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World Journal of Surgery

, Volume 42, Issue 8, pp 2364–2372 | Cite as

Predictive Factors for Intestinal Transmural Necrosis in Patients with Acute Mesenteric Ischemia

  • Sameh Hany Emile
Original Scientific Report

Abstract

Background

Acute mesenteric ischemia (AMI) is a serious and potentially fatal condition. No definite parameter can predict transmural bowel necrosis in patients with AMI to justify early surgical intervention. The current study aimed to identify the clinical, laboratory, and radiologic parameters that can successfully predict the onset of intestinal transmural necrosis in patients with AMI.

Patients and methods

Records of patients with AMI in the period of January 2013 to October 2017 were reviewed. Clinical parameters as patients’ symptoms, vital signs, and signs of peritonitis along with the results of laboratory and radiologic investigations were analyzed to identify predictive factors for intestinal transmural necrosis using binary logistic regression analysis.

Results

One hundred and one patients (70 males) with mean age of 55 years were included. Venous occlusion was the cause of AMI in 78 (77.3%) patients and arterial occlusion in 23 (22.7%) patients. Twenty-two patients completed conservative treatment successfully, whereas 79 patients required exploratory laparotomy. On laparotomy, six patients were found to have viable bowel. Overall, 28 patients had viable bowel and 73 had bowel necrosis. The significant independent predictors for transmural bowel necrosis were mesenteric arterial occlusion (OR: 26.5, p = 0.02), leukocytosis (OR: 1.3, p < 0.0001), acidosis (OR: 3.8, p = 0.04), free intraperitoneal fluid (OR: 4.21, p = 0.005), and combined portal vein and SMV thrombosis in CT scan (OR: 3.4, p = 0.026).

Conclusion

The independent predictors for transmural bowel necrosis were mesenteric arterial occlusion, leukocytosis, acidosis, free intraperitoneal fluid, and combined portal vein and SMV thrombosis in CT scan.

Notes

Compliance with ethical standards

Conflict of interest

None to be declared by the author.

References

  1. 1.
    Sachs SM, Morton JH, Schwartz SI (1982) Acute mesenteric ischemia. Surgery 92(4):646–653PubMedGoogle Scholar
  2. 2.
    Chang RW, Chang JB, Longo WE (2006) Update in management of mesenteric ischemia. World J Gastroenterol 12(20):3243–3247CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Mamode N, Pickford I, Leiberman P (1999) Failure to improve outcome in acute mesenteric ischaemia: seven-year review. Eur J Surg 165(3):203–208CrossRefPubMedGoogle Scholar
  4. 4.
    Kim MY, Suh CH, Kim ST, Lee JH, Kong K, Lim TH et al (2004) Magnetic resonance imaging of bowel ischemia induced by ligation of superior mesenteric artery and vein in a cat model. J Comput Assist Tomogr 28(2):187–192CrossRefPubMedGoogle Scholar
  5. 5.
    Altinyollar H, Boyabatli M, Berberoglu U (2006) D-dimer as a marker for early diagnosis of acute mesenteric ischemia. Thromb Res 117:463CrossRefPubMedGoogle Scholar
  6. 6.
    Kozuch PL, Brandt LJ (2005) Review article: diagnosis and management of mesenteric ischaemia with an emphasis on pharmacotherapy. Aliment Pharmacol Ther 21(3):201–215CrossRefPubMedGoogle Scholar
  7. 7.
    Acosta-Mérida MA, Marchena-Gómez J, Cruz-Benavides F, Hernández-Navarro J, Roque-Castellano C, Rodríguez-Méndez A et al (2007) Predictive factors of massive intestinal necrosis in acute mesenteric ischemia. Cir Esp 81(3):144–149CrossRefPubMedGoogle Scholar
  8. 8.
    Nuzzo A, Maggiori L, Ronot M, Becq A, Plessier A, Gault N et al (2017) Predictive factors of intestinal necrosis in acute mesenteric ischemia: prospective study from an intestinal stroke center. Am J Gastroenterol 112(4):597–605.  https://doi.org/10.1038/ajg.2017.38 CrossRefPubMedGoogle Scholar
  9. 9.
    Duran R, Denys AL, Letovanec I, Meuli RA, Schmidt S (2012) Multidetector CT features of mesenteric vein thrombosis. RSNA radiogr.  https://doi.org/10.1148/rg.325115100 CrossRefGoogle Scholar
  10. 10.
    Dang CV (2017) Acute mesenteric ischemia. Medscape. https://emedicine.medscape.com/article/189146-overview. Accessed 3 Nov 2017
  11. 11.
    Leone M, Bechis C, Baumstarck K et al (2015) Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases. Intens Care Med 41:667–676CrossRefGoogle Scholar
  12. 12.
    Brandt LJ, Boley SJ (2000) AGA technical review on intestinal ischemia. American Gastrointestinal Association. Gastroenterology 118:954–968CrossRefPubMedGoogle Scholar
  13. 13.
    Nuzzo A, Corcos O (2016) Reversible acute mesenteric ischemia. N Engl J Med 375:e31CrossRefPubMedGoogle Scholar
  14. 14.
    Corcos O, Castier Y, Sibert A et al (2013) Effects of a multimodal management strategy for acute mesenteric ischemia on survival and intestinal failure. Clin Gastroenterol Hepatol 11:158–165CrossRefPubMedGoogle Scholar
  15. 15.
    Kandeel A, Genedy M, El-Refai S, Funk AL, Fontanet A, Talaat M (2017) The prevalence of hepatitis C virus infection in Egypt 2015: implications for future policy on prevention and treatment. Liver Int 37(1):45–53.  https://doi.org/10.1111/liv.13186 CrossRefPubMedGoogle Scholar
  16. 16.
    Schnabl B (2013) Linking intestinal homeostasis and liver disease. Curr Opin Gastroenterol 29(3):264–270.  https://doi.org/10.1097/MOG.0b013e32835ff948 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Furukawa A, Kanasaki S, Kono N et al (2009) CT diagnosis of acute mesenteric ischemia from various causes. AJR Am J Roentgenol 192(2):408–416.  https://doi.org/10.2214/AJR.08.1138 CrossRefPubMedGoogle Scholar
  18. 18.
    Sise MJ (2010) Mesenteric ischemia: the whole spectrum. Scand J Surg 99:106–110CrossRefPubMedGoogle Scholar
  19. 19.
    Kaplan LJ (2017) Systemic inflammatory response syndrome. Medscape. https://emedicine.medscape.com/article/168943-overview. Accessed 3 Nov 2017
  20. 20.
    Akyıldız HY, Sözüer E, Uzer H, Baykan M, Oz B (2015) The length of necrosis and renal insufficiency predict the outcome of acute mesenteric ischemia. Asian J Surg 38(1):28–32.  https://doi.org/10.1016/j.asjsur.2014.06.001 CrossRefPubMedGoogle Scholar
  21. 21.
    Demir IE, Ceyhan GO, Friess H (2012) Beyond lactate: is there a role for serum lactate measurement in diagnosing acute mesentericischemia? Dig Surg 29(3):226–235.  https://doi.org/10.1159/000338086 CrossRefPubMedGoogle Scholar
  22. 22.
    Acosta S, Nilsson T (2012) Current status on plasma biomarkers for acute mesenteric ischemia. J Thromb Thrombolysis 33:355–361CrossRefPubMedGoogle Scholar
  23. 23.
    Lange H, Toivola A (1997) Warning signals in acute abdominal disorders. Lactate is the best marker of mesenteric ischemia. Lakartidningen 94(20):1893–1896PubMedGoogle Scholar
  24. 24.
    Studer P, Vaucher A, Candinas D, Schnüriger B (2015) The value of serial serum lactate measurements in predicting the extent of ischemic bowel and outcome of patients suffering acute mesenteric ischemia. J Gastrointest Surg 19(4):751–755.  https://doi.org/10.1007/s11605-015-2752-0 CrossRefPubMedGoogle Scholar
  25. 25.
    Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD (2004) Acute mesenteric ischemia: a clinical review. Arch Intern Med 164:1054–1062CrossRefPubMedGoogle Scholar
  26. 26.
    Muniraj T, Dang S, Pitchumoni CS (2015) Pancreatitis or not?—Elevated lipase and amylase in ICU patients. J Crit Care 30(6):1370–1375CrossRefPubMedGoogle Scholar
  27. 27.
    Van den Heijkant TC, Aerts BA, Teijink JA, Buurman WA, Luyer MD (2013) Challenges in diagnosing mesenteric ischemia. World J Gastroenterol WJG 19(9):1338–1341.  https://doi.org/10.3748/wjg.v19.i9.1338 CrossRefPubMedGoogle Scholar
  28. 28.
    Hmoud B, Singal AK, Kamath PS (2014) Mesenteric venous thrombosis. J Clin Exp Hepatol 4:257–263.  https://doi.org/10.1016/j.jceh.2014.03.052 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Clair DG, Beach JM (2016) Mesenteric ischemia. N Engl J Med 374:959–968.  https://doi.org/10.1056/nejmra1503884 CrossRefPubMedGoogle Scholar
  30. 30.
    Yikilmaz A, Karahan OI, Senol S, Tuna IS, Akyildiz HY (2011) Value of multislice computed tomography in the diagnosis of acute mesenteric ischemia. Eur J Radiol 80(2):297–302CrossRefPubMedGoogle Scholar
  31. 31.
    Reginelli A, Genovese E, Cappabianca S et al (2013) Intestinal ischemia: US-CT findings correlations. Crit Ultrasound J 5(Suppl 1):S7.  https://doi.org/10.1186/2036-7902-5-S1-S7 CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Tilsed JVT, Casamassima A, Kurihara H et al (2016) ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg 42:253–270.  https://doi.org/10.1007/s00068-016-0634-0 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Bala M, Kashuk J, Moore EE et al (2017) Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg WJES 12:38.  https://doi.org/10.1186/s13017-017-0150-5 CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  1. 1.General Surgery Department, Mansoura Faculty of MedicineMansoura University HospitalsMansoura CityEgypt

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