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Colonic involvement in acute mesenteric ischemia: prevalence, risk factors, and outcomes

  • Emergency Radiology
  • Published:
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Abstract

Objectives

This study aimed to investigate the prevalence, risk factors, and outcomes of colonic involvement in patients with acute mesenteric ischemia (AMI).

Methods

CT scans from a prospective cohort of 114 AMI patients treated in an intestinal stroke center between 2009 and 2018 were blindly reviewed by two radiologists. Colon involvement was defined on CT scan by the presence of at least one of the following CT colonic features: wall thickening, pneumatosis, decreased wall enhancement, dilatation, or perforation. In addition, the clinical, biological, and radiological characteristics of patients with and without colonic involvement were compared to identify risk factors for colonic involvement on CT and its impact on morbidity and mortality.

Results

Colonic involvement was identified in 32/114 (28%) patients with AMI, the right colon being more frequently involved (n = 29/32, 91%). Wall thickening (n = 27/32) was the most common CT finding. Occlusion of the inferior mesenteric artery was the only statistically significant risk factor for colonic involvement (35% vs. 15%, p = 0.02). Patients with colonic involvement on CT vs. those without had more frequently transmural colonic necrosis (13% vs. 0%, p = 0.006), short bowel syndrome (16% vs. 4%, p = 0.04), need for long-term parenteral support (19% vs. 5%, p = 0.03), and death during follow-up (22% vs. 10%, p = 0.03).

Discussion

In patients with AMI, colonic involvement is associated with increased morbidity and mortality and should be carefully searched for during initial CT scan assessment.

Key Points

• In a prospective cohort of acute mesenteric ischemia patients from an intestinal stroke center, 28% had an associated colonic involvement on CT.

• Colonic involvement on CT most commonly affected the right colon, and the occlusion of the inferior mesenteric artery was the only risk factor.

• Colonic involvement on CT was associated with increased morbidity and mortality and should be carefully searched for during initial CT scan assessment.

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Abbreviations

AMI:

Acute mesenteric ischemia

CA:

Celiac artery

CT:

Computed tomography

IMA:

Inferior mesenteric artery

SBS:

Short bowel syndrome

SMA:

Superior mesenteric artery

References

  1. Longstreth GF, Yao JF (2009) Epidemiology, clinical features, high-risk factors, and outcome of acute large bowel ischemia. Clin Gastroenterol Hepatol 7(10):1075–80 e1–2; quiz 23

  2. Brandt LJ, Feuerstadt P, Longstreth GF, Boley SJ, American College of Gastroenterology (2015) ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI). Am J Gastroenterol 110(1):18–44; quiz 5

  3. Cappell MS (2004) Colonic toxicity of administered drugs and chemicals. Am J Gastroenterol 99(6):1175–1190

    Article  CAS  Google Scholar 

  4. Hass DJ, Kozuch P, Brandt LJ (2007) Pharmacologically mediated colon ischemia. Am J Gastroenterol 102(8):1765–1780

    Article  Google Scholar 

  5. Ten Heggeler LB, van Dam LJ, Bijlsma A et al (2017) Colon ischemia: right-sided colon involvement has a different presentation, etiology and worse outcome A large retrospective cohort study in histology proven patients. Best Pract Res Clin Gastroenterol 31(1):111–117

    Article  Google Scholar 

  6. Aliosmanoglu I, Gul M, Kapan M et al (2013) Risk factors effecting mortality in acute mesenteric ischemia and mortality rates: a single center experience. Int Surg 98(1):76–81

    Article  Google Scholar 

  7. Acosta-Merida MA, Marchena-Gomez J, Hemmersbach-Miller M, Roque-Castellano C, Hernandez-Romero JM (2006) Identification of risk factors for perioperative mortality in acute mesenteric ischemia. World J Surg 30(8):1579–1585

    Article  Google Scholar 

  8. Nuzzo A, Corcos O (2016) Reversible acute mesenteric ischemia. N Engl J Med. 375(15):e31

    Article  Google Scholar 

  9. Garzelli L, Nuzzo A, Copin P et al (2020) Contrast-enhanced CT for the diagnosis of acute mesenteric ischemia. AJR Am J Roentgenol 215(1):29–38

    Article  Google Scholar 

  10. Nuzzo A, Maggiori L, Ronot M 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

    Article  Google Scholar 

  11. Nuzzo A, Joly F, Ronot M et al (2020) Normal lactate and unenhanced CT-scan result in delayed diagnosis of acute mesenteric ischemia. Am J Gastroenterol 115(11):1902–1905

    Article  Google Scholar 

  12. 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(2):158–165 e2

  13. Nuzzo A, Maggiori L, Paugam-Burtz C et al (2019) Oral antibiotics reduce intestinal necrosis in acute mesenteric ischemia: a prospective cohort study. Am J Gastroenterol 114(2):348–351

    Article  Google Scholar 

  14. von Elm E, Altman DG, Egger M et al (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370(9596):1453–1457

    Article  Google Scholar 

  15. Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ (1995) Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 23(10):1638–1652

    Article  CAS  Google Scholar 

  16. Raff GL, Abidov A, Achenbach S et al (2009) SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr 3(2):122–136

    Article  Google Scholar 

  17. Yang S, Zhao Y, Chen J et al (2019) Clinical features and outcomes of patients with acute mesenteric ischemia and concomitant colon ischemia: a retrospective cohort study. J Surg Res 233:231–239

    Article  Google Scholar 

  18. Oliva IB, Davarpanah AH, Rybicki FJ et al (2013) ACR Appropriateness Criteria (R) imaging of mesenteric ischemia. Abdom Imaging 38(4):714–719

    Article  Google Scholar 

  19. Balthazar EJ, Yen BC, Gordon RB (1999) Ischemic colitis: CT evaluation of 54 cases. Radiology 211(2):381–388

    Article  CAS  Google Scholar 

  20. Cruz C, Abujudeh HH, Nazarian RM, Thrall JH (2015) Ischemic colitis: spectrum of CT findings, sites of involvement and severity. Emerg Radiol 22(4):357–365

    Article  Google Scholar 

  21. Copin P, Ronot M, Nuzzo A et al (2018) Inter-reader agreement of CT features of acute mesenteric ischemia. Eur J Radiol 105:87–95

    Article  Google Scholar 

  22. Romano S, Romano L, Grassi R (2007) Multidetector row computed tomography findings from ischemia to infarction of the large bowel. Eur J Radiol 61(3):433–441

    Article  Google Scholar 

  23. Feuerstadt P, Aroniadis O, Brandt LJ (2015) Features and outcomes of patients with ischemia isolated to the right side of the colon when accompanied or followed by acute mesenteric ischemia. Clin Gastroenterol Hepatol 13(11):1962–1968

    Article  Google Scholar 

  24. Thornton E, Mendiratta-Lala M, Siewert B, Eisenberg RL (2011) Patterns of fat stranding. AJR Am J Roentgenol 197(1):W1-14

    Article  Google Scholar 

  25. Pereira JM, Sirlin CB, Pinto PS, Jeffrey RB, Stella DL, Casola G (2004) Disproportionate fat stranding: a helpful CT sign in patients with acute abdominal pain. Radiographics 24(3):703–715

    Article  Google Scholar 

  26. Tonerini M, Calcagni F, Lorenzi S, Scalise P, Grigolini A, Bemi P (2015) Omental infarction and its mimics: imaging features of acute abdominal conditions presenting with fat stranding greater than the degree of bowel wall thickening. Emerg Radiol 22(4):431–436

    Article  Google Scholar 

  27. Nuzzo A, Corcos O (2017) Management of mesenteric ischemia in the era of intestinal stroke centers: the gut and lifesaving strategy. Rev Med Interne 38(9):592–602

    Article  CAS  Google Scholar 

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Funding

Grants from MSD-Avenir and APHP funded the SURVIBIO study. Alexandre Nuzzo received Ph.D. grants from “Fondation de l’Avenir” and the French Gastroenterology Society (SNFGE).

Author information

Authors and Affiliations

  1. Department of Radiology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France

    Aida Ksouri, Pauline Copin, Fanny Bonvalet, Lilian Bozi, Lorenzo Garzelli, Valérie Vilgrain & Maxime Ronot

  2. Department of Pathology, Beaujon Hospital, APHP.Nord, 92110, Clichy, France

    Dominique Cazals-Hatem

  3. Department of Colorectal Surgery, Beaujon Hospital, APHP.Nord, 92110, Clichy, France

    Yves Panis

  4. Université de Paris, INSERM UMR 1148, Laboratory for Vascular Translational Science, 75018, Paris, France

    Yves Panis, Emmanuel Weiss, Yves Castier, Yoram Bouhnik, Olivier Corcos & Alexandre Nuzzo

  5. Intensive Care Unit, Beaujon HospitalAPHP.Nord, 92110, Clichy, France

    Emmanuel Weiss

  6. Department of Vascular Surgery, Bichat Hospital, APHP.Nord, 75018, Paris, France

    Yves Castier

  7. Intestinal Stroke Center, Department of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, APHP.Nord, 92110, Clichy, France

    Yoram Bouhnik, Olivier Corcos & Alexandre Nuzzo

  8. UMR 1149, Université de Paris, INSERM, 75018, Paris, CRI, France

    Valérie Vilgrain & Maxime Ronot

Authors
  1. Aida Ksouri
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  2. Pauline Copin
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  3. Fanny Bonvalet
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  4. Lilian Bozi
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  5. Dominique Cazals-Hatem
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  6. Lorenzo Garzelli
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  7. Yves Panis
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  8. Emmanuel Weiss
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  9. Yves Castier
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  10. Yoram Bouhnik
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  11. Olivier Corcos
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  12. Valérie Vilgrain
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  13. Maxime Ronot
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  14. Alexandre Nuzzo
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Corresponding author

Correspondence to Maxime Ronot.

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Guarantor

The scientific guarantor of this publication is Maxime Ronot.

Conflict of Interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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• prospective

• diagnostic or prognostic study

• performed at one institution

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Ksouri, A., Copin, P., Bonvalet, F. et al. Colonic involvement in acute mesenteric ischemia: prevalence, risk factors, and outcomes. Eur Radiol 32, 2813–2823 (2022). https://doi.org/10.1007/s00330-021-08318-6

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  • DOI: https://doi.org/10.1007/s00330-021-08318-6

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