Upper Gastrointestinal Bleed Secondary to Duodenal Ischemia (original) (raw)
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Intestinal ischemia: current treatment concepts
Langenbeck's Archives of Surgery, 2010
Purpose Mesenteric ischemia is a condition well-known among physicians treating patients with abdominal symptoms. Even so, mortality rates have not decreased significantly over the last decades. The purpose of this article is to review current treatment concepts of acute and chronic mesenteric ischemia. Results Early diagnosis is one of the most important features that determine a patient's prognosis. Conventional angiography and multidetector computed tomography are therefore appropriate to quickly diagnose mesenteric ischemia, the latter being commonly more available. Once a patient presents with signs of peritonitis, instant laparotomy is indicated, and infarcted bowel segments need to be resected, followed by a second-look operation if necessary. If bowel necrosis is clinically not suspected, different approaches should be applied according to source and nature of mesenteric ischemia. Besides established surgical treatment concepts, more and more interventional procedures are developed and evaluated. However, superiority of these new techniques could only be shown for selected patient groups so far. In chronic mesenteric ischemia, interventional approaches seem to be an attractive alternative in patients who are in a condition too bad to undergo surgery. Patients with colonic ischemia are treated best in a conservative manner and by resolving the underlying cause, if identified. Conclusion Patients with acute mesenteric ischemia are still at highest risk for a fatal course of disease. New diagnostic and therapeutic developments have not been tested in larger studies yet, neither has any of these methods led to an increased survival in studies published so far. Taken together, mesenteric ischemia requires high awareness, earliest possible diagnosis, and treatment by an experienced interdisciplinary team of gastroenterologists, radiologists, and surgeons.
Gastrointestinal ischemia: endoscopic findings in the context of vascular insufficiency
Revista de gastroenterologia del Peru : organo oficial de la Sociedad de Gastroenterologia del Peru, 2019
REPORTE DE CASO INTRODUCTION Acute gastroduodenal ischemia is an uncommon condition due to the extensive blood supply and collateral circulation to the gastrointestinal tract (1,2) , resulting from local or generalized vascular insufficiency caused by hemodynamic shock, vasculitis, disseminated thromboembolism, mesenteric thrombosis, acute distension with gastric volvulus, injection of vasoconstrictors into the left gastric artery, endoscopic procedures such as sclerotherapy or endoscopic submucosal dissection, postoperative complication of fundoplication by laparoscopy, acute aortic dissection and coarctation of the aorta (1-9). Signs and symptoms of this pathology include abdominal pain, nausea, vomiting, gastrointestinal Gastrointestinal ischemia: endoscopic findings in the context of vascular insufficiency Isquemia gastrointestinal: hallazgos endoscópicos en el contexto de la insuficiencia vascular
Surgical Management of Thrombotic Acute Intestinal Ischemia
Annals of Surgery, 2001
To evaluate the University of Kentucky experience in treating acute intestinal ischemia to elucidate factors that contribute to survival. Summary Background Data Acute intestinal ischemia is reported to have a poor prognosis, with survival rates ranging from 0% to 40%. This is based on several reports, most of which were published more than a decade ago. Remarkably, there is a paucity of recent studies that report on current outcome for acute mesenteric ischemia. Methods A comparative retrospective analysis was performed on patients who were diagnosed with acute intestinal ischemia between May 1993 and July 2000. Patients were divided into two cohorts: nonthrombotic and thrombotic causes. The latter cohort was subdivided into three etiologic subsets: arterial embolism, arterial thrombosis, and venous thrombosis. Patient demographics, clinical characteristics, risk factors, surgical procedures, and survival were analyzed. Survival was compared with a collated historical series. Results Acute intestinal ischemia was diagnosed in 170 patients. The etiologies were nonthrombotic (102/170, 60%), thrombotic (58/170, 34%), or indeterminate (10/170, 6%). In the thrombotic cohort, arterial embolism accounted for 38% (22/58) of the cases, arterial thrombosis for 36% (21/58), and venous thrombosis for 26% (15/58). Patients with venous thrombosis were younger. Venous thrombosis was observed more often in men; arterial thrombosis was more frequent in women. The survival rate was 87% in the venous thrombosis group versus 41% and 38% for arterial embolism and thrombosis, respectively. Compared with the collated historical series, the survival rate was 52% versus 25%. Conclusions These results indicate that the prognosis for patients with acute intestinal ischemia is substantially better than previously reported.
IOSR Journals , 2019
Résume: L’ischémie gastrique est une entité rare en raison de la richesse de la vascularisation gastrique et est associée à une mortalité élevée, nécessitant une prise en charge rapide et multidisciplinaire. La symptomatologie clinique est souvent atypique. Nous rapportons un cas d’ischémie gastrique chez une patiente âgée de 63 ans avec des facteurs de risque cardio-vasculaire dont le motif de consultation étaitune hémorragie digestive haute associées à des epigastralgieset dont l’exploration endoscopique a révélé des lésions compatibles avec une ischémie gastrique. L’angioscanner a montré des athéromes multifocaux au niveau du tronc cœliaque et de l’artère mésentérique supérieur et de multiples calcifications aortique sans sténose significative. En raison descomorbidités et la stabilité clinique, un traitement conservateur a été adopté.L'endoscopie de contrôle, effectuée 3 jours plus tard, a montréune disparition complète de l'ischémie gastrique. Abstract: Gastric ischemia is a rare entity because of the richness of gastric vascularization, it is associated with high mortality, requiring rapid and multidisciplinary management. Clinical symptomatology is often atypical. We report a case of gastric ischemia of a 63-year-old patient with cardiovascular risk factors whose reason for consultation was upper gastrointestinal bleedingassociated with epigastric pain. The endoscopic exploration revealed lesions compatible with gastric ischemia. CT angiography showed multifocal atheromas of the celiac trunk and superior mesenteric artery and multiple aortic calcifications without significant stenosis. Due to comorbidities and clinical stability, conservative treatment was adopted. Endoscopy control, performed 3 days later, showed complete disappearance of gastric ischemia.
Acute bowel ischemia: analysis of diagnostic error by overlooked findings at MDCT angiography
Emergency Radiology, 2012
To retrospectively evaluate the frequency and type of findings that were missed in the original reports of multi-detector CT angiography (MDCTA) in patients with suspected acute bowel ischemia. From January 2007 to March 2011, a series of 35 patients who underwent MDCTA of the abdomen and pelvis and had surgery were included. The reports of the initial CT were retrospectively compared with the discharge diagnosis and surgical reports. Discrepant or missing findings were re-evaluated and divided into relevant or not relevant regarding the diagnosis. In 23 of the 35 patients (66 %), all findings were correctly diagnosed in the initial MDCTA report. In the remaining 12 of the 35 patients (34 %), lesions that were not reported were present at surgery. In 10 of the 12 (83 %) patients, the overlooked findings were relevant and subtle: gas in the portal vein (n03), gas in the bowel wall (n03), gas in the portal vein and bowel wall (n02), thrombotic occlusion of the superior mesenteric artery (n01), and thrombotic occlusion of the inferior mesenteric artery (n01). In 2 of the 12 (17 %) patients in whom the MDCTA-overlooked findings were classified as non-relevant, bowel ischemia was found at surgery. With retrospective image interpretation, 83 % of the patients with occlusive mesenteric ischemia at surgery were correctly identified, whereas the remaining 17 % with non-occlusive mesenteric ischemia at surgery showed nonrelevant findings at MDCTA. About 33 % of relevant findings of bowel ischemia were overlooked by the initial MDCTA interpretation, most were subtle findings. However, secondary reading revealed most of these findings and can serve to improve diagnostic performance.
ACUTE MESENTERIC ISCHEMIA: CASE STUDY (Atena Editora)
ACUTE MESENTERIC ISCHEMIA: CASE STUDY (Atena Editora), 2024
Introduction: Acute mesenteric ischemia is a frequently fatal surgical emergency, largely due to delayed diagnosis. Despite advances in therapy and supportive measures, the disease still persists with a high degree of morbidity and mortality, with mortality rates reaching 70% of cases. The nonspecific physical examination, uncertainty of diagnosis, the magnitude of surgeries and possible complications have contributed to limit the experience and justify the failure of treatment. Discussion: Mesenteric ischemia can be caused by arterial or venous obstruction. In the first hours, there are no signs of peritoneal irritation, distension or fever. Radiological signs are often suggestive only in advanced stages, when they reveal wall edema, abnormal separation of the loops, intestinal pneumatosis or presence of gas in the portal system. Most patients have at least some part of the intestine frankly necrotic at the time of diagnosis. It is advisable to avoid resection of a bowel with questionable viability at the time of the first surgery. A second revision surgery “second look” can be performed, ideally 18-48 hours after the first procedure. Wide resections and discontinuity of the colon in the intestinal transit favor the establishment of short bowel syndrome, characterized by diarrhea, weight loss, dehydration, hydroelectrolytic and malabsorptive disorders. Advances in diagnostic methods, combined with advances in maintaining nutritional status, have a positive impact on the prognosis and quality of life of the patient. Conclusion: Despite the enormous advances in diagnostic methods and knowledge of its pathophysiology, the diagnosis of intestinal ischemia remains eminently clinical. The high mortality rates may be related to the difficulty in early diagnosis of intestinal ischemia, and to the lack of specificity of abdominal pain and complementary tests available. It is likely that the incidence of intestinal ischemia is higher than previously recognized.
Isolated duodenal ischemia of unknown etiology: a case report
BMC Surgery
Background Acute abdomen is among the most common presentations observed in clinical practice. The present study describes a patient with isolated duodenal ischemia as an extremely rare etiology of acute abdomen. Case presentation A 79-year-old male with acute abdominal pain, nausea, and vomiting presented to the emergency department of our hospital. He was diagnosed with myelodysplastic syndrome 7 years ago, for which he took thalidomide and erythropoietin as the main medications. The prominent findings of the physical examination were hypotension, tachycardia, fever, mild hypoxemia, and epigastric and right upper quadrant tenderness of the abdomen. Except for mildly increased creatinine and lipase, other laboratory findings were in concordance with myelodysplastic syndrome. Due to the patient’s oliguria, the computed tomography (CT) scan was performed without contrast, which, together with the ultrasonography, raised the clinical impression of acute pancreatitis. The patient’s hyp...
Intestinal Ischemia: US-CT findings correlations
Critical Ultrasound Journal, 2013
Background: Intestinal ischemia is an abdominal emergency that accounts for approximately 2% of gastrointestinal illnesses. It represents a complex of diseases caused by impaired blood perfusion to the small and/ or large bowel including acute arterial mesenteric ischemia (AAMI), acute venous mesenteric ischemia (AVMI), non occlusive mesenteric ischemia (NOMI), ischemia/reperfusion injury (I/R), ischemic colitis (IC). In this study different study methods (US, CT) will be correlated in the detection of mesenteric ischemia imaging findings due to various etiologies. Methods: Basing on experience of our institutions, over 200 cases of mesenteric ischemia/infarction investigated with both US and CT were evaluated considering, in particular, the following findings: presence/absence of arterial/ venous obstruction, bowel wall thickness and enhancement, presence/absence of spastic reflex ileus, hypotonic reflex ileus or paralitic ileus, mural and/or portal/mesenteric pneumatosis, abdominal free fluid, parenchymal ischemia/infarction (liver, kidney, spleen). Results: To make an early diagnosis useful to ensure a correct therapeutic approach, it is very important to differentiate between occlusive (arterial,venous) and nonocclusive causes (NOMI). The typical findings of each forms of mesenteric ischemia are explained in the text. Conclusion: At present, the reference diagnostic modality for intestinal ischaemia is contrast-enhanced CT. However, there are some disadvantages associated with these techniques, such as radiation exposure, potential nephrotoxicity and the risk of an allergic reaction to the contrast agents. Thus, not all patients with suspected bowel ischaemia can be subjected to these examinations. Despite its limitations, US could constitutes a good imaging method as first examination in acute settings of suspected mesenteric ischemia.