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What We Can Learn from Cases of Synchronous Acute Mesenteric Obstruction and Nonocclusive Mesenteric Ischemia: How to Reduce the Acute Mesenteric Ischemia-Related Mortality Rate.
- Source :
-
Annals of vascular surgery [Ann Vasc Surg] 2016 Apr; Vol. 32, pp. 133.e11-7. Date of Electronic Publication: 2016 Jan 22. - Publication Year :
- 2016
-
Abstract
- Although the survival rate of patients with ischemic heart disease has recently increased, it remains unknown why the mortality rate of acute mesenteric ischemia (AMI) remains high. Here, we report a possible method of improving the survival rate of patients with AMI obtained through 2 cases of simultaneous acute mesenteric obstruction (AMO) and nonocclusive mesenteric ischemia (NOMI). Case 1 was a 74-year-old woman with atrial fibrillation, hypertension, and dyslipidemia as underlying diseases who developed NOMI immediately after undergoing SMA thrombolysis. Case 2 was a 69-year-old man with atrial fibrillation, hypertension, chronic heart failure, chronic renal failure, and old myocardial infarction who was diagnosed with SMA occlusion complicated by NOMI on the basis of abdominal angiography findings during the first visit. Cure was achieved by thrombolytic therapy, resection of the necrotic intestine, and continuous intra-arterial and/or intravenous injection of prostaglandin E1 (PGE1) in case 1 and by resection of the necrotic intestine and continuous intra-arterial and/or intravenous injection of PGE1 in case 2. AMO and NOMI have many background similarities (e.g., atherosclerosis, hypertension, and ischemic heart disease), making their coexistence very likely. However, no case of AMO plus NOMI has been reported until now. It is highly probable that concomitant NOMI is overlooked in cases of AMO. When managing AMO, NOMI should be considered as a complication, which may lower the patient's potential risk of developing NOMI and contribute to improved prognosis of both AMO and AMI.<br /> (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Subjects :
- Acute Disease
Aged
Biopsy
Combined Modality Therapy
Computed Tomography Angiography
Female
Humans
Intestine, Small blood supply
Intestine, Small pathology
Male
Mesenteric Ischemia complications
Mesenteric Ischemia diagnostic imaging
Mesenteric Vascular Occlusion complications
Mesenteric Vascular Occlusion diagnostic imaging
Multidetector Computed Tomography
Necrosis
Treatment Outcome
Alprostadil administration & dosage
Intestine, Small surgery
Mesenteric Ischemia therapy
Mesenteric Vascular Occlusion therapy
Thrombolytic Therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1615-5947
- Volume :
- 32
- Database :
- MEDLINE
- Journal :
- Annals of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 26806236
- Full Text :
- https://doi.org/10.1016/j.avsg.2015.11.010