Mesenteric ischemia natural history, complications and prognosis: Difference between revisions

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* In case of occlusive type of acute mesenteric ischemia, mortality can be upto 90% without surgical intervention.<ref name="KärkkäinenAcosta2017">{{cite journal|last1=Kärkkäinen|first1=Jussi M.|last2=Acosta|first2=Stefan|title=Acute mesenteric ischemia (part I) – Incidence, etiologies, and how to improve early diagnosis|journal=Best Practice & Research Clinical Gastroenterology|volume=31|issue=1|year=2017|pages=15–25|issn=15216918|doi=10.1016/j.bpg.2016.10.018}}</ref>
* In case of occlusive type of acute mesenteric ischemia, mortality can be upto 90% without surgical intervention.<ref name="KärkkäinenAcosta2017">{{cite journal|last1=Kärkkäinen|first1=Jussi M.|last2=Acosta|first2=Stefan|title=Acute mesenteric ischemia (part I) – Incidence, etiologies, and how to improve early diagnosis|journal=Best Practice & Research Clinical Gastroenterology|volume=31|issue=1|year=2017|pages=15–25|issn=15216918|doi=10.1016/j.bpg.2016.10.018}}</ref>


* In embolic type of mesenteric arterial occlusion, there is improved outcome after surgical intervention, which is not the case in thrombotic and non-occlusive type of mesenteric ischemia.<ref name="pmid11407335">{{cite journal| author=Endean ED, Barnes SL, Kwolek CJ, Minion DJ, Schwarcz TH, Mentzer RM| title=Surgical management of thrombotic acute intestinal ischemia. | journal=Ann Surg | year= 2001 | volume= 233 | issue= 6 | pages= 801-8 | pmid=11407335 | doi= | pmc=1421323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11407335  }} </ref>
* In embolic type of mesenteric arterial occlusion, there is improved outcome after surgical intervention, which is not the case in thrombotic and non-occlusive type of mesenteric ischemia.<ref name="pmid11407335">{{cite journal| author=Endean ED, Barnes SL, Kwolek CJ, Minion DJ, Schwarcz TH, Mentzer RM| title=Surgical management of thrombotic acute intestinal ischemia. | journal=Ann Surg | year= 2001 | volume= 233 | issue= 6 | pages= 801-8 | pmid=11407335 | doi= | pmc=1421323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11407335  }} </ref><ref name="pmid11407335">{{cite journal| author=Endean ED, Barnes SL, Kwolek CJ, Minion DJ, Schwarcz TH, Mentzer RM| title=Surgical management of thrombotic acute intestinal ischemia. | journal=Ann Surg | year= 2001 | volume= 233 | issue= 6 | pages= 801-8 | pmid=11407335 | doi= | pmc=1421323 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11407335  }} </ref>
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Revision as of 02:17, 13 December 2017

Mesenteric ischemia Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Overview

Natural History

Three progressive phases of ischemic colitis have been described:[1][2]

  • A hyperactive phase occurs first, in which the primary symptoms are severe abdominal pain and the passage of bloody stools. Many patients get better and do not progress beyond this phase.
  • A paralytic phase can follow if ischemia continues; in this phase, the abdominal pain becomes more widespread, the belly becomes more tender to the touch, and bowel motility decreases, resulting in abdominal bloating, no further bloody stools, and absent bowel sounds on exam.

Prognosis

  • Mesenteric ischemia is difficult to diagnose.
  • The prognosis mostly depends on prompt diagnosis and timley medical/surgical intervention depending on the underlying etiology.[3]
  • Generally, the prognosis is poor when there is delay in the treatment, ranging from 0% to 40%.[4]
  • In case of occlusive type of acute mesenteric ischemia, mortality can be upto 90% without surgical intervention.[5]
  • In embolic type of mesenteric arterial occlusion, there is improved outcome after surgical intervention, which is not the case in thrombotic and non-occlusive type of mesenteric ischemia.[4][4]
Type of mesenteric ischemia Survival rate Mortality rate
Arterial embolism 41% 54%
Arterial thrombosis 38% 77%
Venous thrombosis 87% 32%
Poor prognostic factors
Signs and symptoms Signs of shock
  • Tachypnea
  • Tachycardia
Laboratory findings
  • Metabolic acidosis
  • Bandemia
  • Elevated AST (aspartate transferase)
  • Elevated blood urea nitrogen

Complications

Tissue death from lack of blood flow (infarction) in the intestines is the most serious complication of mesenteric artery ischemia. Surgery may be needed to remove the dead portion.

References

  1. Boley, SJ, Brandt, LJ, Veith, FJ. Ischemic disorders of the intestines. Curr Probl Surg 1978; 15:1.
  2. Hunter G, Guernsey J (1988). "Mesenteric ischemia". Med Clin North Am. 72 (5): 1091–115. PMID 3045452.
  3. Meyer T, Klein P, Schweiger H, Lang W (1998). "[How can the prognosis of acute mesenteric artery ischemia be improved? Results of a retrospective analysis]". Zentralbl Chir. 123 (3): 230–4. PMID 9586181.
  4. 4.0 4.1 4.2 Endean ED, Barnes SL, Kwolek CJ, Minion DJ, Schwarcz TH, Mentzer RM (2001). "Surgical management of thrombotic acute intestinal ischemia". Ann Surg. 233 (6): 801–8. PMC 1421323. PMID 11407335.
  5. Kärkkäinen, Jussi M.; Acosta, Stefan (2017). "Acute mesenteric ischemia (part I) – Incidence, etiologies, and how to improve early diagnosis". Best Practice & Research Clinical Gastroenterology. 31 (1): 15–25. doi:10.1016/j.bpg.2016.10.018. ISSN 1521-6918.
  6. Salamone G, Raspanti C, Licari L, Falco N, Rotolo G, Augello G; et al. (2017). "Non-Occlusive Mesenteric Ischemia (NOMI) in Parkinson's disease: case report". G Chir. 38 (2): 71–76. PMC 5509387. PMID 28691670.