Mesenteric Vascular Occlusion: Comparison of Ancillary CT Findings between Arterial and Venous Occlusions and Independent CT Findings Suggesting Life-Threatening Events

OBJECTIVE: To compare the ancillary CT findings between superior mesenteric artery thromboembolism (SMAT) and superior mesenteric vein thrombosis (SMVT), and to determine the independent CT findings of life-threatening mesenteric occlusion. MATERIALS AND METHODS: Our study was approved by the institution review board. We included 43 patients (21 SMAT and 22 SMVT between 1999 and 2008) of their median age of 60.0 years, and retrospectively analyzed their CT scans. Medical records were reviewed for demographics, management, surgical pathology diagnosis, and outcome. We compared CT findings between SMAT and SMVT groups. Multivariate analysis was conducted to determine the independent CT findings of life-threatening mesenteric occlusion. RESULTS: Of 43 patients, 24 had life-threatening mesenteric occlusion. Death related to mesenteric occlusion was 32.6%. A thick bowel wall (p < 0.001), mesenteric edema (p < 0.001), and ascites (p = 0.009) were more frequently associated with SMVT, whereas diminished bowel enhancement (p = 0.003) and paralytic ileus (p = 0.039) were more frequent in SMAT. Diminished bowel enhancement (OR = 20; p = 0.007) and paralytic ileus (OR = 16; p = 0.033) were independent findings suggesting life-threatening mesenteric occlusion. CONCLUSION: The ancillary CT findings occur with different frequencies in SMAT and SMVT. However, the independent findings indicating life-threatening mesenteric occlusion are diminished bowel wall enhancement and paralytic ileus.

Superior mesentric artery embolism.

Mesenteric artery embolism is a rare and an acute abdominal emergency with a very high mortality rate which requires a high index of suspicion for its diagnosis. We hereby report a 55 years old male with rheumatic heart disease in atrial fibrillation with thromboembolic superior mesenteric artery occlusion with a fatal outcome.

Acute mesenteric ischemia: still high mortality rate in the era of 24-hour availability of angiography.

BACKGROUNDS: Acute mesenteric ischemia (AMI) is a serious condition with high mortality rate due to difficult and late diagnosis. Early and aggressive evaluation in high risk patients by mesenteric angiography is the key to the reduction in mortality rate. However; many physicians hesitated to perform it because of its availability, the risk of complications and high negative results. This study reviewed outcome of AMI in term of mortality rate, factors associated with mortality and the rate of angiography in high risk patients. MATERIAL AND METHOD: The clinical data of the patients who were diagnosed as AMI were retrospectively reviewed. The clinical outcome was recorded and the factors associated with mortality were analysed. RESULTS: Thirty-five patients were enrolled into this study during 5 years. The mortality rate was 74.3%. There were 22 high risk patients for AMI. The rate of angiography performed in this group was 4.5% (1/22). The factors associated with mortality were age more than 60 years, patients with peritonitis, hypotension, arterial cause, time interval between admission and operation or treatment more than 24 hours, bowel gangrene >100 cms. However all these factors were not statistically significant. CONCLUSION: The mortality rate of AMI is still high even at the tertiary hospital where the angiography is available 24 hours. To decrease the mortality rate, the physicians must have the high index of suspicion in high risk patients and do not hesitate to perform early mesenteric angiography.

Prognostic factors in acute mesenteric ischemia

The objective of the study was to explore the prognostic factors by comparing survivor from non-survivor group with the diagnosis of acute mesenteric ischemia. This study was conducted at the Aga Khan University Hospital, Karachi over six and half years. Eighteen patients were hospitalized with the diagnosis of acute mesenteric ischemia [AMI]. Survivor and non-survivor groups had 8 and 10 patients respectively, giving the overall mortality rate of 56%. The surviving patients had significantly shorter length of bowel necrosis, i.e. 176 cm [mean] compared to 525cm [mean] in non-survivor group [P-value 0.0003]. The surviving patients also had less number of "re-look" laparotomies as compared to non-survival group; mean 1.1 and 2 respectively [P-value 0.0002]. The higher number of "re-look" laparotomies were attributed to incorrect visual determination of bowel viability at the time of first laparotomy. The duration of symptoms and interval between arrival to hospital and operation were not different between the two groups [P values 0.98 and 0.65 respectively]. Length of bowel necrosis and number of surgical procedures are the prognostic factors in acute mesenteric ischemia. Comparing the two groups also showed that difference in age, sex and symptoms were insignificant

Dímero D e isquemia intestinal aguda: un nuevo marcador en plasma? / D-dimer (plasmatic marker) in acute intestinal ischemia

Antecedentes: La isquemia intestinal tiene una mortalidad mayor al 70 por ciento. Su diagnóstico es un desafío. No existe estudio de certeza para determinar su presencia. El Dímero D (DD) es un marcador de fibrinolisis. Se aplica en el diagnóstico de la trombosis venosa profunda y el tromboembolismo pulmonar. Su nivel plasmático elevado indicaría la presencia de isquemia intestinal aguda (IIA) por enfermedad trombólica. Objetivo: Determinar el valor diagnóstico del DD en la IIA de cualquier etiología. Lugar de aplicación: Hospital Privado de la Comunidad. Diseño: Longitudinal, consecutivo, prospectivo no randomizado. Período: 2001-2002. Población: Determinación de DD en 26 pacientes con diagnóstico presuntivo de IIA. Métodos: Se analizaron la sensibilidad (S), especificidad (E), valor predictivo negativo (VPN) y positivo (VPP) del DD para determinar la IIA (Epidat 2,1). Resultados: Se comprobó la ausencia de isquemia intestinal en 6 casos, en todos ellos el DD fue negativo. En los 4 casos tratados médicamente no se pudo certificar isquemia, asimismo el DD fue negativo. Dichos pacientes evolucionaron favorablemente sin necesidad de cirugía. En 15 de los 16 casos con certeza de isquemia el DD fue positivo. La S del DD para diagnosticar isquemia fue de 93,3 por ciento - VPN 87,5 por ciento - E y VPP, 100 por ciento (Alfa=0,05)

Isquemia intestinal aguda de origen mesentérico / Acute mesenteric ischemia

Se analizan 29 pacientes con diagnóstico de isquemia mesentérica aguda. El dolor abdominal agudo, intenso y persistente, fue el motivo de consulta en todos los casos. Los signos humorales como leucocitos, hemoconcentración e hiperlactacidemia, no son específicos. La arteriografía selectiva de la arteria mesentérica superior permite el diagnóstico y el tratamiento de la isquemia mesentérica extensa, lo que nos llevó a efectuar la revascularización en cuatro de nuestros casos. Las tácticas quirúrgicas empleadas fueron: revascularización y/o resección intestinal. La amyoría de los pacientes desarrollaron complicaciones graves como: shock perioperatorio en 10 casos, sepsis en 10, dehiscencia anastomática en 5, evisceración en 2 y síndrome de malabsorción en uno. La mortalidad alcanzó a 20 pacientes, 69 por ciento, en un gran porcentaje de casos antes de la primer semana de postoperatorio. No falleció ningún revascularizado, mientras que un revascularizado y resecado falleció (50 por ciento), la mortalidad de la resección fue de 13 casos (68 por ciento) y murieron los 6 pacientes a los que sólo se les efectuó una laparotomía exploratoria. El criterio diagnóstico fundado en la "sospecha clínica" y la arteriografía a partir del cual se puede efectuar un tratamiento enérgico y oportuno, puede mejorar de manera importante el pronóstico de esta enfermedad

The biomed caged-ball cardiac valve prosthesis. A study of 120 implants

The purpose of this study was to report our experience with 120 prosthetic valves implanted in 105 patient over an 8 year period. Their preoperative status was compared at an average follow-up period of 4 years (range 1 to 6 years) with the posoperative results. We conclude that the Mexican-made valvels (Biomed) meet the highest international quality standards: they are well tolerated by the patients; their performance is excellent and no postoperative dysfunction of the valves was ever detected. the few complications observed were no different from those reported for foreing ball caged valves. Finally, most of our patients showed a marked improvement postoperatively

Effective management in mesenteric vascular occlusion

In retrospective study we have reviewed all cases of mesenteric infarction treated at the Menia University Hospital between the year 1988 and 1991. Our standard mangement consisted of laparotomy and bowel resection and eventually revascularization, but did not include routine angiography. Twenty seven cases of mesenteric infarction documented by laparotomy were reviewed to assess the cause of the persistently high mortality.Thirteen patients [47%] were felt to have inoperable lesions and were treated by supportive care only while fourteen [53%] were subjected for bowel resection and or revascularization. Of these fourteen patients, six [44%] survived, five [33%] died of an early recurrence of infarction and three [23%] died from an unrelated cause. On the basis of recent clinical research we suggest that treatment should include routine angiography with selective perfusion of vasodilators through the superior mesenteric artery, pharmacological prevention of ischaemic and perfusion tissue damage before surgery and resection anastomoses followed by post-operative anticoagulation

Ischemic bowel disease.

Twenty-five cases with ischemic bowel disease seen over a period of 4 years are presented. Of these, 20 cases presented with acute symptoms and five with chronic symptoms. In the majority of patients, the diagnosis was established at operation and on histopathology. Occlusive disease of the superior mesenteric artery was the commonest cause of acute ischemia. Non-occlusive ischemia was not observed in any case. All the patients were treated by resection and anastomosis of the involved bowel. Vascular procedures were not carried out in any. No planned second-look procedures were carried out. Of the 20 acute cases, eight patients died and three developed complications. One chronic case died and there were no other complications in this group. We suggest that ischemic bowel disease should be considered while dealing with cases presenting as acute abdomen or with chronic abdominal pain.