Preservation of small bowel with the selective use of heparin and second look laparotomy in acute mesenteric ischaemia: A case report (original) (raw)
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Management Of Bowel Ischemia Secondary To Mesenteric Vein Thrombosis: A Tight Rope Walk
The Internet Journal of Gastroenterology, 2010
Acute superior mesenteric vein (SMV) and portal vein (PV) thrombosis can be a complication of hypercoagulable, inflammatory, or infectious states. It can also occur as a complication of medical or surgical intervention. Management of mesenteric and portal vein thrombosis includes both operative and non-operative approaches. Operative interventions include thrombectomy with thrombolysis; this is often employed for patients who present with signs of peritoneal irritation. Nonoperative approaches can be either noninvasive or invasive. Treatment with anticoagulation has been shown to be efficacious, though its rate of recanalization is not as high as with intravascular infusion of thrombolytics. We here describe an interesting case report of a patient who developed ischemic bowel secondary to mesenteric vein thrombosis, who did not qualify for a surgical emergency and provided an interesting challenge in medical management until surgery finally took over the specific management.
Acute Mesenteric Ischaemia in Surgical Perspective- a Single Institute Experience
Journal of Evidence Based Medicine and Healthcare, 2017
BACKGROUND Acute mesenteric ischaemia is a life-threatening abdominal emergency. It may be the result of an arterial or venous occlusion, a vasospasm secondary to low-flow states in ICU patients. The overall incidence is 1 in 1000 hospital admissions. The objective of this descriptive study was to determine the clinical presentations and outcome after surgery of patients with acute mesenteric ischaemia. It was conducted in Department of Surgical Gastroenterology and Liver Transplantation, BMCRI, Bangalore. MATERIALS AND METHODS Descriptive study of all patients having operative diagnosis of acute mesenteric ischaemia from June 2009 to December 2016 were included. RESULTS Total of 31 patients were studied. Their mean age was 60.12 years, 17 were males and 14 were females. Mean BMI was 32.4. Abdominal pain was present in 26 patients, vomiting in 21 and anorexia in 13 patients. Abdominal tenderness was present in 21 patients, abdominal distension and rebound tenderness in 18 patients. Eighteen patients had hypertension, 10 had coronary artery disease and 20 had diabetes mellitus. Eight patients were in haemodynamic instability and 4 patients in renal failure. Except one patient, all underwent CECT abdomen and pelvis. Four patients were managed conservatively with close monitoring after diagnostic laparoscopy. Resection of bowel was done in 27 patients. Two cases had re-exploration. Nine patients deteriorated haemodynamically as sepsis was irreversible and died subsequently. Common immediate postoperative complications are wound infection, dehiscence, pneumonia, septicaemia and MODS. On followup at 1 month, 9 patients were seen with improved nutritional status without any complications. The common complications noted at 1 st month are persistent diarrhoea, deep wound infection, stromal complications, respiratory infection, melena, etc. CONCLUSION Acute Mesenteric Ischaemia (AMI) is a common condition at a GI referral centre. It is commonly distributed among elderly men and women with pre-existing risk factors. The prognosis depends upon time at presentation, general condition at presentation, associated risk factors, extent of bowel gangrene and extent of bowel resected. In high-risk patients with pain abdomen of unexplained cause, we should have a low threshold for diagnosing acute mesenteric ischaemia as our study showed PPV clinical diagnosis of AMI is 57%.Timely diagnosis will prevent the progression of bowel gangrene and early surgical intervention is warranted for better clinical outcome.
Introduction: Acute mesenteric ischemia is deadly from 50% to 90% of cases due to poor understanding of the clinical picture of abdominal pain and the differential diagnosis when it is not suspected and partly because of an unacceptable delay in making the diagnosis. Clinical case: A 31-year-old female with generalized abdominal pain without peritoneal irritation accompanied by vomiting and loose bowel movements. Vital signs: BP 90/70 mmHg, HR 100/min, BF 20/min, Temperature 96.8°F. Laboratory test: Bh: Hto. 39.4, 42.6/103 leukocytes/uL, 89% neutrophils, 10% lymphocytes; QS: glucose
Acute Mesenteric Ischaemia—An Indian Perspective
Indian Journal of Surgery, 2014
In Western countries, acute mesenteric ischaemia is commonly due to arterial occlusion and occurs in patients who are usually in their seventh decade. A venous cause for intestinal gangrene has been reported in only about 10 %. We examined whether this was so in India and compared the clinical features of patients with mesenteric arterial and venous ischaemia and relate these to their ultimate prognosis. We studied retrospectively, the records of all patients admitted or referred to the department with a diagnosis of acute mesenteric ischaemia between January 1997 and October 2012, noting their demographic details and mode of presentation, the results of preoperative imaging and blood investigations, the extent of bowel ischaemia, and the length of bowel that was resected at operation and their outcome. There were 117 patients, 85 males and 32 females whose median age was 53 years. Mesenteric venous thrombosis was seen in 56 patients (48 %) and mesenteric arterial occlusion in 61 (52 %). Forty six patients died (39 %); 15 with venous occlusion (27 %) and 31 with arterial occlusion (51 %). Compared to patients with arterial occlusion, the patients with venous obstruction were younger, had a longer duration of symptoms, were less frequently hypotensive at presentation, had higher platelet counts, had a shorter length of bowel resected, had fewer colonic resections and had a lower mortality. Other predictors of mortality on multivariate analysis were a longer duration of symptoms, lower serum albumin and higher creatinine levels at presentation and a shorter length of residual bowel. In India, acute mesenteric ischaemia in tertiary care centres is due to venous thrombosis in almost half of the patients who are at least a decade younger than those in the West. Significant predictors of mortality include low serum albumin and raised creatinine levels, a shorter residual bowel length and an arterial cause for mesenteric ischaemia.
Complications of non-occlusive mesenteric ischaemia
Acute Medicine & Surgery, 2015
Case: A 65-year-old arteriopath with a history of myocardial infarction 5 months previously presented with classical signs of mesenteric infarction that led to a right hemicolectomy with an end ileostomy. Outcome: Postoperative complications occurred due to unusually large volume ileostomy output in the subsequent 4 weeks, resulting in severe volume depletion and the sequelae that required intensive care support. These were triggered and prolonged by two episodes of intra-abdominal sepsis. Conclusions: Sepsis-induced high ileostomy output following intestinal resection for non-occlusive mesenteric ischaemia is a serious complication. Early restoration of intestinal continuity following bowel resection for established infarction may prevent this complication.
Journal of the Pakistan Medical Association, 2022
Acute mesenteric ischaemia is one of the serious abdominal surgical emergency, which has got very high morbidity and mortality. During the pandemic of COVID -19, besides respiratory complications, the virus was causing venous and arterial thromboembolism that can lead to acute mesenteric ischaemia in otherwise healthy individuals. Early diagnosis and suitable surgical procedures are the key to the better outcome of this disease. Surgical resection of gangrenous gut, leaving healthy gut is an important step of this operation. Leaving less than 200 cm of small intestine leads to short bowel syndrome which has got its own complication. This case report is on a healthy COVID -19 positive patient who presented with acute mesenteric ischaemia. After surgical resection only 1.5 feet small bowel (60 cm) was left behind and anastomosis was done with healthy transverse colon. ---Continue
Acute mesenteric ischaemia: the continuing difficulty in early diagnosis
1993
Five cases of acute intestinal ischaemia due to occlusion of the superior mesenteric artery, all with a delay in diagnosis, are reported here. These cases illustrate the continuing difficulties, in clinical practice, in recognizing mesenteric ischaemia before intestinal infarction has occurred, despite the clinical awareness of this condition.
Delayed Fatal Hemorrhage Due to Small Bowel Mesenteric Laceration
American Journal of Forensic Medicine and Pathology, 2015
Injuries of small bowel and its mesentery due to blunt trauma are uncommon. Of deaths due to delayed intra-abdominal hemorrhage, mesenteric laceration is a rare cause of hemoperitoneum. A case of a 33-year-old man, who was hospitalized with chest and retroperitoneal trauma after a forklift rollover, is presented. He died 10 days after the incident. At autopsy, he had a massive hemoperitoneum due to a small bowel mesenteric laceration, which was not diagnosed during his clinical course. Microscopic examination of the hematoma around the laceration revealed healing and ruptured pseudoaneurysms in the distal branches of the superior mesenteric artery.
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.
Hybrid Management of Acute Portal Vein Thrombosis Complicated by Mesenteric Ischemia
Journal of endovascular resuscitation and trauma management, 2022
Acute portal vein thrombosis complicated by mesenteric ischemia requires emergent treatment to address the compromised bowel as well as the portal vein thrombus. We report a novel hybrid approach to managing this disease process. The procedure we discuss entails exploratory laparotomy and small bowel resection by the acute care emergency surgery team. Following this, the vascular surgery team performs a portal venogram through a branch mesenteric vein accessed through the laparotomy incision and then places a thrombolysis catheter. This technique and approach allows us to provide initial management efficiently and effectively under one operation.