Advertisement

Acute Intestinal Ischemia in Adults: Evidence-Based Emergency Imaging

  • Lisa P. LavelleEmail author
  • Sinead H. McEvoy
  • Anne G. Carroll
  • Richard G. Kavanagh
  • Jeffrey W. McCann
  • Dermot E. Malone
  • Michael Cline
Chapter
Part of the Evidence-Based Imaging book series (Evidence-Based Imag.)

Abstract

Acute intestinal ischemia is defined as inadequate blood supply to the gut. It has a high mortality rate, ranging between 32% and 93% depending on etiology. Acute intestinal ischemia may be caused by arterial or venous occlusion or by nonocclusive hypoperfusion states. The incidence increases with age and the majority of patients are over the age of 60. A high index of clinical suspicion is necessary for early detection and treatment of acute intestinal ischemia as signs, symptoms, and laboratory tests for intestinal ischemia are nonspecific. Multidetector computed tomography angiography is highly sensitive and specific in detecting small bowel ischemia and may be used as a first-line imaging method. In patients for whom contrast-enhanced computed tomography is contraindicated, abdominal radiographs are of little value in the diagnosis of intestinal ischemia; however, ultrasound and magnetic resonance angiography may be used as alternative imaging modalities. While surgery is the mainstay of treatment of acute intestinal ischemia, endovascular revascularization can be considered in patients without clinical evidence of peritonitis but with radiological evidence of advanced ischemia and recent onset of symptoms and with a low threshold for converting to open surgery if required.

Keywords

Intestinal ischemia Computed tomography Ultrasound Magnetic resonance imaging Endovascular Evidence-based imaging Emergency imaging 

References

  1. 1.
    Acosta S, Ogren M, Sternby NH, et al. Eur J Vasc Endovasc Surg. 2004;27(2):145–50.CrossRefGoogle Scholar
  2. 2.
    Schoots IG, Koffeman GI, Legemate DA, et al. Br J Surg. 2004;91(1):17–27.CrossRefGoogle Scholar
  3. 3.
    Bartone G, Severino BU, Armellino MF, et al. Radiol Clin N Am. 2008;46(5):887–9. vCrossRefGoogle Scholar
  4. 4.
    Sreenarasimhaiah J. BMJ. 2003;326(7403):1372–6.CrossRefGoogle Scholar
  5. 5.
    Rhee RY, Gloviczki P, Mendonca CT, et al. J Vasc Surg. 1994;20(5):688–97.CrossRefGoogle Scholar
  6. 6.
    Paterno F, Longo WE. Radiol Clin N Am. 2008;46(5):877–85. vCrossRefGoogle Scholar
  7. 7.
    Gore RM, Yaghmai V, Thakrar KH, et al. Radiol Clin N Am. 2008;46(5):845–75. vCrossRefGoogle Scholar
  8. 8.
    Wiesner W, Khurana B, Ji H, et al. Radiology. 2003;226(3):635–50.CrossRefGoogle Scholar
  9. 9.
    Landow L, Andersen LW. Acta Anaesthesiol Scand. 1994;38(7):626–39.CrossRefGoogle Scholar
  10. 10.
    Romano S, Niola R, Maglione F, et al. Radiol Clin N Am. 2008;46(5):891–908. viCrossRefGoogle Scholar
  11. 11.
    Moschetta M, Telegrafo M, Rella L, et al. World J Radiol. 2014;6(5):130–8.CrossRefGoogle Scholar
  12. 12.
    Horton KM, Fishman EK. Radiographics. 2001;21(6):1463–73.CrossRefGoogle Scholar
  13. 13.
    Ho LM, Paulson EK, Thompson WM. AJR Am J Roentgenol. 2007;188(6):1604–13.CrossRefGoogle Scholar
  14. 14.
  15. 15.
    Whiting PF, Weswood ME, Rutjes AW, et al. BMC Med Res Methodol. 2006;6:9.CrossRefGoogle Scholar
  16. 16.
    Akyildiz H, Akcan A, Ozturk A, et al. Am J Surg. 2009;197(4):429–33.CrossRefGoogle Scholar
  17. 17.
    Aschoff AJ, Stuber G, Becker BW, et al. Abdom Imaging. 2009;34(3):345–57.CrossRefGoogle Scholar
  18. 18.
    Kirkpatrick ID, Kroeker MA, Greenberg HM. Radiology. 2003;229(1):91–8.CrossRefGoogle Scholar
  19. 19.
    Ofer A, Abadi S, Nitecki S, et al. Eur Radiol. 2009;19(1):24–30.CrossRefGoogle Scholar
  20. 20.
    Wiesner W, Hauser A, Steinbrich W. Eur Radiol. 2004;14(12):2347–56.CrossRefGoogle Scholar
  21. 21.
    Zandrino F, Musante F, Gallesio I, et al. Minerva Gastroenterol Dietol. 2006;52(3):317–25.PubMedGoogle Scholar
  22. 22.
    Cudnik MT, Darbha S, Jones J, et al. Acad Emerg Med Off J Soc Acad Emerg Med. 2013;20(11):1087–100.CrossRefGoogle Scholar
  23. 23.
    Menke J. Radiology. 2010;256(1):93–101.CrossRefGoogle Scholar
  24. 24.
    Barmase M, Kang M, Wig J, et al. Eur J Radiol. 2011;80(3):e582–7.CrossRefGoogle Scholar
  25. 25.
    Blachar A, Barnes S, Adam SZ, et al. Emerg Radiol. 2011;18(5):385–94.CrossRefGoogle Scholar
  26. 26.
    Yikilmaz A, Karahan OI, Senol S, et al. Eur J Radiol. 2011;80(2):297–302.CrossRefGoogle Scholar
  27. 27.
    Oliva IB, Davarpanah AH, Rybicki FJ, et al. Abdom Imaging. 2013;38(4):714–9.CrossRefGoogle Scholar
  28. 28.
    Wyers MC. Semin Vasc Surg. 2010;23(1):9–20.CrossRefGoogle Scholar
  29. 29.
    Acosta S, Bjorck M. Br J Surg. 2014;101(1):e100–8.CrossRefGoogle Scholar
  30. 30.
    Beaulieu RJ, Arnaoutakis KD, Abularrage CJ, et al. J Vasc Surg. 2014;59(1):159–64.CrossRefGoogle Scholar
  31. 31.
    Bjornsson S, Resch T, Acosta S. J Gastrointest Surg. 2013;17(5):973–80.CrossRefGoogle Scholar
  32. 32.
    Arthurs ZM, Titus J, Bannazadeh M, et al. J Vasc Surg. 2011;53(3):698–704. discussion 5CrossRefGoogle Scholar
  33. 33.
    Jia Z, Jiang G, Tian F, et al. Eur J Vasc Endovasc Surg. 2014;47(2):196–203.CrossRefGoogle Scholar
  34. 34.
    Karkkainen JM, Lehtimaki TT, Saari P, et al. Cardiovasc Intervent Radiol. 2015;38(5):1119–29.CrossRefGoogle Scholar
  35. 35.
    Brandt LJ, Boley SJ. Gastroenterology. 2000 May;118(5):954–68.CrossRefGoogle Scholar
  36. 36.
    ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA) Res. 36–2011, Amended 2014 (Res. 39).Google Scholar
  37. 37.
    Bae KT, Heiken JP. Eur Radiol. 2005;15(Suppl 5):E46–59.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Lisa P. Lavelle
    • 1
    Email author
  • Sinead H. McEvoy
    • 1
  • Anne G. Carroll
    • 1
  • Richard G. Kavanagh
    • 1
  • Jeffrey W. McCann
    • 1
  • Dermot E. Malone
    • 1
  • Michael Cline
    • 2
  1. 1.Department of RadiologySt. Vincent’s University HospitalDublinIreland
  2. 2.Department of RadiologyInterventional Radiology Resident, Michigan MedicineAnn ArborUSA

Personalised recommendations