Abstract
Bowel ischemia, although rare, is a grave diagnosis requiring prompt recognition and intervention. Early diagnosis is an independent risk factor in outcome. Critically ill patient populations, including those who are post cardiothoracic surgery, pose difficult challenges in the ability to diagnose and treat ischemia. Further, their predisposition towards nonocclusive ischemia creates room for debate in treatment approaches. Limited literature exists for this patient population. The chapter below addresses the best evidence based literature available for diagnosis and intervention within this unique population.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Herbert GS, Steele SR. Acute and chronic mesenteric ischemia. Surg Clin N Am. 2007;87:1115–34.
Bradbury AW, Brittenden J, McBride K, et al. Mesenteric ischemia: a multidisciplinary approach. Br J Surg. 1995;82:1446–59.
Abboud B, Daher R, Boujaude J. Acute mesenteric ischemia after cardiopulmonary bypass surgery. World J Gastroenterol. 2008;14:5361–70.
Guillaume A, Pili-Floury S, Chocron S, Delabrousse E, De Parsebal B, Koch S, Samain E, Capeillier G, Piton G. Acute mesenteric ischemia among post-cardiac surgery patients presenting with multiple organ failure. Shock. 2017;47:296–302.
Klotz S, Vestring T, Rotker J, Schmidt C, Shed HH, Schmid C. Diagnosis and treatment of nonocclusive mesenteric ischemia after open heart surgery. Ann Thorac Surg. 2001;72:1583–6.
O’Dwyer C, Woodson LC, Conroy BP, Lin CY, Deyo DJ, Uchida T, et al. Regional perfusion abnormalities with phenylephrine during normothermic bypass. Ann Thorac Surg. 1997;63:728–35.
Mothes H, Koeppen J, Bayer O, Richter M, Kabisch B, Schwarzkopf D, Hein HAT, Doenst T, Settmacher U. Acute mesenteric ischemia following cardiovascular surgery – a nested case-control study. Int J Surg. 2016;26:79–85.
Eris C, Yavuz S, Yalcinkaya S, Gucu A, Toktas F, Yumun G, Erdolu B, Ozyazicoglu A. Acute mesenteric ischemia after cardiac surgery: an analysis of 53 patients. Sci World J. 2013;2013:6311534. 8 pages
Sastry P, Hardman G, Page A, Parker R, Goddard M, Large S, Jenkins DP. Mesenteric ischemia following cardiac surgery: the influence of intraoperative perfusion parameters. Interact Cardiovasc Thorac Surg. 2014;19:419–24.
Nilsson J, Hansson E, Andersson B. Intestinal ischemia after cardiac surgery: analysis of a large registry. J Cardiothorac Surg. 2013;8:156–63.
Nashe S, Roques F, Sharpies L, Nilsson J, Smith C, Goldstone A, Lockowandt U. EuroSCOREII. Eur J Cardiothorac Surg. 2012;41:743–5.
Andersson B, Andersson R, Brandt J, Hoglund P, Algotsson L, Nilsson J. Gastrointestional complications after cardiac surgery – improved risk stratification using a new scoring model. Interact Cadriovasc Thorac Surg. 2010;10:366–70.
Hong J, Gilder E, Blenkiron C, Jiang Y, Evennett N, Petrov M, Phillips A, Windsor JA, Gillham M. Nonocclusive mesenteric infarction after cardiac surgery: potential biomarkers. J Surg Res. 2017;211:21–9.
McCarthy E, Little M, Briggs J, Sutcliffe J, Tapping CR, Patel R, Bratby MJ, Uberoi R. Radiology and mesenteric ischemia. Clin Radiol. 2015;70:698–705.
Olivia IV, Davarpanah AH, Rybicki FJ, et al. ACR appropriateness criteria imaging of mesenteric ischemia. Abdom Imaging. 2013;38:714–9.
Menke J. Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis. Radiology. 2010;1:93–101.
Bourcier S, Oudjit A, Goudard G, Charpentier J, Leblanc S, Coriat R, Herve G, Dousset B, Mira JP, Pene F. Diagnosis of non-occlusive acute mesenteric ischemia in the intensive care unit. Ann Intensive Care. 2016;6:112.
Kougias P, Lau D, Hosam F, Sayed E, Zhou W, Huynh TT, Lin PH. Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg. 2007;46(3):467–74.
Hackert Z, Kienle P, Weitz J, Wener G, Szabo G, Hagl M, Buchler Q, Schmiet J. Accuracy of diagnostic laparoscopy for early diagnosis of abdominal complications after cardiac surgery. Surg Endosc. 2003;17:1671–4.
Schoots IG, Levi MM, Reekers JA, et al. Thrombolytic therapy for acute superior mesenteric artery occlusion. J Vasc Interv Radiol. 2005;16:317–29.
Schermerhorn ML, Giles KA, Handan AD, et al. Mesenteric revascularization: management and outcomes in the United States, 1988–2006. J Vasc Surg. 2009;50:341–8.
Zettervall SL, Lo RC, Soden PA, Deery SE, Ultee KH, Pinto DS, Wyers MC, Schermerhorn ML. Trends in treatment and mortality for mesenteric ischemia in the United States from 2000 to 2012. Ann Vasc Surg. 2017;42:111–9.
Arthurs ZM, Titus J, Bannazadeh M, et al. A comparison of endovascular revasculariztion with traditional therapy for the treatment of acute mesenteric ischemia. J Vasc Surg. 2011;53:698–704.
Zhao Y, Henghui Y, Chen Y, Deng J, Wang M, Zilun L, Chang G. Management of acute mesenteric ischemia: a critical review and treatment algorithm. Vasc Endovasc Surg. 2017;50:183–92.
Beaulieu EJ, Arnaoutakis KD, Abularrage CJ, Efron DT, Schneider E, Black JH. Comparison of open and endovascular treatment of acute mesenteric ischemia. J Vasc Surg. 2014;59(1):159–64.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Williamson, A.J., Millis, J.M. (2019). Ischemic Bowel in the Post Cardiothoracic Patient. In: Lonchyna, V. (eds) Difficult Decisions in Cardiothoracic Critical Care Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-04146-5_40
Download citation
DOI: https://doi.org/10.1007/978-3-030-04146-5_40
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-04145-8
Online ISBN: 978-3-030-04146-5
eBook Packages: MedicineMedicine (R0)