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Acute Mesenteric Ischemia

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Abstract

The diagnosis and management of patients with acute mesenteric ischemia (AMI) is challenging. Despite recent advancements in diagnostic accuracy and improved care of critically ill patients, the mortality rate for this entity has remained relatively unchanged over the past several decades, primarily due to delays in diagnosis leading to irreversible bowel ischemia and necrosis. Certain recent advances, however, suggest that progress may be evident, primarily via prompt early diagnosis which affords timely treatment of AMI. Endovascular therapy has become an option in patients with an established mesenteric event, especially if diagnosed early. This chapter reviews the classification, etiology, clinical presentation, diagnosis, and treatment of patients with AMI.

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References

  1. Corcos O, Nuzzo A. Gastro-intestinal vascular emergencies. Best Pract Res Clin Gastroenterol. 2013;27:709–25.

    Article  PubMed  Google Scholar 

  2. Vokurka J, Olejnik J, Jedlicka V, Vesely M, Ciernik J, Paseka T. Acute mesenteric ischemia. Hepatogastroenterology. 2008;55:1349–52.

    PubMed  Google Scholar 

  3. Herbert GS, Steele SR. Acute and chronic mesenteric ischemia. Surg Clin North Am. 2007;87:1115–34.

    Article  PubMed  Google Scholar 

  4. Mastoraki A, Mastoraki S, Tziava E, Touloumi S, Krinos N, Danias N, et al. Mesenteric ischemia: pathogenesis and challenging diagnostic and therapeutic modalities. World J Gastrointest Pathophysiol. 2016;7:125–30.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Arch Intern Med. 2004;164:1054–62.

    Article  PubMed  Google Scholar 

  6. Quiroga B, Verde E, Abad S, et al. Detection of patients at high risk for nonocclusive mesenteric ischemia in hemodialysis. J Surg Res. 2013;180:51–5.

    Article  PubMed  Google Scholar 

  7. Kumar S, Sarr MG, Kamath PS. Mesenteric venous thrombosis. N Engl J Med. 2001;345:1683–8.

    Article  CAS  PubMed  Google Scholar 

  8. Taylor LM, Moneta GL, Porter JM. Treatment of acute intestinal ischemia caused by arterial occlusions. In: Rutherford RB, editor. Vascular surgery. 5th ed. Philadelphia: WB Saunders; 2000. p. 1512–8.

    Google Scholar 

  9. Park WM, Gloviczki P, Cherry Jr KJ, Hallett Jr JW, Bower TC, Panneton JM, et al. Contemporary management of acute mesenteric ischemia: factors associated with survival. J Vasc Surg. 2002;35:445–52.

    Article  Google Scholar 

  10. Moneta GL. Diagnosis of intestinal ischemia. In: Rutherford RB, editor. Vascular surgery. 5th ed. Philadelphia: WB Saunders; 2000. p. 1501–10

    Google Scholar 

  11. Eslami MH, Rybin D, Doros G, McPhee JT, Farber A. Mortality of acute mesenteric ischemia remains unchanged despite significant increase in utilization of endovascular techniques. Vascular. 2016;24:44–52.

    Article  PubMed  Google Scholar 

  12. White CJ. Chronic mesenteric ischemia: diagnosis and management. Prog Cardiovasc Dis. 2011;54:36–40.

    Article  PubMed  Google Scholar 

  13. Lock G. Acute intestinal ischaemia. Best Pract Res Clin Gastroenterol. 2001;15(1):83–98.

    Article  CAS  PubMed  Google Scholar 

  14. Evennett NJ, Petrov MS, Mittal A, Windsor JA. Systematic review and pooled estimates for the diagnostic accuracy of serological markers for intestinal ischemia. World J Surg. 2009;33:1374–83.

    Article  PubMed  Google Scholar 

  15. Acosta S, Nilsson T. Current status on plasma biomarkers for acute mesenteric ischemia. J Thromb Thrombolysis. 2012;33:355–61.

    Article  CAS  PubMed  Google Scholar 

  16. Acosta S. Epidemiology of mesenteric vascular disease: clinical implications. Sem Vasc Surg. 2010;23:4–8.

    Article  Google Scholar 

  17. Kärkkäinen JM, Lehtimäki TT, Manninen H, Paajanen H. Acute mesenteric ischemia is a more common cause than expected of acute abdomen in the elderly. J Gastrointest Surg. 2015;19:1407–14.

    Article  PubMed  Google Scholar 

  18. Allaix ME, Krane MK, Zoccali M, Umanskiy K, Hurst R, Fichera A. Postoperative portomesenteric venous thrombosis: lessons learned from 1,069 consecutive laparoscopic colorectal resections. World J Surg. 2014;38:976–84.

    Article  PubMed  Google Scholar 

  19. Fichera A, Cicchiello LA, Mendelson DS, et al. Superior mesenteric vein thrombosis after colectomy for inflammatory bowel disease: a not uncommon cause of postoperative acute abdominal pain. Dis Colon Rectum. 2003;46:643–8.

    Article  PubMed  Google Scholar 

  20. Hatoum OA, Spinelli KS, Abu-Hajir M, et al. Mesenteric venous thrombosis in inflammatory bowel disease. J Clin Gastroenterol. 2005;39:27–31.

    PubMed  Google Scholar 

  21. Noh KW, Wolfsen HC, Bridges MD, et al. Mesenteric venous thrombosis following laparoscopic antireflux surgery. Dig Dis Sci. 2007;52:273–5.

    Article  PubMed  Google Scholar 

  22. Swartz DE, Felix EL. Acute mesenteric venous thrombosis following laparoscopic Roux-en-Y gastric bypass. JSLS. 2004;8:165–9.

    PubMed  PubMed Central  Google Scholar 

  23. Lam L, Acosta J. Abdominal pain after uncomplicated laparoscopic appendectomy. J Am Coll Surg. 2007;204:177–8.

    Article  PubMed  Google Scholar 

  24. Stamou KM, Toutouzas KG, Kekis PB, et al. Prospective study of the incidence and risk factors of postsplenectomy thrombosis of the portal, mesenteric, and splenic veins. Arch Surg. 2006;141(7):663–9.

    Article  PubMed  Google Scholar 

  25. Leebeek FW, Smalberg JH, Janssen HL. Prothrombotic disorders in abdominal vein thrombosis. Neth J Med. 2012;70:400–5.

    CAS  PubMed  Google Scholar 

  26. Kougias P, Lau D, El Sayed HF, Zhou W, Huynh TT, Lin PH. Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg. 2007;46:467–74.

    Article  PubMed  Google Scholar 

  27. Furukawa A, Kanasaki S, Kono N, Wakamiya M, Tanaka T, Takahashi M, et al. CT diagnosis of acute mesenteric ischemia from various causes. Am J Roentgenol. 2009;192:408–16.

    Article  Google Scholar 

  28. Aschoff AJ, Stuber G, Becker BW, Hoffmann MH, Schmitz BL, Schelzig H, et al. Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging. 2009;34:345–57.

    Article  CAS  PubMed  Google Scholar 

  29. Hagspiel KD, Flors L, Hanley M, Norton PT. Computed tomography angiography and magnetic resonance angiography imaging of the mesenteric vasculature. Tech Vasc Interv Radiol. 2015;18:2–13.

    Article  PubMed  Google Scholar 

  30. Oliva IB, Davarpanah AH, Rybicki FJ, et al. ACR Appropriateness criteria imaging of mesenteric ischemia. Abdom Imaging. 2013;38:714–9.

    Article  PubMed  Google Scholar 

  31. Gaussorgues P, Guerugniand PY, Vedrinne JM, et al. Bacteremia following cardiac arrest and cardiopulmonary resuscitation. Intensive Care Med. 1988;14:575.

    Article  CAS  PubMed  Google Scholar 

  32. Kidambi H, Herbert R, Kidambi AV. Ultrasonic demonstration of superior mesenteric and splenoportal venous thrombosis. J Clin Ultrasound. 1986;14:199–201.

    Article  CAS  PubMed  Google Scholar 

  33. Sise MJ. Mesenteric ischemia: the whole spectrum. Scand J Surg. 2010;99:106–10.

    Article  CAS  PubMed  Google Scholar 

  34. Carver TW, Vora RS, Taneja A. Mesenteric Ischemia. Crit Care Clin. 2016;32:155–71.

    Article  PubMed  Google Scholar 

  35. Corcos O, Castier Y, Sibert A, et al. Effects of a multimodal management strategy for acute mesenteric ischemia on survival and intestinal failure. Clin Gastroenterol Hepatol. 2013;11:158–65.

    Article  PubMed  Google Scholar 

  36. Plumereau F, Mucci S, Le Naoures P, Finel JB, Hamy A. Acute mesenteric ischemia of arterial origin: importance of early revascularization. J Visc Surg. 2015;152:17–22.

    Article  CAS  PubMed  Google Scholar 

  37. Kashuk JL, Cothren CC, Moore EE, Johnson JL, Biffl WL, Barnett CC. Primary repair of civilian colon injuries is safe in the damage control scenario. Surgery. 2009;146:663–8.

    Article  PubMed  Google Scholar 

  38. Wichman HJ, Cwikiel W, Keussen I. Interventional treatment of mesenteric venous occlusion. Pol J Radiol. 2014;79:233–8.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Singal AK, Kamath PS, Tefferi A. Mesenteric venous thrombosis. Mayo Clin Proc Mayo Clin. 2013;88:285–94.

    Article  PubMed  Google Scholar 

  40. Schoots IG, Levi MM, Reekers JA, et al. Thrombolytic therapy for acute superior mesenteric artery occlusion. J Vasc Interv Radiol. 2005;16:317–29.

    Article  PubMed  Google Scholar 

  41. Landis MS, Rajan DK, Simons ME, et al. Percutaneous management of chronic mesenteric ischemia: outcomes after intervention. J Vasc Interv Radiol. 2005;16:1319–25.

    Article  PubMed  Google Scholar 

  42. Beaulieu RJ, Arnaoutakis KD, Abularrage CJ, Efron DT, Schneider E, Black III JH. Comparison of open and endovascular treatment of acute mesenteric ischemia. J Vasc Surg. 2014;59:159–64.

    Article  PubMed  Google Scholar 

  43. Acosta S, Bjorck M. Modern treatment of acute mesenteric ischaemia. Br J Surg. 2014;101:100–8.

    Article  Google Scholar 

  44. Bobadilla JL. Mesenteric ischemia. Surg Clin N Am. 2013;93:925–40.

    Article  PubMed  Google Scholar 

  45. Kim BG, Ohm JY, Bae MN, Kim HN, Kim YJ, Chung MH, et al. Successful percutaneous aspiration thrombectomy for acute mesenteric ischemia in a patient with atrial fibrillation despite optimal anticoagulation therapy. Can J Cardiol. 2013;29:1329.e5–7.

    Article  Google Scholar 

  46. Schoenbaum SW, Pena C, Koenigsberg P, Katzen BT. Superior mesenteric artery embolism: treatment with intra arterial urokinase. JVIR. 1992;3:485–90.

    Article  CAS  PubMed  Google Scholar 

  47. Simó G, Echenagusia AJ, Camuñez F, Turégano F, Cabrera A, Urbano J. Superior mesenteric arterial embolism: local fibrinolytic treatment with urokinase. Radiology. 1997;204:775–9.

    Article  PubMed  Google Scholar 

  48. Jia Z, Jiang G, Tian F, Zhao J, Li S, Wang K, et al. Early endovascular treatment of superior mesenteric occlusion secondary to thromboemboli. Eur J Vasc Endovasc Surg. 2014;47:196–203.

    Article  CAS  PubMed  Google Scholar 

  49. Erdogan E, Turfan M, Akkaya M, Bacaksız A, Tasal A, Ergelen M, et al. Successful recanalization of acute superior mesenteric artery ischemia with balloon angioplasty and aspiration embolectomy. Eur Geriatr Med. 2013;4:350–1.

    Article  Google Scholar 

  50. Blauw JTM, Meerwaldt R, Brusse-Keizer M, Kolkman JJ, Gerrits D, Geelkerken RH. Retrograde open mesenteric stenting for acute mesenteric ischemia. J Vasc Surg. 2014;60:726–34.

    Article  PubMed  Google Scholar 

  51. Tilsed JV, Casamassima A, Kurihara H, Mariani D, Martinez I, Pereira J, et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg. 2016;42:253–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Boley SJ, Sprayregan S, Siegelman SS, Veith FJ. Initial results from an aggressive roentgenological and surgical approach to acute mesenteric ischemia. Surgery. 1977;82:848–55.

    CAS  PubMed  Google Scholar 

  53. Sise MJ. Acute mesenteric ischemia. Surg Clin N Am. 2014;94:165–81.

    Article  PubMed  Google Scholar 

  54. Schoots IG, Koffeman GI, Legemate DA, Levi M, van Gulik TM. Systematic review of survival after acute mesenteric ischaemia according to disease aetiology. Br J Surg. 2004;91:17–27.

    Article  CAS  PubMed  Google Scholar 

  55. Abdu RA, Zakhour BJ, Dallis DJ. Mesenteric venous thrombosisd1911 to 1984. Surgery. 1987;101(4):383–8.

    CAS  PubMed  Google Scholar 

  56. Edwards MS, Cherr GS, Craven TE, Olsen AW, Plonk GW, Geary RL, et al. Acute occlusive mesenteric ischemia: surgical management and outcomes. Ann Vasc Surg. 2003;17:72–9.

    Article  PubMed  Google Scholar 

  57. Klempnauer J, Grothues F, Bektas H, Pichlmayr R. Long-term results after surgery for acute mesenteric ischemia. Surgery. 1997;121:239–43.

    Article  CAS  PubMed  Google Scholar 

  58. Gupta PK, Natarajan B, Gupta H, Fang X, Fitzgibbons Jr RJ. Morbidity and mortality after bowel resection for acute mesenteric ischemia. Surgery. 2011;150:779–87.

    Article  PubMed  Google Scholar 

  59. Schermerhorn ML, Giles KA, Hamdan AD, Wyers MC, Pomposelli FB. Mesenteric revascularization: management and outcomes in the United States, 1988–2006. J Vasc Surg. 2009;50:341.el–8.

    Article  Google Scholar 

  60. Huang HH, Chang YC, Yen DH, Kao WF, Chen JD, Wang LM, et al. Clinical factors and outcomes in patients with acute mesenteric ischemia in the emergency department. J Chin Med Assoc. 2005;68:299–306.

    Article  PubMed  Google Scholar 

  61. Ryer EJ, Oderich GS, Bower TC, Macedo TA, Vrtiska TJ, Duncan AA, et al. Differences in anatomy and outcomes in patients treated with open mesenteric revascularization before and after the endovascular era. J Vasc Surg. 1611;2011(53):e2–8.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Hadassah Medical Center, Jerusalem, Israel

    Miklosh Bala MD

  2. Assia Medical Group, Tel Aviv, Israel

    Jeffry Kashuk MD

Authors
  1. Miklosh Bala MD
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  2. Jeffry Kashuk MD
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Correspondence to Jeffry Kashuk MD .

Editor information

Editors and Affiliations

  1. Emergency and Trauma Surgery Service, C.A. Pizzardi Maggiore Hospital AUSL Bologna, Bologna, Italy

    Salomone Di Saverio

  2. Surgery and Emergency, Maggiore Hospital of Parma, Parma, Italy

    Fausto Catena

  3. General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy

    Luca Ansaloni

  4. General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy

    Federico Coccolini

  5. Trauma, Emergency Medicine, Harvard Medical School Massachusetts General Hospital, Boston, Massachusetts, USA

    George Velmahos

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Bala, M., Kashuk, J. (2016). Acute Mesenteric Ischemia. In: Di Saverio, S., Catena, F., Ansaloni, L., Coccolini, F., Velmahos, G. (eds) Acute Care Surgery Handbook. Springer, Cham. https://doi.org/10.1007/978-3-319-15362-9_26

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  • DOI: https://doi.org/10.1007/978-3-319-15362-9_26

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