Differential factors between the acute mesenteric ischemia evolutive stages
Abstract
Background: the acute mesenteric ischemia is a highly lethal disease, mainly due to the rapid evolution from its premature stage to the late one, the symptomatology in its start-up period and for the com-plexity of its management.
Objective: to determine the clinical, laboratory, imagenological and evolutionary differences between the stages of the disease.
Methods: an analytical transversal study was carried out. The universe was composed by 32 patients with acute mesenteric ischemia positive diagnosis in the period from December 2015 to March 2018, in Vladimir Ilich Lenin General Hospital.
Results: peritoneal reaction is linked to the advanced stage in a highly significant way. There were no air-fluid levels in most of the ischemic patients, unlike the nechrosis stage, where levels were pre-sent in most of the patients. The difference between the pH and lactate average values in both of disease phases were statistically highly significant. All the cases with atrial fibrillation were dianosed in the late stage. All the patients with intestinal necrosis and more than 2/3 of the af-fected with intestinal ischemia perished.
Conclusions: the delay in diagnosis was associated with high mortality. The early clinical suspicion of an acute abdomen, the assessment of hemodynamic parameters and the identification of risk factors such as atrial fibrillation, favor timely treatment in the ischemic stage and the possibility of sur-vival.
DeCS: MESENTERIC ISCHEMIA/diagnosis; MESENTERIC ISCHEMIA/mortality; MESENTERIC ISCHE-MIA/therapy; FACTORES DE RIESGO; OBSERVATIONAL STUDY.
Downloads
References
1. Liao G, Chen S, Cao H, Wang W, Gao Q. Review: Acute superior mesenteric artery embolism. A vascular emergency cannot be ignored by physicians. Medicine [Internet]. 2019 [citado 07 Dic 2020];98(6):e14446. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380707/.
2. Memet O, Zhang L, Shen J. Serological biomarkers for acute mesenteric ischemia. Ann Transl Med [Internet]. 2019 [citado 07 Dic 2020];7(16):[aprox. 9 p.]. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736808/pdf/atm-07-16-394.pdf
3. Acosta S, Ogren M, Sternby NH. Incidence of acute thrombo-embolic occlusionof the superior mesenteric artery-a population-based study. Eur J Vasc Endovasc Surg. 2004;27(2):145-50.
4. Luzón Solanas L, Montoro Huguet M. Enfermedades del mesenterio, Procesos inflamatorios, Patología vascular. Isquemia mesentérica. Medicine. 2016;12(4):178-88.
5. Martínez L, Guadagno H, Saez M. Epidemiología de las emergencias médico quirúrgicas no traumáticas. Cuad Chile de Cir. 1986;30:25-30.
6. Ministerio de Salud Pública. Mortalidad materna según causa. 2017-2019. Anuario estadístico de Salud Pública 2019 [Internet]. La Habana: Dirección de Registros médicos y estadísticas en salud; 2020 [citado 07 Dic 2020]. Disponible en:
https://files.sld.cu/bvscuba/files/2020/05/Anuario-Electr%c3%b3nico-Espa%c3%b1ol-2019-ed-2020.pdf
7. Yildirim D, Hut A, Tatar C, Turgut D, Akinci M, Toptas M. Prognostic factors in patients with acute mesenteric ischemia. Turk J Surg [Internet]. 2017 [citado 07 Dic 2020];33(2):104-109. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508232/pdf/tjs-33-2-104.pdf
8. Cakir M, Yildirim D, Sarac F, Donmez T, Mirapoglu S, Hut A, et al. In the Experimental Model of Acute Mesenteric Ischemia, The Correlation of Blood Diagnostic Parameters with the Duration of Ischemia and their Effects on Choice of Treatment. J Inv Surg [Internet]. 2018 [citado 07 Dic 2020];32:1-9. Disponible en: https://www.tandfonline.com/doi/abs/10.1080/08941939.2018.1437486?journalCode=iivs20
9. Yang H, Wang BL. Evaluation of the diagnostic value of multi-slice spiral CT in acute mesen-teric ischemic diseases: a meta-analysis of randomized controlled trials. Eur Rev Med Pharmacol Sci [Internet]. 2019 [citado 07 Dic 2020];23:10218-10225. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31841175/.
10. Soler Vaillant R, Mederos Curbelo ON, Galiano Gil JM. Isquemias vasculares del intestino. En: Soler Vaillant R, Mederos Curbelo ON, editores. Cirugía. Afecciones quirúrgicas frecuentes. T. II. La Habana: Editorial Ciencias Médicas; 2016.p. 366-375.
11. Luther B, Mamopoulos A, Lehmann C, Klar E. The ongoing challenge of acute mesenteric ischemia. Visc Med [Internet]. 2018 [citado 07 Dic 2020];34:217-223. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6103345/.
12. Marconato R, Nezi G, Capovilla G, Moletta L, Baldan N, Canton SA, et al. Primary mesenteric vein thrombosis: a case series. J Surg Case Rep [Internet]. 2020 [citado 07 Dic 2020];2020(3):16. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092682/.
13. Florim S, Almeida A, Rocha D, Portugal P. Acute mesenteric ischaemia: a pictorial review. Insigh Imag [Internet]. 2018 [citado 07 Dic 2020];9:673-682. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6206376/.
14. Agrawal SN, Singh K, Dhruv K, Kanwar K. Superior Mesenteric Artery Occlusion: A case report and Mini Review. Int J Med Rev Case Rep [Internet]. 2019 [citado 07 Dic 2020];3(7):478-481. Disponible en: http://mdpub.net/fulltext/172-1555672852.pdf?1609869352
15. Bala M, Kashuk J, Moore EE, Kluger Y, Biffl W, Gomes CA, et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2017;12:38.
16. Zogheib E, Cosse C, Sabbagh C, Marx S, Caus T, Henry M, et al. Biological scoring system for early prediction of acute bowel ischemia after cardiac surgery: the PALM score. Ann Intensi-ve Care [Internet]. 2018 [citado 07 Dic 2020];8(1):46. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5906418/.
17. Destek S, Yabacı A, Abik YN, Gel VO, Değer KC. Predictive and prognostic value of L-lactate, D-dimer, leukocyte, C-reactive protein and neutrophil/lymphocyte ratio in patients with acute mesenteric ischemia. Ulus Travma Acil Cerrahi Derg [Internet]. 2020 [citado 07 Dic 2020];26(1):86-94. Disponible en: https://tjtes.org/jvi.aspx?un=UTD-61580
18. Hot S, Egin S, Ilhan M, Bademler S, Dikker O, Aciksari K, et al. The value of potassium, pH and D-dimer levels in early diagnosis of acute mesenteric ischemia: an experimental study on rats. Arch Med Scien [Internet]. 2019 [citado 07 Dic 2020];15:1-5. Disponible en: https://pdfs.semanticscholar.org/0f9c/bf8d7faf09ca3344d0d6dd3a5c8d4bf30563.pdf?_ga=2.50268768.710415588.1607955993-2044273459.1607955993
19. Tilsed JV, Casamassima A, Kurihara H, Mariani D, Casas I, Pereira J, et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg. 2016;42:253-70.
20. Canfora A, Ferronetti A, Marte G, Di Maio V, Mauriello C, Maida P, et al. Predictive factors of intestinal necrosis in acute mesenteric ischemia. Open Med. 2019;14:883-889. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6947755/.
21. Aliosmanoglu I, Gul M, Kapan M, Arikanoglu Z, Taskesen F, Basol Q, et al. Risk factors ef-fecting mortality in acute mesenteric ischemia and mortality rates: a single center experience. Int Surg. 2013;98(1):76–81.
22. Ranchordás S, Cunha C, Roque R, Féria L, Rui M. Acute mesenteric ischemia: a review of 50 cases. Int Surg J [Internet]. 2019 Jul [citado 07 Dic 2020];6(7):2272-2278. Disponible en: https://www.ijsurgery.com/index.php/isj/article/view/4144/2967
23. Nuzzo A, Maggiori L, Ronot M, Becq A, Plessier A, Gault N, et al. Predictive factors of intes-tinal necrosis in acute mesenteric ischemia: prospective study from an intestinal stroke center. Am J Gastroenterol. 2017 Apr;112(4):597-605.
24. Del Río ML, González Fajardo JA, Vaquero Puerta C. Isquemia mesentérica aguda. Diagnósti-co y tratamiento. Rev Angiología [Internet]. 2015 [citado 07 Dic 2020];67(2):133-139. Disponi-ble en: https://www.elsevier.es/es-revista-angiologia-294-articulo-isquemia-mesenterica-aguda-diagnostico-tratamiento-S0003317014001631
25. Rodríguez de la Calle J, Arroyo Bielsa A. Isquemia mesentérica aguda. En: Vaquero Morillo F, Clará Velasco A, editores. Tratado de las enfermedades vasculares. Barcelona: Viguera Edito-res; 2006. p. 659-67.
Published
How to Cite
Issue
Section
License
Copyright: Camagüey Medical Archive Magazine, offers immediately after being indexed in the SciELO Project; Open access to the full text of the articles under the principle of making available and free the research to promote the exchange of global knowledge and contribute to a greater extension, publication, evaluation and extensive use of the articles that can be used without purpose As long as reference is made to the primary source.
Conflicts of interest: authors must declare in a mandatory manner the presence or not of conflicts of interest in relation to the investigation presented.
(Download Statement of potential conflicts of interest)
The Revista Archivo Médico de Camagüey is under a License Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 International (CC BY 4.0).
This license allows others to distribute, to mix, to adjust and to build from its work, even for commercial purposes, as long as it is recognized the authorship of the original creation. This is the most helpful license offered. Recommended for maximum dissemination and use of licensed materials. The full license can be found at: https://creativecommons.org/licenses/
22 julio 2025