.001–1.026) were independent risk factors associated with complications(Clavien‒Dindo ≥ 2).ConclusionsOur analysis suggests that acute occlusive mesenteric ischemia patients with a creatine kinase isoenzyme level greater than 2.22 ng/mL or a surgical time longer than 156 min are more likely to experience complications’(Clavien‒Dindo ≥ 2) occurrence within 6 months of the first admission.

Mesentéric Segmentary Thrombosis. Atipical presentation. Clinical Case.

Introduction. No occlusive mesenteric ischemia was first reported by Ende et al., in 1958 as a syndrome of small intestinal necrosis in patients with heart failure subsequently, hypoperfusion of the intestines due to various factors induces mesenteric vascular spasm. Clínical Case. A 74-year-old female was admitted to the Emergency Department due to jaundice, intolerance to the oral route, and hemodynamic instability, Septic Shock of abdominal origin secondary to Cholangitis secondary to Choledocholithiasis. After 72 h, she was discharged from the Intensive Care Unit due to improvement to continue surveillance in the General Surgery Hospitalization. During his stay on the floor of General Surgery, she again presented intolerance to the oral intake, abdominal distension, and clinical deterioration, for which a Tomography of the Abdomen was performed, finding significant distension of the small bowel loops from the distal ileum secondary to two circular hyperdense images of 14 and 16 mm located 3.2 cm proximal to the ileocecal valve, as well as free fluid in the cavity, for which it was decided to perform Exploratory Laparotomy with the following findings: Two stones with pigmented biliary characteristics located 3 cm from the ileocecal valve of 1.5 cm each one, segmental mesenteric ischemia of approximately 60 cm in the terminal ileum, ascites 400 cc of purulent yellow fluid, multiple loose liver-omentum-transverse colon adhesions; 60 cm resection of the terminal ileum + ileostomy is performed. In the postoperative period, the patient was admitted to the Intensive Care Unit where she evolved favorably until her hospital discharge. Discussion. Medical patients are often admitted to the ICU for the management of septic or hypovolemic Shock or respiratory failure. Although recent clinical practice guidelines recommend light sedation for patients in the ICU, some patients require deep sedation during the initial phase of ICU management. Therefore, for medical ICU patients, early evaluation of abdominal symptoms might be difficult. In addition, physicians often overlook the monitoring of abdominal symptoms in medical patients, which can lead to a delayed NOMI diagnosis and an increase in mortality.

Basic demographic characteristics and prevalence of comorbidities in acute mesenteric ischemia: a systematic review and proportional meta-analysis

Purpose The aim of this systematic review and meta-analysis was to examine and assess the basic demographic characteristics and prevalence of comorbidities in acute mesenteric ischemia (AMI) and its various subtypes. Patients and methods A literature search was conducted by using the databases PubMed, EMBASE, and Google Scholar (to June 1, 2022). Random-effects or fixed-effects models were selected to pool means and proportions and their corresponding 95% confidence intervals (CI), based on heterogeneity between studies. The results of meta-analyses for basic demographic characteristics and prevalence (proportions) of each specific comorbidities of acute mesenteric ischemia (AMI) and its various subtypes were described. Results Ninety-nine studies were included in the meta-analysis, including 17,103 patients with AMI. Furthermore, 7941 patients with subclass diagnoses of AMI were identified, including 3,239 patients with arterial occlusive mesenteric ischemia (AOMI), 2,977 patients with nonocclusive mesenteric ischemia (NOMI), and 1,725 patients with mesenteric venous thrombosis (MVT). As a surgical emergency, AMI is associated with older patients and a high likelihood of multisystem comorbidities. Comorbidities of AMI involved multiple systemic diseases, including cardiovascular disease, endocrine and metabolic diseases, kidney diseases, digestive diseases, respiratory diseases, cerebrovascular diseases, vascular diseases, and cancer. Conclusion The basic demographic characteristics and the prevalence of comorbidities of different subtypes of AMI are different. The management of comorbidities should be an essential part of improving the prognosis of AMI patients and may contribute to precise prevention of AMI.

S3304 Acute Occlusive Mesenteric Ischemia From Venous and Aortic Thrombosis in a Patient with Hyperhomocysteinemia and Liver Cirrhosis

Introduction: Portal vein thrombosis (PVT) is a severe complication of liver cirrhosis and one of its major consequences include intestinal ischemia. Hyperhomocysteinemia (HHcy) has been suggested to be an independent risk factor for deep venous thrombosis, but limited data are available on the prevalence of HHcy in patients with PVT complicating liver cirrhosis. Several clinical studies have also demonstrated the role of HHcy in arterial and venous thrombosis. Case Description/Methods: We report a case of a 57 year old male with Liver Cirrhosis from Alcoholic Liver Disease, who presented at our ED with a two week history of dull periumbilical pain which worsened on the day of consult. Plain abdominal CT scan showed nonspecific small bowel enteritis. He was placed on general liquid diet and started on Ciprofloxacin and Metronidazole intravenously. However, on the third hospital day, he complained of sudden severe abdominal pain accompanied by abdominal distention, guarding, and direct and rebound tenderness on all quadrants. He had hypotension and on laboratory workup, had decreasing hemoglobin levels with elevated WBC count and lactate. Contrast-enhanced abdominal CT scan revealed portal and superior mesenteric vein thrombosis, bowel wall ischemia along the segment of the jejenum in the left hemiabdomen, and infrarenal abdominal aorta and ascending aorta thrombi. Emergency exploratory laparotomy was done with segmental jejunoileal resection and primary end-to-end anastomosis with intraoperative findings of gangrenous small bowels measuring 100 cm in length, with the rest of the proximal small bowels noted to be dilated and edematous. The patient was transferred to the intensive care unit post-operatively for closer monitoring; Heparin drip was started 24 hours post-surgery. Histopathology results showed extensive transmural infarction, hemorrhage, and necrosis on small bowel segments; organizing thrombi were seen on mesenteric vessels. The patient was worked-up for other causes of hypercoagulable states which showed elevated Homocysteine levels at 20.6 (NV: 5-12). Discussion: It is likely that HHcy may increase the risk of patients with liver cirrhosis to develop arterial and venous thrombosis considering the pivotal role the liver plays in the metabolism of sulphur amino acids and Hcy-related vitamin storage. Therefore, identification of this high-risk group may be important to plan prevention management, such as vitamin supplementation, other Hcy-lowering strategies, or long-term anticoagulation.

ダメージコントロール戦略で救命した広範囲非閉塞性腸管虚血の1例(A case of massive non–occlusive mesenteric ischemia survived by damage control strategy)

要旨症例は72歳の女性。既往に壊死性大腸炎にて大腸全摘術。前日からの嘔吐，意識障害のため救急搬送された。画像検査で小腸の全体的な拡張，右側腹部の小腸壁の造影不良を認めた。搬入時よりショック状態であり，血液検査ではアシドーシスと凝固障害を認めた。非閉塞性腸管虚血症，敗血症性ショックと診断してdamage control surgeryを含む集学的加療の方針とした。初回手術では，人工肛門から口側100cmの範囲でまだら状に色調不良を呈していたため同部位を切除し，術後に上腸間膜動脈から血管拡張薬療法を施行した。2回目の手術でさらに切除断端より口側80cmを追加切除した。また，十二指腸に色調不良を認めたため，術後に総肝動脈造影を施行したところ十二指腸壁の部分的描出不良を確認し，総肝動脈に対して選択的血管拡張薬動注療法を追加した。第5病日より循環動態が安定し，昇圧剤は終了とした。第18病日から経管栄養を開始，第125病日にリハビリ目的で転院となった。十二指腸を含む広範囲非閉塞性腸管虚血であり，また重篤な基礎疾患を有していたが，ダメージコントロール戦略を用いた手術と選択的血管拡張薬動注療法を組み合わせることで救命しえた症例を経験したため，報告する。

Relationship of superior mesenteric artery thrombus density with transmural intestinal necrosis on multidetector computed tomography in acute mesenteric ischemia.

Acute arterial occlusive mesenteric ischemia with transmural intestinal necrosis (TIN) is a fatal disease, which is difficult to diagnose on multidetector computed tomography (MDCT). The aim of the present study was to determine the relationship of superior mesenteric artery (SMA) thrombus density with TIN on MDCT in patients with acute mesenteric ischemia (AMI) due to SMA thromboembolism. In this retrospective study, 33 patients who underwent abdominal MDCT and angiography for AMI due to SMA thromboembolism were divided into two groups: the AMI with TIN group and the AMI without TIN group. We analyzed the relationships of clinical characteristics, qualitative MDCT signs, and SMA thrombus density with TIN. The SMA thrombus density was measured on non-contrast MDCT. Univariate and multivariate analyses were performed to determine the risk factors for predicting TIN. The diagnostic performances of risk factors were evaluated by receiver-operating characteristic (ROC) curve analysis. Of the patients with AMI enrolled in this study, 33.3% (11/33) were diagnosed with TIN. Peritonitis (P=0.042), bowel wall thinning (P=0.033), and pneumatosis/portomesenteric gas (P=0.010) were significantly associated with TIN. AMI patients with TIN exhibited a higher SMA thrombus density than AMI patients without TIN [41.2±6.1 vs. 34.2±3.0 Hounsfield unit (HU), P=0.003]. Multivariate analysis showed that SMA thrombus density was an independent predictor of TIN [P=0.044, hazard ratio (HR): 1.82, 95% confidence interval (CI): 1.02-3.25]. For diagnosing AMI with TIN, the area under the ROC curve (AUC) of SMA thrombus density (0.83) was larger than those of peritonitis (0.68), bowel wall thinning (0.66), and pneumatosis/portomesenteric gas (0.71). In patients with AMI, erythrocyte-rich thrombus blocking the SMA trunk which has a higher density on MDCT is prone to the occurrence of TIN compared with erythrocyte-scarce thrombus with a lower density. SMA thrombus density could be an independent risk factor for TIN in patients with AMI due to SMA thromboembolism.

計画的二期手術にて救命し得た，高浸透圧高血糖症候群を契機に発症した非閉塞性腸管虚血症の1例(Succesful treatment of non–occlusive mesenteric ischemia induced by hyperosmolar hyperglycemic state, requiring planned two–stage surgery: a case report)

要旨症例は67歳の男性で，喉頭癌（cT3N1M0 stage III）に対し喉頭亜全摘術および気管切開術を施行された。術後の経管栄養開始後に血糖上昇傾向となり，その後，高浸透圧高血糖症候群（hyperosmolar hyperglycemic syndrome: HHS）を発症した。さらに浸透圧利尿による脱水にて腸管低灌流を合併したことによると思われる非閉塞性腸管虚血症（non–occlusive mesenteric ischemia: NOMI）が疑われたため，緊急で診断的腹腔鏡検査を施行した。その結果，明らかに壊死した腸管を認めたため開腹手術に移行し，初回手術では壊死腸管の切除のみを行った。集中治療後に二期的に腸管再建術を施行し，その際にインドシアニングリーン蛍光法にて残存腸管に血流障害がないことを確認した。今回我々は，HHSを契機に発症したと考えられるNOMIの1例を経験した。NOMIは非常に致死率の高い予後不良な疾患であるが，計画的な二期手術および集中治療にて救命し得た。自験例について，文献的考察を交えて報告する。

心臓手術後の非閉塞性腸管虚血症（NOMI）に対して小腸分節切除と分離腸管造設により救命し得た1例

心臓手術後の非閉塞性腸管虚血症（NOMI）に対して小腸分節切除と分離腸管造設により救命し得た1例

Clinical Features and Factors Affecting Postoperative Mortality for Obstructive Acute Mesenteric Ischemia in China: A Hospital- Based Survey.

PurposeThe study aimed to report the clinical manifestation and identify the risk factors for postoperative mortality in patients who were diagnosed with obstructive acute mesenteric ischemia (AMI) based on a survey of a hospital in western China.Patients and MethodsWe reviewed clinical data of 108 patients with obstructive AMI at West China Hospital, Sichuan University, from 2011 to 2017. Clinical characteristic was described and compared. Factors affecting postoperative survival were analyzed.ResultsA total of 108 obstructive AMI cases were included in this study, with an overall average age of 57.1 years, including 58 arterial occlusive mesenteric ischemia (AOMI) and 50 mesenteric venous thrombosis (MVT). AOMI patients were older and had a significantly higher frequency of these comorbidities, including heart disease, hypertension, and diabetes. In comparison, MVT had a significantly higher proportion of male patients and a higher frequency of liver disease. A total of 77 patients underwent laparotomy, and the 30-day postoperative mortality rate was 29.9%. Multivariate logistic regression analysis showed that the time interval from admission to surgery (adjust OR 1.19; 95% CI [1.07–1.34], P = 0.005), platelet count (adjust OR = 0.98; 95% CI [0.97–0.99], P = 0.008) and AOMI (adjust OR = 5.55; 95% CI [1.36–22.55], P = 0.017) were independent predictors of 30-day mortality after exploratory laparotomy for obstructive AMI. Further analysis of the 45 AOMI showed that the time interval from admission to surgery (adjustOR 1.22; 95% CI [1.01–1.47], P = 0.036) and platelet count (adjustOR = 0.98; 95% CI [0.97–0.99], P = 0.020) were independent risk factors for 30-day postoperative mortality of AOMI.ConclusionEarly identification of AOMI, improving the efficiency of enhanced CT examination, strengthening doctor–patient communication, active laparotomy, and optimize platelet management may also help reduce the overall short-term mortality of obstructive AMI. Building the multidisciplinary team model of diagnostic imaging, vascular intervention, and surgical treatment to manage obstructive AMI may be urgently needed in western China.

Preoperative Risk Factors for Short-Term Postoperative Mortality of Acute Mesenteric Ischemia after Laparotomy: A Systematic Review and Meta-Analysis.

Objective Our objective was to comprehensively present the evidence of preoperative risk factors for short-term postoperative mortality of acute mesenteric ischemia after laparotomy. Methods PubMed, Embase, and Google Scholar were searched from January 2000 to January 2020. Studies evaluating the postoperative risk factors for short-term postoperative mortality of acute mesenteric ischemia after laparotomy were included. The outcome extracted were patients' demographics, medical history, and preoperative laboratory tests. Results Twenty studies (5011 patients) met the inclusion criteria. Studies were of high quality, with a median Newcastle-Ottawa Scale Score of 7. Summary short-term postoperative mortality was 44.38% (range, 18.80%–67.80%). Across included studies, 49 potential risk factors were examined, at least two studies. Meta-analysis of predictors based on more than three studies identified the following preoperative risk factors for higher short-term postoperative mortality risk: old age (odds ratio [OR], 1.90, 95% confidence interval [CI], 1.57–2.30), arterial occlusive mesenteric ischemia versus mesenteric venous thrombosis (OR, 2.45, 95% CI 1.12–5.33), heart failure (OR 1.33, 95% CI 1.03–1.72), renal disorders (OR 1.61, 95% CI 1.24–2.07), and peripheral vascular disease (OR 1.38, 95% CI 1.00–1.91). Nonsurvivors were older (standardized mean difference [SMD], 0.32, 95% CI 0.24–0.40), had higher creatinine levels (SMD 0.50, 95% CI 0.25–0.75), and had lower platelet counts (SMD −0.32, 95% CI −0.50 to −0.14). Conclusion The short-term postoperative mortality of acute mesenteric ischemia who underwent laparotomy is still high. A better understanding of these risk factors may help in the early identification of high-risk patients, optimization of surgical procedure, and improvement of perioperative management.

Unusual arterial thrombotic events in Covid-19 patients

IntroductionCOVID-19 infection is commonly complicated with pro-thrombotic state and endothelial dysfunction. While several studies reported a high incidence of venous thromboembolic events. The occurrence of arterial thromboses are yet rarely described and could be underestimated. ObjectivesTo describe the clinical and biological characteristics of COVID-19 patients presenting with an associated arterial thromboembolic event. Material and methodsWe performed a retrospective multicentric study in 3 centers between France and Italy. All patients with a confirmed SARS-CoV-2 infection and arterial thromboembolic events were included in the analysis. ResultsFrom March 8th to April 25th 2020, we identified 20 patients (24 events) with arterial thromboembolic events over 209 admitted patients (9.6%) with severe COVID-19 infection. Arterial thrombotic events included acute coronary occlusions (n = 9), stroke (n = 6), limb ischemia (n = 3), splenic infarcts (n = 3), aortic thrombosis (n = 2) and occlusive mesenteric ischemia (n = 1). At the time of the event, 10/20 (50%) of patients received thromboprohylaxis, 2/20 (10%) were receiving treatment dose anticoagulation and 5/20 (25%) were receiving antiplatelet therapy. ConclusionOur observations suggest that serious arterial thrombotic events might occur in Covid-19 patients. However, the exact incidence of such events and the best way to prevent them yet remains to be investigated.

復温後数時間で非閉塞性腸管虚血（non–occlusive mesenteric ischemia: NOMI）を合併した偶発性低体温症(Accidental hypothermia complicated by non–occlusive mesenteric ischemia within several hours after rewarming)

要旨 70歳代の女性が意識障害にて救急搬送された。来院時は血圧測定不能，脈拍50/分，Glasgow coma scale（GCS）7，体温25.3℃（膀胱温）と，低体温症，意識障害，循環不全を認めた。能動的復温を行い体温上昇とともに意識，循環は改善傾向となり，来院8時間後には体温36.5℃，血圧163/93mmHg，脈拍105/分（不整），GCS 14まで改善した。来院12時間後に尿量低下を認めるも呼吸循環は安定していた。しかし，来院18時間後に急変し心肺停止となった。自己心拍再開するも高度な代謝性アシドーシスを認め，循環動態は不安定な状態であった。腹部超音波検査などから，原因として腸管壊死を疑うも全身状態・患者背景を考慮し侵襲的治療は行わない方針となり，来院26時間後に永眠した。病理解剖にて腸管の虚血変化を認め，腸管血管の閉塞は認めず非閉塞性腸管虚血の診断となった。偶発性低体温症に腸管虚血を合併した症例の報告は少数だが，復温し数時間後に腸管虚血の徴候を認めている症例が多く，循環障害を伴う偶発性低体温症では，復温後数時間は血液ガス検査や腹部所見などの綿密なモニタリングを行うことでNOMIの早期診断に有効である可能性がある。

A Case of Non–occlusive Mesenteric Ischemia in Which Stoma Color Was Useful for Diagnosis

A Case of Non–occlusive Mesenteric Ischemia in Which Stoma Color Was Useful for Diagnosis

A Case of Non–occlusive Mesenteric Ischemia Complicated by Treatment for Rhabdomyolysis

A Case of Non–occlusive Mesenteric Ischemia Complicated by Treatment for Rhabdomyolysis

Кишечная стенка при острой ишемии: данные прижизненной оптической когерентной томографии и гистологического анализа

The objective is to study the morphometric signs of small bowel ischemic damage basing on intravital optical coherence tomography data and further histological analysis Materials and methods. The study was carried out on male Wistar rats with the use of two models of acute intestinal ischemia: acute occlusive mesenteric ischemia by а. jejunales ligation (group “I”) and acute arteriovenous ischemia by a small bowel loop and frill strangulation together with а. et v. jejunales (group “II”). The state of intramural vessels in vivo was evaluated with the use of optical coherence angiography (OCA). After the macroscopic signs of non-viability appeared the bowel was resected and its stepwise histological analysis was carried out. Results. Ischemic damage development in group “I” was accompanied by decrease of bowel wall thickness by 34,8-42,4% (p=0,032) due to submucous layer destruction - based on histological analysis data and also by decrease of total length of functioning intramural vessels by 4,6% (p=0,004) - based on OCA data. According to the OCA data in group “II” the length of functioning vessels decreased by 89,6%in the strangulated bowel loop and by 6,1% in adducent and abducent sections (p=0,001). In the strangulated loop histological specimens sharply dilated thrombosed veins were seen in all layers of bowel wall, seromuscular layer oedema and diapedesis hemorrhages of mucous coat also took place as well as bowel wall thickening by 25,2% in comparison with the intact one. Conclusions. Сomplex analysis of in vivo optical coherence tomography results and further histological analysis of ischemic small bowel wall made it possible to determine the morphological manifestations which are specific for arterial and arteriovenous mesenteric blood flow disorder. In cases of mesenteric artery occlusion hypoperfusion and mucous coat ischemia are predominant among pathogenetic mechanisms of bowel wall alteration. In the strangulated bowel the main factor of destruction and necrosis is acute insufficiency of venous outflow.

Superior Mesenteric Artery Occlusion: A case report and mini Review.

Introduction: Acute mesenteric ischemia/occlusion is a life-threatening vascular emergency that requires early diagnosis and intervention to restore mesenteric blood flow and to prevent loss of life. Despite progress in our understanding about the mesenteric ischemia, diagnostic modalities, and treatment options, the mesenteric ischemia remains a diagnostic challenge. This leads to delayed implementation of treatment and thus contributes to high mortality and morbidity. Methods: Here, we have presented a case report of superior mesenteric artery thrombosis. It discusses the various aspects of superior mesenteric artery occlusion, the etiology, the difficulty with diagnosis, and the best possible course of action. Results: The Superior Mesenteric Artery (SMA) supplies the whole of the small intestine except the superior part of the duodenum. It also supplies the caecum, ascending colon and most of the transverse colon. Acute mesenteric ischemia (AMI) is a syndrome caused by inadequate blood flow through the mesenteric vessels, resulting in ischemia and eventual gangrene of the bowel wall. Conclusion: The acute mesenteric ischemia (AMI) comprises four different primary clinical entities, Non-occlusive mesenteric ischemia (NOMI), and occlusive mesenteric artery ischemia (OMAI).This OMAI is further subdivided into acute mesenteric arterial embolism (AMRE) and acute mesenteric arterial thrombosis (AMRT). The AMI as the venous disease takes the form of Mesenteric venous thrombosis. (MVT). The overall prevalence of AMI is 0.1% of all hospital admissions; venous thrombosis is found in approximately 0.001% of patients who undergo exploratory laparotomy. The risk factor for AMI includes arrhythmia, heart diseases, mitral stenosis, endocarditis, recent MI, and intra-abdominal malignancies.

Pathomorphological manifestations of ischemic involvement of the small intestine in acute occlusion of the mesenteric artery

Relevance. Lethality rates (63-95%) among patients with acute intestinal ischemia remain consistently high during the last decades. Despite the high urgency of the problem and numerous works devoted to visualization, early laboratory and instrumental diagnostics of ischemic bowel disease, clinical results have not changed significantly during the last 15-20 years. Pathogenetic mechanisms of various variants of ischemic intestinal lesion and their pathomorphological manifestations should become the basis for the development of surgical tactics and require specification.
 The aim is to study pathomorphological manifestations and to clarify on their basis the pathogenetic mechanisms of ischemic involvement of the small intestine in acute occlusion of the mesenteric artery in the experiment.
 Materials and methods. An experimental study was performed on 10 laboratory animals - male rats of the Wistar line. Modeling acute mesenteric ischemia was carried out via dressing of the jejunal artery. The ischemic intestine was collected for a stepwise histological study, the morphometry of the layers of the intestinal wall and the prevalence of necrosis.
 Results. At the time of the appearance of macroscopic signs of lack of vitality in the central sector of the ischemic intestine, the wall thickness was 47.6% less than normal and in the adjacent peripheral sectors by 40.6%. Thinning of the intestinal wall was due to alteration of the mucosa with a decrease in its share in the total wall thickness from 86 to 82% (p = 0.021) in all sectors. The share of area occupied by necrosis in groups "B" and "C" was not statistically significant (p = 0.872) and amounted to 17.1 [7.3; 64.9]%. The state of the intramural vessels of the intestinal wall had significantly changed in comparison with the intact intestine. Signs of hypoperfusion in the form of sludge in the microvessels of the mucous membrane and the submucosa had been revealed.
 Conclusions. Pathomorphological manifestations of ischemic bowel disease in acute occlusive mesenteric ischemia resulted in a decrease in the total thickness of the wall and a change in the ratio of serous-muscular and mucosal-submucosal layers due to a decrease in the proportion of the latter. The severity of necrosis in the central and peripheral parts of the ischemic intestine did not differ.

A Case of Gangrenous Ischemic Colitis Expanding to the Entire Colorectum With a Complication of Non─occlusive Mesenteric Ischemia

A Case of Gangrenous Ischemic Colitis Expanding to the Entire Colorectum With a Complication of Non─occlusive Mesenteric Ischemia

What is the Best Revascularization Strategy for Acute Occlusive Arterial Mesenteric Ischemia: Systematic Review and Meta-analysis.

Acute mesenteric ischemia (AMI) is a life-threatening disease that leads to bowel infarction and death. The optimal management of AMI remains controversial. The present meta-analysis aimed to estimate the prognostic impact of surgical (SG) versus endovascular or hybrid intervention (EV) as the first-line treatment for acute arterial occlusive mesenteric ischemia and to assess whether endovascular strategy was actually effective in reducing bowel resection. MEDLINE, Scopus and the Cochrane Library databases were searched. There have been no randomized controlled trials comparing SG versus EV for the treatment of AMI. We undertook this systematic review and meta-analysis according to MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines, assessing the included study quality with the Newcastle-Ottawa scale. Seven studies comparing EV versus SG as first strategy for the treatment of AMI were selected for the analyses, reporting of 3020 patients. EV was associated with a reduced risk of in-hospital mortality (RR 0.68; 95% CI 0.59-0.79; fixed-effects analysis; p<0.0001; I 2=4.9%; τ 2=0.025). Pooled prevalence of mortality was 19% for EV and 34% for SG. EV also showed a benefit impact on risk of bowel resection and second-look laparotomy. The present meta-analysis outlines that endovascular revascularization strategy seems to offer advantages in terms of in-hospital mortality and morbidity in case of arterial occlusive AMI. A multidisciplinary team consisting of radiologists, interventional radiologists, cardiovascular and general surgeons comes out to be essential to tailor the right procedure to the patient and improve the outcomes associated with AMI.