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PURPOSE: To investigate vascular features on abdominal Computed-Tomography Angiography (CTA) correlated with 48-h mortality in patients who underwent arterial acute intestinal ischemia (AAII) surgery. The secondary objective was to create a prognostic score on the 48-h mortality after surgery, based on the most relevant signs. METHOD: We included 104 patients who underwent surgery for acute mesenteric ischemia. 2 radiologists retrospectively blind reviewed the preoperative CTA scans. They used a standardized analysis grid for the arterial and venous vascular signs described in angiography. When signs were present, the affected abdominal quadrant was specified in coronal reconstruction. Each sign was analyzed for 48-h mortality on CTA. A score based on signs correlated with early mortality was developed and evaluated by ROC curve analysis. RESULTS: 22 patients died within 48 h. The number of superior mesenteric artery (SMA) branches was significantly reduced in deceased patients (p = 0.006). Other prognostic factors associated with 48-h mortality were decreased venous return in area number 1 corresponding to right colic flexure, proximal half of the transverse colon, proximal ileum (p = 0.04) and decreased venous return in more than 2 zones (p = 0.01). The weighted AAII48 score included 1 protective clinical item and 5 radiological items. The area under the ROC curve was 0.784 with, for a 6-point threshold value, a sensitivity of 68% and a specificity of 77%. The intraclass correlation coefficient for interobserver reproducibility of the score was 0.81 [95% CI 0.73; 0.87]. CONCLUSION: Three vascular signs on CTA were found to be prognostic factors for early mortality: SMA branches number ≤ 5 (p = 0.006), decreased venous return in area 1 (p = 0.04), and > 2 areas of decreased venous return (p = 0.01). They were incorporated into the AAII48 score. This score could help to identify patients at risk and to adapt subsequent management.

Purpose: Primary acute intestinal ischaemia (AII) is an abdominal catastrophe caused by intravascular obstruction of blood supply. It is difficult to diagnose. Computerized tomography (CT) scan is the modality of choice for diagnostic evaluation. Majority of previous studies have evaluated CT findings in patients where AII was suspected. However, unveiling the unique radiological findings also in not initially suspected AII patients, might lead to the timely management of AII patients, and is the aim of this study. Methods: In a single-center, retrospective case–control study, preoperative radiological findings from abdominal CT scans in 48 patients with primary AII were compared with 80 non-ischemic controls. Radiological findings were analyzed using multivariable logistical regression with adjustment for age and gender and reported as odds ratios (OR) with 95% confidence intervals (CI) and p values. Results: Thirty-nine (81%) cases with AII were referred to an abdominal CT scan without a specific clinical suspicion of AII. Three main radiological categories (intestinal wall pathology [OR 7.4, CI 2.3–24.0, p value < 0.001], gastrointestinal vessel pathology [OR 19.3, CI 4.6–80.5, p value < 0.001) and intestinal diameter [OR 4.7, CI 1.6–13.4, p value 0.004]) were significantly different in AII patients. Subgroup analysis implied that pneumatosis intestinalis, increased contrast enhancement in the bowel wall, inferior mesenteric artery arteriosclerosis and colonic contraction were predictors of AII. Conclusion: Radiological changes within the intestinal wall, luminal diameter and gastrointestinal vessels are independent predictors of AII. Awareness of these radiological findings, therefore, plays a central role in patients with an indistinct clinical picture in early recognition and treatment of a life-threatening AII. Trial registration number: NCT04361110 (April 24, 2020), retrospectively registered.

BACKGROUND: It remains a challenge to distinguish whether the damaged intestine is viable in treating acute mesenteric ischemia. In this study, photoacoustic imaging (PAI) was used to observe intestinal tissue viability after ischemia and reperfusion injury in rats. METHODS: An in vivo study was conducted using forty male SD rats, which were randomly divided into a sham-operated (SO) group, a 1 h ischemia group, a 2 h ischemia group, and an ischemia-reperfusion (I/R) group with 10 rats in each group. In the ischemia group, the superior mesenteric artery (SMA) was isolated and clamped for 1 and 2 h, respectively, and in the I/R group, after ischemia for 1 h, the clamp was removed and reperfused for 1 h. The same time interval was used in the SO group. Immediately after establishing the animal model, a PAI examination was performed, and the small intestine was collected for histopathology. RESULTS: The levels of PAI parameters Hb, HbR, MAP 760, and MAP 840 were increased to different degrees in the ischemia groups, especially in the 2 h ischemia group, compared with the SO group (P

Serum lactate is a non-specific marker of tissue hypoperfusion. Elevated serum lactate is used in the differential diagnosis of acute intestinal ischemia. Although this practice is controversial, in the absence of other validated markers lactate is still used because of its high sensitivity. We present the cases of two patients who developed acute mesenteric ischemia as a post-surgical complication. The patients reported moderate abdominal pain -a non-specific symptom in the postoperative context- and tests showed progressively increasing serum lactate levels, which facilitated suspicion and subsequent diagnostic confirmation through an imaging test. These cases highlight the physiopathological importance of lactate elevation in the perioperative context and of performing a differential diagnosis of its possible causes, including mesenteric ischemia. Although the outcome was negative in the first case, early suspicion allowed us to make an effective diagnosis and administer appropriate treatment in the second patient.

The causes of diagnostic errors during daily medical practice can be several, mainly attributable to perceptual, interpretive and communication factors. The eventuality of radiological error is much more amplified in the emergency setting where a high number of complex multidetector-row computed tomography (MDCT) images must be evaluated quickly and critical time decisions need to be taken. In particular, in this context, the diagnosis of vascular intestinal diseases represents a crucial and difficult challenge in case of acute abdominal pain given the importance of being able to identify patient with high suspicious for intestinal ischemia and for a specific patient to judge if his ischemia is reversible or irreversible. Awareness of potential biases which can lead to diagnostic errors together with an extensive knowledge of the imaging features of these pathologies can lead to promptly recognize them with fewer mistakes, improving patients' outcome. This article reviews the MDCT findings of acute intestinal ischemia and acute colonic ischemia and analyzes the main types of diagnostic errors, underlining the importance of being familiarized with them to avoid misdiagnosis.

Abdominal surgical pathology in elderly patient is relevant because of two fundamental factors: life expectancy rises and some features of the elderly patients make the diagnosis and treatment a challenge. The prevalence of acute diverticulitis increases with age and usually is located in bowel sigmoid. Diagnosis relies on clinical history and computed tomography (CT). Treatment is conservative (antibiotics), surgery is required only if complications. The diagnosis of acute cholecystitis is based on clinical history and ultrasound; frequently, treatment is surgical with laparoscopic approach. The early diagnosis of acute intestinal ischemia is based on a high level of clinical suspicion and CT angiography is mandatory. Surgical treatment is based on revascularization and non-viable bowel resection. Sigmoid volvulus is the most frequent. Diagnosis is carried out using CT. Initial treatment is endoscopic decompression accompanied by delayed resection of redundant sigma.

The novel COVID-19 disease, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus, apart from its respiratory complications and coagulopathy, is also involved in damage to other organ systems. We present a report of presumptive case of COVID-19 positive patient with no respiratory symptoms with superior mesenteric vein and portal vein thrombosis along with acute intestinal ischemia. The patient underwent exploratory laparotomy, resection of the ischemic bowel loops with proximal ileostomy and distal mucous fistula. The case highlights that despite the absence of respiratory symptoms, patients infected with SARS-CoV-2 may show atypical presentations, such as gastrointestinal symptoms. © 2020 Rotonda Publications. All rights reserved.

During acute intestinal ischemia reperfusion (IR) injury, the intestinal epithelial barrier (IEB) function is often disrupted. Enteric glial cells (EGCs) play an important role in maintaining the integrity of IEB functions. However, how EGCs regulate IEB function under IR stimulation is unknown. The present study reveals that the adenosine A2A receptor (A2AR) is important for mediating the barrier-modulating roles of EGCs. A2AR knockout (KO) experiments revealed more serious intestinal injury in A2AR KO mice than in WT mice after IR stimulation. Moreover, A2AR expression was significantly increased in WT mice when challenged by IR. To further investigate the role of A2AR in IEB, we established an in vitro EGC-Caco-2 co-culture system. Hypoxia stimulation was used to mimic the process of in vivo IR. Treating EGCs with the CGS21680 A2AR agonist attenuated hypoxia-induced intestinal epithelium damage through up-regulating ZO-1 and occludin expression in cocultured Caco-2 monolayers. Furthermore, we showed that A2AR and metabotropic glutamate receptor 5 (mGluR5) combine to activate the PKCα-dependent pathway in conditions of hypoxia. This study shows, for the first time, that hypoxia induces A2AR-mGluR5 interaction in EGCs to protect IEB function via the PKCα pathway.

Background Over the past decades, great attention has been given to the nervous system modulating effects on the immune response in inflammation-associated injuries, such as acute intestinal ischemia-reperfusion (IR). Recently we proved the anti-inflammatory and antioxidant effects of 5-hydroxytryptamine (5-HT)1B/1D receptors in intestinal IR injury in rats. Also, the alpha7 nicotinic acetylcholine (α7-nACh) receptor has anti-inflammatory effects in different inflammation-associated injuries. Starting from these premises, we aimed to examine the function of the α7-nACh receptors and the functional interactions between the anti-inflammatory and antioxidant effects of α7-nACh and 5-HT1B/1D receptors in acute intestinal IR injury. Methods To confirm the expression and localization of α7-nACh receptors on the ileum nerves, an immunofluorescence-based method was applied. Then, intestinal IR injury was induced by 30 min occlusion of superior mesenteric artery and reperfusion for 2 h in rats. Acute systemic administration of α7-nACh receptor agonist PNU-282987 and antagonist methyllycaconitine, and 5-HT1B/1D receptors agonist (sumatriptan) and antagonist (GR127, 935) were used in the model of intestinal IR injury. Finally, biochemical and histological parameters were assessed. Results Α7-nACh receptors were expressed by 9% on the ileum nerves. Likewise, activation of the α7-nACh receptor showed anti-inflammatory and antioxidant effects in intestinal IR injury but not as well as 5-HT1B/1D receptors. Interestingly, 5-HT1B/1D receptors via attenuation of glutamate (Glu) release indirectly activated the α7-nACh receptor and its protective effects against inflammation and oxidative stress. Conclusion The protective effect of the α7-nACh receptor on intestinal IR injury was activated indirectly through the 5-HT1B/1D receptors' modulatory impact on Glu release.

The World Health Organization has declared novel coronavirus disease 2019 (COVID-19) a global public health emergency. Although respiratory symptoms predominate in COVID-19, thrombosis can occur in patients with COVID-19. This paper reports a case of an 82-year-old female with a prior medical history of hypertension, diabetes presenting with fever and cough, and was diagnosed with COVID-19. The patient subsequently developed progressively worsening of abdominal distention, tenderness, and underwent emergent laparotomy. She was found to have a gangrenous colon. This case adds to the limited literature regarding the extrapulmonary complications of COVID-19. (Korean J Gastroenterol 2020;76:164-166)

The objective is to study the morphometric signs of small bowel ischemic damage basing on intravital optical coherence tomography data and further histological analysis Materials and methods. The study was carried out on male Wistar rats with the use of two models of acute intestinal ischemia: acute occlusive mesenteric ischemia by а. jejunales ligation (group “I”) and acute arteriovenous ischemia by a small bowel loop and frill strangulation together with а. et v. jejunales (group “II”). The state of intramural vessels in vivo was evaluated with the use of optical coherence angiography (OCA). After the macroscopic signs of non-viability appeared the bowel was resected and its stepwise histological analysis was carried out. Results. Ischemic damage development in group “I” was accompanied by decrease of bowel wall thickness by 34,8-42,4% (p=0,032) due to submucous layer destruction - based on histological analysis data and also by decrease of total length of functioning intramural vessels by 4,6% (p=0,004) - based on OCA data. According to the OCA data in group “II” the length of functioning vessels decreased by 89,6%in the strangulated bowel loop and by 6,1% in adducent and abducent sections (p=0,001). In the strangulated loop histological specimens sharply dilated thrombosed veins were seen in all layers of bowel wall, seromuscular layer oedema and diapedesis hemorrhages of mucous coat also took place as well as bowel wall thickening by 25,2% in comparison with the intact one. Conclusions. Сomplex analysis of in vivo optical coherence tomography results and further histological analysis of ischemic small bowel wall made it possible to determine the morphological manifestations which are specific for arterial and arteriovenous mesenteric blood flow disorder. In cases of mesenteric artery occlusion hypoperfusion and mucous coat ischemia are predominant among pathogenetic mechanisms of bowel wall alteration. In the strangulated bowel the main factor of destruction and necrosis is acute insufficiency of venous outflow.

Background: Acute intestinal ischemia is an abdominal suffering occasioned by a sudden reduction of mesenteric blood circulation. It is a rare and potentially serious medical-surgical emergency, deadly in 50% to 100% of cases. Diagnosis is known to be difficult at the early stage during which a well-conducted treatment may help reduce mortality. Multi-detector scanners were assessed to be far more sensitive and appropriate for the diagnosis of mesenteric ischemia than angiography. Objective: Study the tomodensitometric aspects of acute intestinal ischemia, and the traps of late diagnosis, in order to optimize the care and improve the prognosis of this disease. Patients and Methods: This is a prospective, longitudinal and descriptive study covering a period of nine (9) months. We have included all cases of acute intestinal ischemia. Results: Twenty (20) cases of acute intestinal ischemia were registered i.e. a frequency of 2.2 cases per month. The average age of the patients was 67.8 years with 0.7 as sex ratio. Abdominal pain was noted in all cases. History of cardiovascular disease was found in seven (7) cases. Abdominal angioscan was performed in fifteen (15) cases. There was a suspected diagnosis upon request in ten (10) cases. The main intestinal lesions were the lack of parietal enhancement (13 cases) and parietal thickening (12 cases). There were sixteen (16) cases of acute mesenteric ischemia and four (4) cases of ischemic colitis. The acute mesenteric ischemia was arterial in eleven (11) cases, venous in two (2) cases and mixed in two (2) cases. Diagnosis was made at the stage of intestinal infarction in eleven (11) cases. Ten (10) patients were operated and 10 others were treated medically. Thirteen (13) cases of death were registered. Conclusion: Acute intestinal ischemia is a rare but serious disease. Abdominal pain is the main ground for consultation. Diagnosis is often late and focuses on abdominal CT angiography. An early diagnosis could help improve its prognosis.

Relevance. Lethality rates (63-95%) among patients with acute intestinal ischemia remain consistently high during the last decades. Despite the high urgency of the problem and numerous works devoted to visualization, early laboratory and instrumental diagnostics of ischemic bowel disease, clinical results have not changed significantly during the last 15-20 years. Pathogenetic mechanisms of various variants of ischemic intestinal lesion and their pathomorphological manifestations should become the basis for the development of surgical tactics and require specification. The aim is to study pathomorphological manifestations and to clarify on their basis the pathogenetic mechanisms of ischemic involvement of the small intestine in acute occlusion of the mesenteric artery in the experiment. Materials and methods. An experimental study was performed on 10 laboratory animals - male rats of the Wistar line. Modeling acute mesenteric ischemia was carried out via dressing of the jejunal artery. The ischemic intestine was collected for a stepwise histological study, the morphometry of the layers of the intestinal wall and the prevalence of necrosis. Results. At the time of the appearance of macroscopic signs of lack of vitality in the central sector of the ischemic intestine, the wall thickness was 47.6% less than normal and in the adjacent peripheral sectors by 40.6%. Thinning of the intestinal wall was due to alteration of the mucosa with a decrease in its share in the total wall thickness from 86 to 82% (p = 0.021) in all sectors. The share of area occupied by necrosis in groups "B" and "C" was not statistically significant (p = 0.872) and amounted to 17.1 [7.3; 64.9]%. The state of the intramural vessels of the intestinal wall had significantly changed in comparison with the intact intestine. Signs of hypoperfusion in the form of sludge in the microvessels of the mucous membrane and the submucosa had been revealed. Conclusions. Pathomorphological manifestations of ischemic bowel disease in acute occlusive mesenteric ischemia resulted in a decrease in the total thickness of the wall and a change in the ratio of serous-muscular and mucosal-submucosal layers due to a decrease in the proportion of the latter. The severity of necrosis in the central and peripheral parts of the ischemic intestine did not differ.

Acute mesenteric ischemia is considered uncommon, but it appears to be more frequent cause of acute abdomen than appendicitis or ruptured abdominal aortic aneurysm in elderly patients. Surgical treatment without revascularization is associated with high overall mortality, up to 80%. The modern treatment of acute mesenteric ischemia requires collaboration of gastrointestinal surgeons, vascular surgeons, and interventional radiologists. Early revascularization may reduce the overall mortality associated with acute mesenteric ischemia by up to 50%. Clinical suspicion and contrast-enhanced computed tomography performed at early stage are keys to improve outcomes of acute mesenteric ischemia treatment. This review summarizes what the acute care surgeon needs to know about acute mesenteric ischemia with special emphasis on slowly progressing “acute on chronic” mesenteric ischemia.

T-cells have been demonstrated to modulate ischemia–reperfusion injury (IRI) in the kidney, lung, liver, and intestine. Whereas most T-cell subpopulations contribute primarily to the antigen-specific effector and memory phases of immunity, γδ-T-cells combine adaptive features with rapid, innate-like responses that can place them in the initiation phase of immune reactions. Therefore, we aimed to clarify the role of γδ-T-cells in intestinal IRI. Adult wild-type (WT) and γδ-T-cell-deficient mice were subjected to acute intestinal IRI. Gene expression of pro-inflammatory cytokines and influx of leukocyte subpopulations in the gut were assessed by qPCR and flow cytometry. Serum transaminases were measured as an indicator of distant organ IRI. Intestinal IRI led to increased influx of neutrophils, pro-inflammatory cytokine expression and LDH/ALT/AST elevation. Selective deficiency of γδ-T-cells significantly decreased pro-inflammatory cytokine levels and neutrophil infiltration in the gut following IRI compared to controls. Furthermore, γδ-T-cell deficiency resulted in decreased LDH and transaminases levels in sera, indicating amelioration of distant organ injury. Increasing evidence demonstrates a key role of T-cell subpopulations in IRI. We demonstrate that γδ-T-cell deficiency ameliorated pro-inflammatory cytokine production, neutrophil recruitment and distant organ injury. Thus, γδ-T-cells may be considered as mediators contributing to the inflammatory response in the acute phase of intestinal IRI.

The aim of the study was to use multimodal optical coherence tomography (MM OCT) to evaluate microstructure and microcirculation in the proximal and distal sections of the intestine relative to the resected area in acute mesenteric ischemia. Materials and Methods The study was carried out using three groups of male Wistar rats weighing 270–435 g (n=18). Acute occlusive arterial ischemia of the small intestine was initiated in all animals. After 80–90 min, the ischemic non-viable part of the intestine was resected, and the operation was completed by stoma exteriorization (group 1, n=6), by applying purse-string sutures (group 2, obstructive resection, n=6), or by internal drainage of the proximal and distal ends of the small intestine (group 3, bypass, n=6). Relaparotomy and anastomosis formation were performed 2 days later. With the help of MM OCT at each stage of the surgical intervention, images were obtained from the serous membrane side: the intestinal wall microstructure (layers) was viewed using cross-polarization OCT (CP OCT) and the intramural circulation — using optical coherent angiography (OCA). The MM OCT images obtained from the terminal intestine sections immediately after resection and 2 days later (before the anastomosis formation) were compared between the experimental groups, as well as with the pre-ischemic data (norm). All resected sections of the intestine were then histologically examined. The MM OCT data were compared with the histological and intravital macroscopy data. Results As a result of studying the intestinal wall microstructure by in vivo CP OCT, it was found that during ostomy (group 1) and obstructive resection (group 2), the images showed signs of tissue edema and destructive changes in the mucous membrane that were confirmed histologically, while with bypass surgery (group 3), there were minimal changes as compared with the norm. According to the OCA data, on day 2 of ostomy in the proximal and distal segments of the intestine, there was a noticeable disappearance of small and medium blood vessels; mainly large arteries and veins could be visualized. Following obstructive resection (purse-string suturing) or bypass surgery, the most noticeable changes (a decrease in the number of visualized blood vessels) were observed in the distal part of the intestine. The L index calculated from OCA images and characterizing the total length of the intramural perfused vasculature, showed a statistically significant decrease during ostomy: 12.18 [10.40; 14.20] μm — in the proximal and 10.67 [7.98; 13.05] μm — in the distal section; for comparison, the L index before ischemia was 18.90 [17.98; 19.73] μm and 18.74 [17.46; 19.90] μm, respectively (p=0.0001). In obstructive resection (group 2), statistically significant differences in the L parameter were found only for the distal bowel section: 16.39 [12.37; 18.10] μm compared with 18.74 [17.46; 19.90] μm before ischemia (p=0.041). After bypass surgery (group 3), there were no significant deviations in the L index. Conclusion By using MM OCT, we found that in treating the remaining sections of the intestine after its emergency resection for acute mesenteric ischemia, the type of surgical technique determines the tissue structure in the period before the delayed anastomosis is applied. The least pronounced and most balanced changes occur in the proximal and distal segments of the intestine when operated using the bypass technique. However, to recommend this type of surgery, the development of reliable, safe, and effective bypass instruments is needed.

Novel coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China, and declared by World Health Organization as a pandemic in March 2020. Since then, it has been well known for COVID-19 patients to present with clinical manifestations of severe acute respiratory syndrome (SARS-CoV-2) similar to the influenza. However, in the course of the disease, various pathological complications of high clinical significance have remained unknown. Impaired blood supply to the visceral vascular system can cause serious life-threatening acute damage. We report a case of a 60-year-old female with difficulty in breathing and extensive acute intestinal ischemia confirmed to be associated with SARS-CoV-2 infection. The patient developed a sudden abdominal pain and succumbed shortly after admission before imaging studies were performed. Autopsy revealed massive bowel ischemia. This case highlights the importance of paying attention to serious and less known clinical manifestations other than pulmonary symptoms and fever.

Gastrointestinal symptoms, such as diarrhea (most common among gastrointestinal symptoms), nausea/vomiting, anorexia, abdominal pain, abnormal liver enzymes, and pancreatitis, are being increasingly recognized in patients with coronavirus disease 2019 (COVID-19). Moreover, COVID-19 has also been implicated in coagulopathy, especially in patients with severe disease. Here, we report a case of acute intestinal ischemia secondary to superior mesenteric thrombosis in a young female patient with mild COVID-19.

Acute intestinal ischemia is a life-threatening condition. The current gold standard, with evaluation based on visual and tactile sensation, has low specificity. In this study, we explore the feasibility of using machine learning models on images of the intestine, to assess small intestinal viability. A digital microscope was used to acquire images of the jejunum in 10 pigs. Ischemic segments were created by local clamping (approximately 30 cm in width) of small arteries and veins in the mesentery and reperfusion was initiated by releasing the clamps. A series of images were acquired once an hour on the surface of each of the segments. The convolutional neural network (CNN) has previously been used to classify medical images, while knowledge is lacking whether CNNs have potential to classify ischemia-reperfusion injury on the small intestine. We compared how different deep learning models perform for this task. Moreover, the Shapley additive explanations (SHAP) method within explainable artificial intelligence (AI) was used to identify features that the model utilizes as important in classification of different ischemic injury degrees. To be able to assess to what extent we can trust our deep learning model decisions is critical in a clinical setting. A probabilistic model Bayesian CNN was implemented to estimate the model uncertainty which provides a confidence measure of our model decisions.

Background Some studies have investigated the diagnostic value of intestinal fatty acid binding protein (I-FABP) for acute intestinal ischemia (II), but the results were not always consistent. Therefore, we performed a systematic review and meta-analysis to determine the diagnostic accuracy of I-FABP for II. Methods Publications included in the PubMed and EMBASE before April 7, 2019 were retrieved to identify studies investigating the diagnostic accuracy of I-FABP for II. The Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess the quality of eligible studies. Diagnostic accuracy of I-FABP in all eligible studies was pooled by a bivariate model. Summary receiver operating characteristic (ROC) curves (AUC) were constructed to calculate the overall diagnostic accuracy of I-FABP. Results A total of 10 studies with 1,265 (219 IIs and 1,046 controls) subjects were included in this systematic review and meta-analysis. The major design weaknesses of included studies were patient selection bias. The overall diagnostic sensitivity, specificity, and AUC of I-FABP were 0.75 (95% CI: 0.68 - 0.82), 0.85 (95% CI: 0.74 - 0.92), and 0.82 (95% CI: 0.79 - 0.86), respectively. In patients with acute abdominal pain, the sensitivity, specificity, and AUC of I-FABP were 0.71 (95% CI: 0.59 - 0.81), 0.89 (95% CI: 0.69 - 0.97) and 0.80 (95% CI: 0.76 - 0.83), respectively. Conclusions I-FABP has moderate diagnostic accuracy for II. Due the patient selection bias of available studies, further studies with rigorous design are needed to evaluate the diagnostic accuracy of I-FABP for II.

Background: Acute intestinal ischemia-reperfusion injury (AIIRI) is a devastating clinical condition relevant to multiple diseases processes, including sepsis, trauma, transplantation, and burns. An AIIRI is a contributor to the development of multiple organ dysfunction syndrome (MODS). Oncostatin M (OSM)/oncostatin M receptor (OSMR) signaling is an unrecognized and novel candidate pathway for the mediation of MODS. In this study, we hypothesized that OSM mediates the injury mechanism of AIIRI leading to MODS. Methods: Wild-type (WT) and OSMR-knockout (OSMR-/-) C57BL/6 mice underwent AIIRI using a well-established model of selective occlusion of the superior mesenteric artery (SMA). Serum cytokine concentrations were measured using a multiplex detection system. Further tissue analysis was conducted with polymerase chain reaction, enzyme-linked immunosorbent assay, Western blots, and histologic review. Results: Survival was significantly higher in WT than in OSMR-/- groups at 30 minutes of ischemia with 2 hours of reperfusion (100% versus 42.9%; P = 0.015). No significant differences in the degree of local intestinal injury was seen in the two groups. In contrast, the degree of lung injury, as evidenced by myeloperixodase activity, was lower in OSMR-/- animals in the early AIIRI groups. There was a greater degree of renal dysfunction in OSMR-/- mice. Oncostatin M mediated interleukin (IL)-10 upregulation, with WT animals having significantly lower IL-10 concentrations (52.04 ± 23.06 pg/mL versus 324.37 ± 140.35 pg/mL; P = 0.046). Conclusion: Oncostatin M signalling is essential during acute intestinal ischemia-reperfusion injury. An OSMR deficiency results in decreased early lung injury but increased renal dysfunction. There was a significantly increased mortality rate after AIIRI in mice with OSMR deficiency. Augmentation of OSM may be a novel immunomodulatory strategy for AIIRI.

Objective The current study was conducted to clarify whether the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are clinically useful in predicting postoperative mortality among patients undergoing surgery for acute intestinal ischemia (AII). Materials and methods The study was conducted as a retrospective investigation of 37 consecutive patients operated for AII between January 2014 and September 2019. Data regarding potential prognostic factors, including age, sex, preoperative white blood cell count (WBC), C-reactive protein (CRP), neutrophil, lymphocyte, and platelet counts were obtained from medical records. Results Univariate analysis revealed that age, WBC, and neutrophil count were predictors of postoperative mortality. In multivariate analysis, age (OR=1.14; 95% CI, 1.005-1.303; P=0.02) was found to be the only independent variable predicting postoperative mortality. Conclusions Preoperative NLR and PLR cannot be used as independent variables to predict postoperative 30-day mortality in patients with AII who underwent surgery. WOS:000504824600003 31886096

Introduction Non-occlusive mesenteric ischemia (NOMI) is a type of acute intestinal ischemia, and its associated mortality is very high. In laparotomy of NOMI, we often have difficulty determining the area of bowel resection. We herein describe a case in which we detected the area of bowel resection using indocyanine green (ICG) fluorescence imaging. Presentation of the case An 89-year-old man diagnosed as having advanced gastric cancer underwent distal gastrectomy. On the night of postoperative day 4, he strongly complained of distention of the abdomen. The laboratory data indicated severe metabolic acidosis and dehydration. The abdominal computed tomography scan showed a dilated small bowel, but there were no specific signs suggestive of bowel necrosis. We suspected NOMI and decided to perform emergency laparotomy because we could not exclude the possibility of bowel necrosis. During the operation, we could not detect the necrotic bowel macroscopically. After injecting 2.5 mg of ICG, the ischemic area of the bowel became visible as a region with poor fluorescence emission using the Photodynamic Eye™ (Hamamatsu Photonics K.K.). We resected the ischemic bowel and performed anastomosis. We confirmed that he was alive at 4 months after the operation of NOMI. Conclusion Intraoperative ICG fluorescence imaging makes it possible to detect necrotic intestine that cannot be found with the naked eye. By using this method, planned reoperation to find any newly developed necrotic intestine might be unnecessary. Intraoperative ICG fluorescence imaging is useful for defining the area of ischemic bowel in a patient with NOMI.

Acute Mesenteric Ischemia (A.M.I.) is a potentially life-threatening condition syndrome due to inadequate or completely absent blood supply through superior or inferior mesenteric artery. The etiologies are various. Early diagnosis is essential to improve the clinical outcome. Despite advances in knowledge of pathophysiology, laboratory diagnosis and imaging techniques, acute intestinal ischemia is still associated with mortality rates.

Objective: To detect the expression and distribution of I-FABP in intestinal tissue and the changes of serum concentrations at different time of acute intestinal ischemia, and explore the significance and mechanism of I-FABP in early diagnosis of acute ischemic bowel disease. Methods: The selected 96 healthy adult SD rats were randomly divided into the experimental group and control group; 48 in each group. Each group was randomly subdivided into 6 groups with 8 rats in each group. The superior mesenteric artery was ligated in the experimental group and the peritoneal switch operation was performed in the control group. The venous blood samples were extracted from each group rats’ right ventricle at 0.5 h, 1 h, 2 h, 4 h, 8 h, 12 h after the operation and the concentration of I-FABP was tested respectively. Then the rats were killed, and the diseased intestinal tubes were cut out for paraffin sections. The I-FABP in intestinal tissue was stained by routine HE staining and direct immunofluorescence staining. Results: The I-FABP was mainly expressed in the epithelial villi of intestinal mucosa, and there was a small amount of expression in the intestinal submucosa and even the muscularis. Within 1 hour of intestinal ischemia, the number of I-FABP positive granules in the intestine and intestinal cavity increased gradually, and then gradually decreased after 1 hour. The difference has statistically significant between the experimental group and the control group (P < 0.05). The serum I-FABP: In the experimental group, the serum I-FABP concentration began to increase at 0.5 h, and reached a peak at 1 h (290. 24 ± 156.69) μg·L–1, then gradually decreased. Compared with the control group, the difference was statistically significant (P < 0.05). Conclusion: I-FABP usually mainly exists in the epithelial cells of intestinal mucosa. When acute intestinal ischemia occurs, the epithelial cells of intestinal mucosa permeability changes; I-FABP expression rapidly releases to intestinal tissue and intestinal cavity, and is absorbed into the blood. Therefore, I-FABP has certain clinical significance in early diagnosis and treatment of acute intestinal ischemia.

Neuroendocrine tumors represent a heterogeneous group of neoplasms that arise from neuroendocrine cells and secrete various peptides and bioamines. While gastrointestinal neuroendocrine tumors, commonly called carcinoids, account for about 2/3 of all neuroendocrine tumors, they are relatively rare. Small intestine neuroendocrine tumors originate from intestinal enterochromaffin cells and represent about 1/4 of small intestine neoplasms. They can be asymptomatic or cause nonspecific symptoms, which usually leads to a delayed diagnosis. Imaging modalities can aid diagnosis and surgery remains the mainstay of treatment. We present a case of a jejunal neuroendocrine tumor that caused nonspecific symptoms for about 1 year before manifesting with acute mesenteric ischemia. Abdominal X-rays revealed pneumatosis intestinalis and an abdominal ultrasound and computed tomography confirmed the diagnosis. The patient was submitted to segmental enterectomy. Histopathological study demonstrated a neuroendocrine tumor with perineural and arterial infiltration and lymph node metastasis. The postoperative course was uneventful and the patient denied any adjuvant treatment.

The traditional definition of tissue ischemia-a decreased level of oxygen deliverability by bloodstream that results in cell hypoxia. Anatomical and functional hindrance to blood flow is the basis of tissue hypoperfusion. Arterial, venous and functional disturbances in blood circulation lead to acute intestinal ischemia. In 85-90 % of cases acute mesenterial ischemia was caused by arterial reasons: thrombosis or embolism. Venous thrombosis is responsible for 10%-15% of acute mesenterial ischemia cases.

Acute mesenteric venous thrombosis is a rare condition but serious. We report here a new case in a 35-year-old man presenting with paroxysmal abdominal pain during 13 days. The diagnosis of superior mesenteric venous thrombosis was confirmed by CT angiography, and the patient was operated on the third day of a well-conducted medical treatment with intravenous heparinotherapy, in the presence of localized peritonitis. The laparotomy revealed an ischemic ileal portion treated by segmental resection and terminoterminal anastomosis without complication.

Non-traumatic perforation of the small bowel is a relatively rare occurrence. It requires prompt diagnosis and operative management to minimize morbidity and mortality. The etiology of small bowel perforations varies widely and can have a significant impact on management strategies. Clinicians that manage these patients should be aware of the diverse etiologies of small bowel perforation as they impact operative techniques, intraoperative care, postoperative management, and prognosis.

Irreversible electroporation (IRE) is a non-thermal ablation technique used especially in locally advanced pancreatic carcinomas that are considered surgically unresectable. We present the first case of acute superior mesenteric artery (SMA) occlusion secondary to pancreatic IRE procedure that has not been reported before in the literature. A 66-year-old man underwent neoadjuvant chemoradiotherapy for locally advanced pancreatic ductal adenocarcinoma. IRE procedure was applied to the patient during laparotomy under general anesthesia. After finishing the procedure, an acute intestinal ischemia was detected. A conventional vascular angiography was performed and a metallic stent was successfully placed to the SMA and blood flow was maintained. It is important to be careful in such cases of tumor involvement of SMA when evaluating for IRE procedure of pancreatic tumor.

The article reviews the intestinal ischemia theme on newborn and children. The intestinal ischemia may be either acute - intestinal infarction (by vascular obstruction or by reduced mesenteric blood flow besides the occlusive mechanism), either chronic.In neonates, acute intestinal ischemia may be caused by aortic thrombosis, volvulus or hypoplastic left heart syndrome.In children, acute intestinal ischemia may be caused by fibromuscular dysplasia, volvulus, abdominal compartment syndrome, Burkitt lymphoma, dermatomyositis (by vascular obstruction) or familial dysautonomia, Addison’s disease, situs inversus abdominus (intraoperative), burns, chemotherapy administration (by nonocclusive mesenteric ischemia). Chronic intestinal ischemia is a rare condition in pediatrics and can be seen in abdominal aortic coarctation or hypoplasia, idiopathic infantile arterial calcinosis.

Objectives To evaluate the clinical significance of pneumatosis intestinalis (PI) including the influence on treatment and outcome. Method and Materials Two radiologists jointly reviewed MDCT-examinations of 149 consecutive emergency patients (53 women, mean age 64, range 21-95) with PI of the stomach (n = 4), small (n = 68) and/or large bowel (n = 96). PI extension, distribution and possibly associated porto-mesenteric venous gas (PMVG) were correlated with other MDCT-findings, risk factors, clinical management, laboratory, histopathology, final diagnosis and outcome. Results The most frequent cause of PI was intestinal ischemia (n = 80,53.7 %), followed by infection (n = 18,12.1 %), obstructive (n = 12,8.1 %) and non-obstructive (n = 10,6.7 %) bowel dilatation, unknown aetiologies (n = 8,5.4 %), drugs (n = 8,5.4 %), inflammation (n = 7,4.7 %), and others (n = 6,4 %). Neither PI distribution nor extension significantly correlated with underlying ischemia. Overall mortality was 41.6 % (n = 62), mostly related to intestinal ischemia (p = 0.003). Associated PMVG significantly correlated with underlying ischemia (p = 0.009), as did the anatomical distribution of PMVG (p = 0.015). Decreased mural contrast-enhancement was the only other MDCT-feature significantly associated with ischemia (p p

PURPOSE: Acute mesenteric ischaemia (AMI) accounts for about 1:1000 acute hospital admissions. Untreated, AMI will cause mesenteric infarction, intestinal necrosis, an overwhelming inflammatory response and death. Early intervention can halt and reverse this process leading to a full recovery, but the diagnosis of AMI is difficult and failure to recognize AMI before intestinal necrosis has developed is responsible for the high mortality of the disease. Early diagnosis and prompt treatment are the goals of modern therapy, but there are no randomized controlled trials to guide treatment and the published literature contains a high ratio of reviews to original data. Much of that data comes from case reports and often small, retrospective series with no clearly defined treatment criteria. METHODS: A study group of the European Society for Trauma and Emergency Surgery (ESTES) was formed in 2013 with the aim of developing guidelines for the management of AMI. A comprehensive literature search was performed using the Medical Subject Heading (MeSH) thesaurus keywords "mesenteric ischaemia", "bowel ischaemia" and "bowel infarction". The bibliographies of relevant articles were screened for additional publications. After an initial systematic review of the literature by the whole group, a steering group formulated questions using a modified Delphi process. The evidence was then reviewed to answer these questions, and recommendations formulated and agreed by the whole group. RESULTS: The resultant recommendations are presented in this paper. CONCLUSIONS: The aim of these guidelines is to provide recommendations for practice that will lead to improved outcomes for patients.

Background Venous thrombosis is a serious complication of combined contraceptive usage. However, mesenteric venous thrombosis and intestinal necrosis are infrequently seen in women using oral contraceptives, and in such cases diagnosis is often delayed. Case presentation We report the case of a 38-year-old obese female patient who presented with acute abdominal pain. A bowel infection was first diagnosed and treated with antibiotics. Contrast-enhanced tomography of the abdomen revealed diffuse ischemia of the small intestine with superior mesenteric thrombosis. Laparotomy with segmental resection of both small and large bowel was performed. No predisposing factor of mesenteric venous thrombosis was demonstrated except association of the combined contraceptive with obesity. Conclusion This report highlights the need for clinicians to suspect venous mesenteric thrombosis in women of reproductive age with acute abdominal pain and poor physical findings. Detailed personal history including prescriptions should help to quickly and accurately determine the problem.

Patient: Male, 55-year-old Final Diagnosis: Acute intestinal infarction • COVID provoked thromboembolism • superior mesenteric artery thrombosis Symptoms: Abdominal pain • diarrhea • nausea Medication:— Clinical Procedure: Exploratory laparotomy • primary anastomosis • small bowel resection • thromboembolectomy Specialty: Gastroenterology and Hepatology • General and Internal Medicine • Surgery Objective: Unusual clinical course Background: The novel COVID-19 disease caused by the SARS-CoV-2 virus is a highly infectious disease that originated in Wuhan, China, and has rapidly spread throughout the world. In addition to respiratory complications, the virus has also been implicated in damage to other organ systems as well as coagulopathy. The present report describes the first presumptive case of COVID-19-associated acute superior mesenteric artery thrombosis and acute intestinal ischemia. Case Report: A 55-year old man presented to the emergency department with nausea, generalized abdominal pain and diarrhea; he denied having a fever or any respiratory symptoms. Computed tomography (CT) of the abdomen and pelvis revealed bilateral pulmonary ground-glass opacities. He tested positive for SARS-CoV-2, and was treated with hydroxychloroquine, azithromycin and ceftriaxone, and was discharged home after five days of inpatient treatment. One week later, the patient returned with recurrent nausea, vomiting and worsening diffuse abdominal pain. A CT scan of the abdomen showed a 1.6-cm clot, causing high grade narrowing of the proximal superior mesenteric artery and bowel ischemia. The patient emergently underwent exploratory laparotomy, thromboembolectomy and resection of the ischemic small bowel. A post-operative complete hypercoagulable workup was unrevealing. Conclusions: Despite the absence of respiratory symptoms, patients infected with SARS-CoV-2 may show atypical presentations, such as gastrointestinal symptoms. Clinicians managing patients with suspected or confirmed SARSCoV-2 infection during the COVID-19 pandemic should monitor these patients for potential complications that may arise from this disease.

To demonstrate the results of endovascular treatment of 15 patients with acute mesenteric ischemia.There were 15 patients with acute mesenteric ischemia who underwent surgery (9 men and 6 women). Mean age was 77±11 years. Acute intestinal ischemia was caused by thromboembolism of superior mesenteric artery (9 patients), thrombosis of superior mesenteric artery (5 patients) and critical stenosis of the ostia of superior mesenteric artery and celiac trunk (1 patient). Mean time from clinical manifestation of disease to admission to the hospital was 13 hours (range 2-72 hours). In-hospital development of acute mesenteric ischemia was noted in 2 patients. Indications for endovascular intervention and techniques of endovascular revascularization of superior mesenteric artery are described in the article.Blood flow restoration in superior mesenteric artery was achieved in 14 (93%) out of 15 patients. Laparotomy was required in 4 (27%) patients for extensive resection of necrotic intestine (n=1, 6.7%), local resection of small bowel (n=2, 13%). In another (6.7%) patient, intestine was recognized as viable after laparotomy. A bulk of intestine was preserved in most patients (n=14, 93%). In-hospital mortality rate was 47% (7 patients died). The main cause of nosocomial death (6 cases) was reperfusion syndrome followed by respiratory distress syndrome and multiple organ failure.New methods of prevention and treatment of reperfusion syndrome can improve the results of treatment of acute mesenteric ischemia.Цель работы - демонстрация результатов эндоваскулярного лечения 15 пациентов с острым артериальным нарушением мезентериального кровообращения. Материалы и методы. Оперированы 15 (9 мужчин и 6 женщин) больных с острой ишемией кишечника. Средний возраст больных составил 77±11 лет. Причиной острой ишемии кишечника явились тромбоэмболия верхней брыжеечной артерии (n=9), ее тромбоз (n=5) и критический стеноз устья верхней брыжеечной артерии и чревного ствола (n=1). Средние сроки от начала заболевания до поступления в стационар 13 ч (от 2 до 72 ч), у 2 пациентов острое нарушение мезентериального кровообращение развилось в стационаре. Описаны применяемые в клинике показания к попытке эндоваскулярного вмешательства, методы и техника эндоваскулярной реваскуляризации верхней брыжеечной артерии. Результаты. Технический успех в виде восстановления магистрального кровотока в верхней брыжеечной артерии на уровне всех сегментов достигнут у 14 (93%) пациентов. Лапаротомия выполнена у 4 (27%) больных: обширная резекция некротизированного кишечника потребовалась в 1 (6,7%) случае, у 2 (13%) пациентов резекция тонкой кишки была необширная, у 1 (6,7%) пациентки после эндоваскулярной реваскуляризации на лапаротомии кишечник признан жизнеспособным. Основная протяженность кишечника сохранена у 14 (93%) пациентов. Внутригоспитальная летальность составила 47% (n=7). Основной причиной внутригоспитального летального исхода (n=6) явился реперфузионный синдром с развитием респираторного дистресс-синдрома и полиорганной недостаточности. Заключение. Поиск и разработка методов профилактики и лечения реперфузионного синдрома могут улучшить результаты лечения острого артериального нарушения мезентериального кровообращения.

Acute intestinal ischemia is a relative rare abdominal emergency, associated with considerably high morbidity and mortality rates. Although the conventional diagnostic approach to acute intestinal ischemia entails a preliminary evaluation of signs and symptoms, followed by radiological and laboratory investigations, a definitive diagnosis is can usually be made after laparotomy, which still remains the gold standard diagnostic (and therapeutic) procedure. Several potential laboratory biomarkers have been investigated over the past decades, but none of these seems to reach a suitable diagnostic accuracy for an early and reliable diagnosis of intestinal ischemia. The aim of this narrative review is to provide an overview on traditional laboratory tests for diagnosing acute intestinal ischemia (i.e., complete blood count, D-dimer, blood gas analysis, total lactic acid, C-reactive protein and procalcitonin), and summarize current evidence regarding some emerging and potentially useful biomarkers such as D-lactate, intestinal fatty acid-binding protein (I-FABP), ischemia modified albumin (IMA), α-glutathione S-transferase (α-GST), interleukin-6 (IL-6), citrulline and smooth muscle protein of 22 kDa (SM22). Among the various tests, D-lactate, IMA and I-FABP are perhaps the most promising, since they are characterized by optimal sensitivity and relatively good specificity, early kinetics, and can be measured with assays suited for a rapid diagnosis.

В статье приведено клиническое наблюдение 83-летней пациентки, которой выполнена успешная аспирационная тромбэктомия из верхней брыжеечной артерии по поводу тромбоэмболии с использованием эндоваскулярного реперфузионного катетера ACE68. В связи с удовлетворительным анигографическим и клиническим результатом - дополнительных манипуляций (стентирование артерии, селективный тромболизис) не потребовалось. Сроки от начала заболевания до восстановления кровотока в бассейне верхней брыжеечной артерии составили 24 часа, лапаротомия или лапароскопия впоследствие не выполнялась. В работе также обсуждаются показания к эндоваскулярному лечению острой окклюзии верхней брыжеечной артерии., Article presents a clinical case of 83-year old woman with successful aspiration thrombectomy from the superior mesenteric artery due to its thromboembolism with the help of endovascular reperfusion catheter ACE68. Due to the satisfactory angiographic and clinical results - additional manipulations (artery stenting, selective thrombolysis) were not performed. Time from the onset of the disease to the restoration of blood mesenteric flow in the basin of the superior mesenteric artery was 24 hours, laparotomy or laparoscopy in post-operative period were not necessary. This article also discusses indications for endovascular treatment of acute occlusion of the superior mesenteric artery, №3 (2018)