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Mesenteric Ischemia for the Acute Care Surgeon

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Common Problems in Acute Care Surgery

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Abstract

Mesenteric ischemia remains one of the most challenging diseases for the acute care surgeon to care for. Identification of the disease process and expedient progression to therapy are the key components of successful management. Depending on etiology, early treatment with revascularization, anticoagulation, resuscitation, antibiotics, and early surgical intervention remain paramount to improve outcomes and prevent disease progression. The mainstays of therapeutic advancement in the recent era have focused on evolution of endovascular techniques. Despite these advancements over the past 30 years, mesenteric ischemia remains a devastating disease with high mortality rates. This chapter describes a multidisciplinary approach to caring for these challenging patients, reviewing classical and novel therapeutic methodologies.

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References

  1. van Gulik TM, Schoots I. Anastomosis of Riolan revisited: the meandering mesenteric artery. Arch Surg. 2005;140(12):1225–9.

    Google Scholar 

  2. van Petersen AS, Kolkman JJ, Meerwaldt R, et al. Mesenteric stenosis, collaterals, and compensatory blood flow. J Vasc Surg. 2014;60(1):111–9.e2. doi:10.1016/j.jvs.2014.01.063.

  3. Ibukuro K, Tsukiyama T, Mori K, Inoue Y. The congenital anastomoses between hepatic arteries: angiographic appearance. Surg Radiol Anat. 2000;22(1):41–5.

    Article  CAS  PubMed  Google Scholar 

  4. Hiatt J, Gabbay J, Busuttil R. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. 1994;220(1):50–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Arjhansiri K, Charoenrat P, Kitsukjit W. Anatomic variations of the hepatic arteries in 200 patients done by angiography. J Med Assoc Thail. 2006;89:S161–8.

    Google Scholar 

  6. Elliot II JW. The operative relief of gangrene of intestine due to occlusion of the mesenteric vessels. Ann Surg. 1895;21(1):9–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Herbert GS, Steele SR. Acute and chronic mesenteric ischemia. Surg Clin North Am. 2007;87(5):1115–34. doi:10.1016/j.suc.2007.07.016.

    Article  PubMed  Google Scholar 

  8. Bobadilla JL. Mesenteric Ischemia. Surg Clin North Am. 2013;93(4):925–40. doi:10.1016/j.suc.2013.04.002.

    Article  PubMed  Google Scholar 

  9. Ageno W, Riva N, Schulman S, et al. Long-term clinical outcomes of splanchnic vein thrombosis: results of an international registry. JAMA Intern Med. 2015;175(9):1474–80. doi:10.1001/jamainternmed.2015.3184.

    Article  PubMed  Google Scholar 

  10. McKinsey J, Gewertz B. Acute mesenteric ischemia. Surg Clin North Am. 1997;77(2):307–18.

    Article  CAS  PubMed  Google Scholar 

  11. Stone JR, Wilkins LR. Acute mesenteric ischemia. Tech Vasc Interv Radiol. 2015;18(1):24–30. doi:10.1053/j.tvir.2014.12.004.

  12. Sise MJ. Acute mesenteric ischemia. Surg Clin North Am. 2014;94(1):165–81. doi:10.1016/j.suc.2013.10.012.

    Article  PubMed  Google Scholar 

  13. Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Arch Intern Med. 2004;164(10):1054–62. doi:10.1001/archinte.164.10.1054.

  14. Berland T, Oldenburg WA. Acute mesenteric ischemia. Curr Gastroenterol Rep. 2008;10(3):341–6.

    Article  PubMed  Google Scholar 

  15. Mesina C, Vasile I, Pasalega M, Calota F, Vilcea D. Acute mesenteric ischemia. Chirurgia (Bucur). 2008;103(4):385–94.

    CAS  Google Scholar 

  16. Wilkins LR, Stone JR. Chronic Mesenteric Ischemia. Tech Vasc Interv Radiol. 2015;18(1):31–7. doi:10.1053/j.tvir.2014.12.005.

    Article  PubMed  Google Scholar 

  17. Pecoraro F, Rancic Z, Lachat M, et al. Chronic mesenteric ischemia: critical review and guidelines for management. Ann Vasc Surg. 2013;27(1):113–22. doi:10.1016/j.avsg.2012.05.012.

    Article  PubMed  Google Scholar 

  18. Singal AK, Kamath PS, Tefferi A. Mesenteric venous thrombosis. Mayo Clin Proc. 2013;88(3):285–94. doi:10.1016/j.mayocp.2013.01.012.

    Article  PubMed  Google Scholar 

  19. Cappell MS. Colonic toxicity of administered drugs and chemicals. Am J Gastroenterol. 2004;99(6):1175–90. doi:10.1111/j.1572-0241.2004.30192.x.

    Article  CAS  PubMed  Google Scholar 

  20. Fischer J, Ozaki K, Kelly E. In: Fischer J, editor. Mastery of surgery, 6th Ed. 2012:2371–2377.

    Google Scholar 

  21. Neuman MD, Allen S, Schwarze ML, et al. Acute mesenteric ischemia. Tech Vasc Interv Radiol. 2015;10(4):1071–72. doi:10.1007/s00068-015-0546-4.

  22. Eliason JL, Wainess RM, Dimick JB, et al. The effect of secondary operations on mortality following abdominal aortic aneurysm repair in the United States: 1988–2001. Vasc Endovascular Surg. 2005;39(6):465–72.

    Article  PubMed  Google Scholar 

  23. Weber JM, Boules M, Fong K, et al. Median arcuate ligament syndrome is not A vascular disease. Ann Vasc Surg. 2015. doi:10.1016/j.avsg.2015.07.013.

    PubMed  Google Scholar 

  24. Duran M, Pohl E, Grabitz K, Schelzig H, Sagban TA, Simon F. The importance of open emergency surgery in the treatment of acute mesenteric ischemia. World J Emerg Surg. 2015;10:45-015–0041-0046. doi:10.1186/s13017-015-0041-6.

  25. Mansour M. Management of acute mesenteric ischemia. Arch Surg. 1999;134(3):328–30.

    Article  CAS  PubMed  Google Scholar 

  26. Gupta P, Natarajan B, Gupta H, Fang X, Fitzgibbons R. Morbidity and mortality after bowel resection for mesenteric ischemia. Surgery. 2011;150:779–87.

    Article  PubMed  Google Scholar 

  27. Leone M, Bechis C, Baumstarck K, et al. Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases. Intensive Care Med. 2015;41(4):667–76. doi:10.1007/s00134-015-3690-8.

  28. Lehtimaki TT, Karkkainen JM, Saari P, Manninen H, Paajanen H, Vanninen R. Detecting acute mesenteric ischemia in CT of the acute abdomen is dependent on clinical suspicion: review of 95 consecutive patients. Eur J Radiol. 2015. doi:S0720-048X(15)30098-X

    Google Scholar 

  29. Hagspiel KD, Flors L, Hanley M, Norton PT. Computed tomography angiography and magnetic resonance angiography imaging of the mesenteric vasculature. Tech Vasc Interv Radiol. 2015;18(1):2–13. doi:10.1053/j.tvir.2014.12.002.

  30. Lee M, Sperry J, Rosengart M. Evaluating for acute mesenteric ischemia in critically ill patients: diagnostic peritoneal lavage is associated with reduced operative intervention and mortality. J Trauma Acute Care Surg. 2014;77(3):441–7.

    Article  PubMed  Google Scholar 

  31. Park WM, Gloviczki P, Cherry Jr KJ, et al. Contemporary management of acute mesenteric ischemia: factors associated with survival. J Vasc Surg. 2002;35(3):445–52.

    Article  PubMed  Google Scholar 

  32. Plumereau F, Mucci S, Le Naoures P, Finel JB, Hamy A. Acute mesenteric ischemia of arterial origin: importance of early revascularization. J Visc Surg. 2015;152(1):17–22. doi:10.1016/j.jviscsurg.2014.11.001.

  33. Inoue Y, Schichijo Y, Ibukuro K. Indications for the intra-arterial infusion of urokinase in the treatment of acute intestinal ischemia in patients with heart disease. Rofo. 1985;143(6):660–4. doi:10.1055/s-2008-1052889.

  34. Biebl M, Oldenburg WA, Paz-Fumagalli R, McKinney JM, Hakaim AG. Surgical and interventional visceral revascularization for the treatment of chronic mesenteric ischemia–when to prefer which? World J Surg. 2007;31(3):562–8. doi:10.1007/s00268-006-0434-5.

  35. Khripun AI, Mironkov AB, Shurygin SN, Abashin MV, Priamikov AD. Endovascular interventions for acute ischemia of intestine. Khirurgiia (Sofiia). 2015;(7):62–4.

    Google Scholar 

  36. Serracant Barrera A, Luna Aufroy A, Hidalgo Rosas JM, et al. Acute mesenteric ischemia: utility of endovascular techniques. Cir Esp. 2015. doi:S0009-739X(15)00183-9

    Google Scholar 

  37. Jia Z, Jiang G, Tian F, et al. Early endovascular treatment of superior mesenteric occlusion secondary to thromboemboli. Eur J Vasc Endovasc Surg. 2014;47(2):196–203. doi:10.1016/j.ejvs.2013.09.025.

  38. Schoots IG, Levi MM, Reekers JA, Lameris JS, van Gulik TM. Thrombolytic therapy for acute superior mesenteric artery occlusion. J Vasc Interv Radiol. 2005;16(3):317–29.

    Google Scholar 

  39. Eslami MH, Rybin D, Doros G, McPhee JT, Farber A. Mortality of acute mesenteric ischemia remains unchanged despite significant increase in utilization of endovascular techniques. Vascular. 2015. doi:1708538115577730.

    Google Scholar 

  40. Raupach J, Lojik M, Chovanec V, et al. Endovascular management of acute embolic occlusion of the superior mesenteric artery: a 12-year single-centre experience. Cardiovasc Intervent Radiol. 2015. doi:10.1007/s00270-015-1156-6.

  41. Blauw JT, Meerwaldt R, Brusse-Keizer M, et al. Retrograde open mesenteric stenting for acute mesenteric ischemia. J Vasc Surg. 2014;60(3):726–34. doi:10.1016/j.jvs.2014.04.001.

  42. Atema JJ, Gans SL, Boermeester MA. Systematic review and meta-analysis of the open abdomen and temporary abdominal closure techniques in non-trauma patients. World J Surg. 2015;39(4):912–25. doi:10.1007/s00268-014-2883-6.

  43. Ishizuka M, Nagata H, Takagi K, et al. Usefulness of intraoperative observation using a fluorescence imaging instrument for patients with nonocclusive mesenteric ischemia. Int Surg. 2015;100(4):593–99. doi:10.9738/INTSURG-D-14-00038.1.

  44. Ballard JL, Stone WM, Hallett JW, Pairolero PC, Cherry KJ. A critical analysis of adjuvant techniques used to assess bowel viability in acute mesenteric ischemia. Am Surg. 1993;59(5):309–11.

    CAS  PubMed  Google Scholar 

  45. Schoenberg MH, Beger HG. Reperfusion injury after intestinal ischemia. Crit Care Med. 1993;21(9):1376–86.

    Article  CAS  PubMed  Google Scholar 

  46. Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA. 2010;303(8):739–46. doi:10.1001/jama.2010.158.

  47. Jansen TC, van Bommel J, Schoonderbeek FJ, et al. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010;182(6):752–61. doi:10.1164/rccm.200912-1918OC.

  48. Connelly CR, Schreiber MA. Endpoints in resuscitation. Curr Opin Crit Care. 2015:1. doi:10.1097/MCC.0000000000000248.

    Google Scholar 

  49. Jeejeebhoy KN. Management of short bowel syndrome: avoidance of total parenteral nutrition. Gastroenterology. 2006;130(2 Suppl 1):S60–6.

    Article  CAS  PubMed  Google Scholar 

  50. Howard L, Malone M. Current status of home parenteral nutrition in the United States. Transpl Proc. 1996;28:2691–5.

    CAS  Google Scholar 

  51. Karkkainen JM, Lehtimaki TT, Manninen H, Paajanen H. Acute Mesenteric Ischemia Is a More Common Cause than Expected of Acute Abdomen in the Elderly. J Gastrointest Surg. 2015;19(8):1407–1414. doi:10.1007/s11605-015-2830-3 [doi].

  52. Neuman MD, Allen S, Schwarze ML, Uy J. Using time-limited trials to improve surgical care for frail older adults. Ann Surg. 2015;261(4):639–41. doi:10.1097/SLA.0000000000000939.

  53. Cooper Z, Corso K, Bernacki R, Bader A, Gawande A, Block S. Conversations about treatment preferences before high-risk surgery: a pilot study in the preoperative testing center. J Palliat Med. 2014;17(6):701–7. doi:10.1089/jpm.2013.0311.

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Authors and Affiliations

  1. Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Rod L611, Portland, OR, 97239, USA

    Rebecca JoAnne Weddle, Justin J. J. Watson & Jennifer Marie Watters

Authors
  1. Rebecca JoAnne Weddle
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  2. Justin J. J. Watson
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  3. Jennifer Marie Watters
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Correspondence to Jennifer Marie Watters .

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Editors and Affiliations

  1. Department of Surgery, The University of Texas McGovern Medical School - Houston, Houston, Texas, USA

    Laura J. Moore

  2. General Surgery and Trauma Ben Taub Hospital, Houston, Texas, USA

    S. Rob Todd

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Weddle, R.J., Watson, J.J.J., Watters, J.M. (2017). Mesenteric Ischemia for the Acute Care Surgeon. In: Moore, L., Todd, S. (eds) Common Problems in Acute Care Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-42792-8_30

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  • DOI: https://doi.org/10.1007/978-3-319-42792-8_30

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