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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Mesenteric ischemia usually occurs in elderly patients, especially those with predisposing factors. It has also been described in young patients using oral contraceptive pills or illicit drugs. We present a case of a middle-aged woman who developed acute focal ischemia of the small intestine without predisposing factors. The unusual presentation of this patient, combined with her relative youth, obscured the diagnosis, which was ultimately made at laparotomy. The diagnosis of mesenteric ischemia should be considered in patients of any age presenting with recurrent or severe abdominal pain, particularly when no alternative cause is apparent. The definitive study to diagnose mesenteric ischemia is angiography. Unless identified early in its course, the condition may progress to frank infarction with a significant increase in morbidity and mortality. Because of this, an aggressive approach to the diagnosis and therapy of mesenteric ischemia is essential.
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PMID:Acute mesenteric ischemia in a middle-aged patient: case report and discussion. 874 45

In summary, we report two cases of mesenteric ischemia following cocaine abuse in young women. In such cases it is always difficult to prove a direct causal relationship between the abuse of cocaine and mesenteric ischemia. Both our patients were relatively young (in their thirties) and did not have any history of atherosclerosis, and their urine toxicity screens were positive for the use of cocaine. Cocaine-related hospital visits are on the increase. Mesenteric ischemia should be considered in the differential diagnosis when evaluating a young patient with a history of cocaine abuse presenting with an acute abdomen.
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PMID:Mesenteric ischemia secondary to cocaine abuse: case reports and literature review. 917 33

Abdominal vascular catastrophes are due to rupture of arterial aneurysms or arterial occlusion leading to end organ ischemia. In this article, we will discuss rupture of abdominal aortic aneurysms and visceral artery aneurysms. Arterial occlusion secondary to embolism, thrombosis and dissection will be presented. Mesenteric ischemia secondary to low flow states, venous thrombosis and other conditions will also be covered. These uncommon, but frequently fatal pathological processes, are of interest to both general and vascular surgeons.
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PMID:Abdominal vascular catastrophes. 943 41

Acute mesenteric ischemia is a rare but severe complication after open heart surgery. Its incidence (0.2-0.4%) is quite low, but mortality rates are ranging between 70% and 100%. From October 1992 to December 1996, 4,640 patients underwent open heart surgery with cardiopulmonary bypass: 74.6% coronary artery bypass graft (CABG) operations, 23.2% valve replacement including aortic repairs, and 2.2% corrections of congenital heart diseases or tumors of the heart. The overall mortality rate (30 days) was 3.4%, and after CABG, 2.9%. Twelve patients (0.26%), following CABG (one combined with aortic valve replacement, one with mitral reconstruction, and one with carotid disobliteration) developed signs of acute mesenteric ischemia in the early postoperative period (day 1 to 5). In all patients various abdominal symptoms, leukocytosis, acidosis, hyperlactatemia, hyperosmolality, renal failure, and, finally, hemodynamic instability were observed. Eleven patients underwent emergency laparotomy. Mesenteric angiography was done if possible in still stable patients (n=7); it showed severe stenosis or occlusion prior to the operation in each case. Other diagnostic methods were not reliable. In six patients (55%) during the first look, extensive bowel necrosis was found and in five patients an ischemic intestine but no necrosis was detected. Of these, three patients were affected by extensive bowel gangrene at the second look. In the fourth patient a disseminated peripheral ischemia of the entire small intestine was found intraoperatively. After mechanical release and stimulation normal bowel function could be reestablished. One patient underwent percutaneous transluminal angioplasty prior to the laparotomy. Bowel perfusion was still deteriorated but no necrosis was found intraoperatively. These patients were the only survivors in the investigated group; 10 of 12 patients (83.3%) died in the early postoperative period (day 1 to day 6). Predisposing factors for mesenteric ischemia are: arteriosclerotic patients after CABG (100%), age >70 years (91.7%), hyperosmotic dehydration (100%), and cardiac ischemia in 25%. Mesenteric ischemia is a fatal complication with high mortality rates after open heart surgery, especially in older, dehydrated patients with generalized atherosclerotic vessel disease. As the acute mesenteric ischemia usually starts during anesthesia or in the early postoperative period, setting of immediate diagnosis is very difficult. With the occurrence of typical symptoms diagnostic and therapeutic procedures (angiography and laparotomy) must be done very urgently owing to the life-threatening mesenteric process. When mesenteric gangrene already has taken place, the prognosis is very poor, despite extensive resection. Prevention can be exercised by avoiding perioperative hyperosmotic dehydration of patients at high risk.
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PMID:Acute mesenteric ischemia after open heart surgery. 955 29

Mesenteric ischemia following intestinal infarction caused by occlusion of the superior mesenteric artery is a rare and devastating disease. The overall mortality is a high as 80%. The purpose of this prospective study was to investigate erythrocyte flux to defined areas of the intestine immediately after laparotomy by using laser Doppler flowmetry (LDF) assessment. We tried to predict the intestinal viability and recovery of the small bowel, and further tried to define the level of critical perfusion below which intestinal resection is indicated. 13 patients undergoing surgery for acute mesenteric ischemia were prospectively studied. Multiple LDF assessment of bowel blood flow (4 records/segment) were performed on 48 ischemically injured bowel segments intraoperatively. All patients underwent a second-look procedure within 48 h to define the viability of the previously suspicious segments. All 18 resected bowel segments were histologically evaluated for the extent of ischemia. In addition clinical judgement as well as histological findings were compared with the laser Doppler records. There was a 19% (9 of 48) incidence of histologically proven nonviable bowel segments with a significant decrease in intestinal erythrocyte flux below 50 perfusion units intraoperatively in all those patients. But there was a 50% (9 of 18) incidence of nonviable segments among the clinically proven viable and subsequently resected segments, only. Therefore, clinical judgement alone had a overall accuracy of 87% and a predictive value of only 69%, compared to the 100% overall accuracy, sensitivity and predictive values of LDF assessment. The results of this study demonstrate that LDF is a sensitive guide and feasible method to evaluate and define the viability of ischemically injured intestine.
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PMID:Intraoperative laser Doppler flowmetry: a predictor of ischemic injury in acute mesenteric infarction. 984 64

Mesenteric ischemia after cardiac surgery is rare but dramatic. We present a patient who had acute mesenteric ischemia following low cardiac output after coronary artery bypass grafting. Our patient was successfully treated with continuous intra-arterial perfusion with papaverine. We think that selective angiography must be performed as early as mesenteric ischemia is suspected, to get earlier diagnosis and treatment of an ischemic patient.
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PMID:Mesenteric ischemia after coronary artery bypass grafting: should local continuous intra-arterial perfusion with papaverine be regarded as a treatment? 1021 60

Mesenteric ischemia is a well-recognized clinical entity among the elderly. Although first described more than 500 years ago, advances in both diagnostic and treatment regimens only minimally have improved on the bleak morbidity and mortality rates associated with this disease. Significant progress, however, has been made in understanding the pathophysiology behind a visceral vascular compromise. Using this knowledge, physicians have been able to rechannel their efforts. Rather than focusing on the development of new treatment options for bowel infarction, physicians place more emphasis on the prevention and early detection of bowel ischemia. The goal is to identify accurately individuals at risk and intervene medically before irreversible infarction occurs. After briefly discussing the history, epidemiology, and pathophysiology of mesenteric ischemia, this article reviews the past, current, and future approaches to the diagnosis and treatment of this challenging condition.
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PMID:Mesenteric ischemia in the elderly. 1039 40

We report a case of acute type I aortic dissection with ischemic enterocolitis due to blood flow insufficiency in the superior mesenteric artery. The patient was a 52-year-old man who visited the hospital with major complaints of sudden low back pain and melena. Mesenteric ischemia was suspected, and angiography revealed type I aortic dissection with accompanying blood flow insufficiency in the superior mesenteric artery. Because catheterization during angiography improved the blood flow disorder and prevented intestinal necrosis, it was possible to replace the ascending aorta with a prosthetic graft. Arterial pulsation in the mesentery was recovered by the operation and the patient's life was saved without bowel resection. This case demonstrates that prompt surgical or percutaneous relief of ischemia in major organs is important to save lives in the cases of acute aortic dissection with ischemic complications.
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PMID:Type I acute aortic dissection accompanied by ischemic enterocolitis due to blood flow insufficiency in the superior mesenteric artery. 1051 43

Mesenteric ischemia is a life threatening event instead of colic ischemia which recovers in 90% of cases. Three points will be investigated: chronic mesenteric ischemia; acute mesenteric ischemia; colic ischemia.
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PMID:[Diagnostic strategies for ischemic enteropathies]. 1106 87

Mesenteric ischemia is a complicated disorder whose prevalence in the United States is increasing as the population ages. It is often difficult to diagnose, both clinically and radiologically. In the past, computed tomography (CT) has allowed only limited success in the early detection of ischemia. However, with the introduction of multi-detector row CT and three-dimensional (3D) imaging, it is now possible to perform a detailed CT examination of the small bowel and mesenteric vessels. Multi-detector row CT allows routine studies to be performed much faster than with single-detector CT scanners and makes available new applications, especially in the field of CT angiography. Its increased speed and narrower collimation, coupled with the use of water as an oral contrast agent, improve visualization of the bowel wall and mesenteric vasculature. Multi-detector row CT with 3D reformatting may improve the ability to make an early diagnosis and identify the cause of disease in patients with suspected acute or chronic mesenteric ischemia. In many cases, this examination has eliminated the need for additional imaging studies such as Doppler ultrasonography or angiography. Further investigation will be needed to determine the scope of the utility of multi-detector row CT in this clinical setting.
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PMID:Multi-detector row CT of mesenteric ischemia: can it be done? 1170 17


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