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Nichtokklusive mesenteriale Ischämie (NOMI)

Moderne diagnostische und therapeutisch interventionelle Strategien aus radiologischer Sicht

Nonocclusive mesenteric ischemia (NOMI)

Modern diagnostic and therapeutic interventional strategies from a radiological point of view

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Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die nichtokklusive Mesenterialischämie (NOMI) ist eine seltene Form der mesenterialen Perfusionsstörungen mit einer hohen Sterblichkeitsrate, die v. a. durch eine verzögerte Diagnosestellung begünstigt wird.

Zielsetzung

Zur Reduktion der Mortalität und Morbidität sind eine Optimierung der Diagnostik und eine Anpassung an moderne diagnostische Möglichkeiten nötig.

Empfohlenes Vorgehen

Neuere Studien empfehlen die bislang nicht standardisierte Einbindung der Computertomographie in den diagnostischen Workflow. Diese Arbeit gibt einen Überblick über die aktuelle Datenlage zur Diagnostik der NOMI.

Abstract

Background

Nonocclusive mesenteric ischemia (NOMI), a rare form of mesenteric perfusion, is associated with a high mortality rate, especially when the diagnosis is delayed.

Objective

Optimizing the diagnostic workup and the use of modern diagnostic possibilities are needed to reduce mortality and morbidity.

Recommended approach

Recent studies recommend not yet standardized integration of computed tomography into the diagnostic workup. This paper gives an overview of the current data for the diagnosis of NOMI.

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Literatur

  1. Sise MJ (2014) Acute mesenteric ischemia. Surg Clin North Am 94:165–181

    Article  PubMed  Google Scholar 

  2. Eris C, Yavuz S, Yalcinkaya S et al (2013) Acute mesenteric ischemia after cardiac surgery: an analysis of 52 patients. ScientificWorldJournal 2013:631534

    Article  PubMed Central  PubMed  Google Scholar 

  3. Oliva IB, Davarpanah AH, Rybicki FJ et al (2013) ACR Appropriateness criteria® imaging of mesenteric ischemia. Abdom Imaging 38:714–719

    Article  PubMed  Google Scholar 

  4. Acosta S, Wadman M, Syk I et al (2010) Epidemiology and prognostic factors in acute superior mesenteric artery occlusion. J Gastrointest Surg 14:628–635

    Article  PubMed  Google Scholar 

  5. Brandt LJ, Boley SJ (1991) Nonocclusive mesenteric ischemia. Annu Rev Med 42:107–117

    Article  CAS  PubMed  Google Scholar 

  6. Trompeter M, Brazda T, Remy CT et al (2002) Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy. Eur Radiol 12:1179–1187

    Article  PubMed  Google Scholar 

  7. Stockmann H, Roblick UJ, Kluge N et al (2000) Diagnosis and therapy of non-occlusive mesenteric ischemia (NOMI). Zentralbl Chir 125:144–151

    CAS  PubMed  Google Scholar 

  8. Brandt LJ, Boley SJ (2000) AGA technical review on intestinal ischemia. Gastroenterology 118:954–968

    Article  CAS  PubMed  Google Scholar 

  9. Barmase M, Kang M, Wig J et al (2011) Role of multidetector CT angiography in the evaluation of suspected mesenteric ischemia. Eur J Radiol 80:e582–e587

    Article  PubMed  Google Scholar 

  10. Nakamura Y, Urashima M, Toyota N et al (2013) Non-occlusive mesenteric ischemia (NOMI): utility of measuring the diameters of the superior mesenteric artery and superior mesenteric vein at multidetector CT. Jpn J Radiol. 10.1007/s11604-013-0245-1

  11. Yikilmaz A, Karahan OI, Senol S et al (2011) Value of multislice computed tomography in the diagnosis of acute mesenteric ischemia. Eur J Radiol 80:297–302

    Article  PubMed  Google Scholar 

  12. Klar E, Rahmanian PB, Bucker A et al (2012) Acute mesenteric ischemia: a vascular emergency. Dtsch Arztebl Int 109:249–256

    PubMed Central  PubMed  Google Scholar 

  13. Ernst S, Luther B, Zimmermann N et al (2003) Current diagnosis and therapy of non-occlusive mesenteric ischemia. Rofo 175:515–523

    Article  CAS  PubMed  Google Scholar 

  14. Lock G, Scholmerich J (1995) Non-occlusive mesenteric ischemia. Hepatogastroenterology 42:234–239

    CAS  PubMed  Google Scholar 

  15. Kramer SC, Gorich J, Oertel F et al (2003) Non-occlusive mesenteric ischemia. Rofo 175:1177–1183

    Article  CAS  PubMed  Google Scholar 

  16. Engel A, Adler OB, Loberant N et al (1989) Nonocclusive ischaemic bowel disease in patients on chronic haemodialysis. Rofo 150:704–707

    Article  CAS  PubMed  Google Scholar 

  17. Minko P, Groesdonk H, Stroeder J et al (2012) A scoring system for the assessment of angiographic findings in non-occlusive mesenteric ischemia (NOMI). Rofo 184:805–809

    Article  CAS  PubMed  Google Scholar 

  18. Yasuda T, Takeyama Y, Ueda T et al (2003) Nonocclusive visceral ischemia associated with severe acute pancreatitis. Pancreas 26:95–97

    Article  PubMed  Google Scholar 

  19. Hahn J-M (2013) Checkliste Innere Medizin, 7. Aufl. Georg Thieme Verlag KG, [s.l.]

  20. Markogiannakis H, Memos N, Messaris E et al (2011) Predictive value of procalcitonin for bowel ischemia and necrosis in bowel obstruction. Surgery 149:394–403

    Article  PubMed  Google Scholar 

  21. Lankisch PG, Mahlke R, Lübbers H (2006) Das akute Abdomen aus internistischer Sicht. Dtsch Arztebl 103:A2179–A2188

    Google Scholar 

  22. Grundmann RT, Petersen M, Lippert H, Meyer F (2010) The acute (surgical) abdomen – epidemiology, diagnosis and general principles of management. Z Gastroenterol 48:696–706

    Article  CAS  PubMed  Google Scholar 

  23. Björck M, Wanhainen A (2010) Nonocclusive mesenteric hypoperfusion syndromes: recognition and treatment. Semin Vasc Surg 23:54–64

    Article  PubMed  Google Scholar 

  24. Woodhams R, Nishimaki H, Fujii K et al (2010) Usefulness of multidetector-row CT (MDCT) for the diagnosis of non-occlusive mesenteric ischemia (NOMI): assessment of morphology and diameter of the superior mesenteric artery (SMA) on multi-planar reconstructed (MPR) images. Eur J Radiol 76:96–102

    Article  PubMed  Google Scholar 

  25. Carrie C, Gisbert-Mora C, Quinart A et al (2012) Non-occlusive mesenteric ischemia detected by ultrasound. Intensive Care Med 38:333–334

    Article  PubMed  Google Scholar 

  26. Johnson JO (2012) Diagnosis of acute gastrointestinal hemorrhage and acute mesenteric ischemia in the era of multi-detector row CT. Radiol Clin North Am 50:173–182

    Article  PubMed  Google Scholar 

  27. Radiology ACo (2011) ACR–SPR practice guideline for the performance of diagnostic Computed Tomography (CT) of the abdomen and computed tomography of the pelvis

  28. Mitsuyoshi A, Obama K, Shinkura N et al (2007) Survival in nonocclusive mesenteric ischemia: early diagnosis by multidetector row computed tomography and early treatment with continuous intravenous high-dose prostaglandin E(1). Ann Surg 246:229–235

    Article  PubMed Central  PubMed  Google Scholar 

  29. Furukawa A, Kanasaki S, Kono N et al (2009) CT diagnosis of acute mesenteric ischemia from various causes. AJR Am J Roentgenol 192:408–416

    Article  PubMed  Google Scholar 

  30. Wessling J, Buerke B (2012) CT und MRT des Dünndarms. Radiologie up2date 12:203–227

    Article  Google Scholar 

  31. Siegelman SS, Sprayregen S, Boley SJ (1974) Angiographic diagnosis of mesenteric arterial vasoconstriction. Radiology 112:533–542

    Article  CAS  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Kammerer, M. Köhler, C. Schülke, P. Lebiedz, W. Heindel und B. Buerke geben an, dass kein Interessenkonflikt besteht.

Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigen oder des gesetzlich bestellten Betreuers vor.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Institut für Klinische Radiologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland

    S. Kammerer, M. Köhler, C. Schülke, W. Heindel & B. Buerke

  2. Department für Kardiologie und Angiologie, Schwerpunkt internistische Intensivmedizin/ Notfallmedizin, Universitätsklinikum Münster, Münster, Deutschland

    P. Lebiedz

Authors
  1. S. Kammerer
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  2. M. Köhler
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  3. C. Schülke
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  4. P. Lebiedz
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  5. W. Heindel
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  6. B. Buerke
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Correspondence to S. Kammerer.

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Kammerer, S., Köhler, M., Schülke, C. et al. Nichtokklusive mesenteriale Ischämie (NOMI). Med Klin Intensivmed Notfmed 110, 545–550 (2015). https://doi.org/10.1007/s00063-014-0420-x

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  • DOI: https://doi.org/10.1007/s00063-014-0420-x

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