RESUMEN
Background Acute arterial mesenteric ischemia requires emergency treatment and is associated with high mortality rate and poor quality of life. Identifying factors associated with survival without intestinal resection (hereafter, intestinal resection-free [IRF] survival) could help in treatment decision-making after first-line endovascular revascularization. Purpose To identify factors associated with 30-day IRF survival in patients with acute arterial mesenteric ischemia whose first-line treatment was endovascular revascularization. Materials and Methods Patients with acute arterial mesenteric ischemia whose first-line treatment was endovascular revascularization because of a low probability of bowel necrosis were included in this single-center retrospective cohort (May 2014 to August 2022). Patient demographics, laboratory values, clinical characteristics at admission, CT scans, angiograms, and endovascular revascularization-related variables were included. The primary end point was 30-day IRF survival, and secondary end points were 3-month, 1-year, and 3-year overall survival. Factors independently associated with 30-day IRF survival were identified with binary logistic regression. Results A total of 117 patients (median age, 70 years [IQR, 60-77]; 53 female, 64 male) were included. Within 30 days after revascularization, 73 of 117 patients (62%) survived without resection, 28 of 117 (24%) survived after resection, 14 of 117 (12%) died without resection, and two of 117 (2%) underwent resection but died. The 30-day IRF survival was 63% (74 of 117). The 3-month, 1-year, and 3-year mortality rate was 18% (21 of 117), 21% (25 of 117), and 27% (32 of 117), respectively. Independent predictors of 30-day IRF survival were persistent bowel enhancement at initial CT (odds ratio [OR], 0.3; 95% CI: 0.2, 0.8; P = .013) and C-reactive protein (CRP) level less than 100 mg/L (OR, 0.3; 95% CI: 0.1, 0.8; P = .002). The 30-day IRF survival was 86%, 61%, 47%, and 23% in patients with both favorable features, persistent bowel enhancement but CRP level greater than 100 mg/L, no bowel enhancement but CRP level less than 100 mg/L, and both unfavorable features, respectively. Conclusion Independent predictors associated with 30-day IRF survival in patients with acute arterial mesenteric ischemia whose first-line treatment was endovascular revascularization were persistent bowel wall enhancement at initial CT and CRP level less than 100 mg/L. © RSNA, 2024 Supplemental material is available for this article.
Asunto(s)
Procedimientos Endovasculares , Isquemia Mesentérica , Humanos , Masculino , Femenino , Isquemia Mesentérica/cirugía , Isquemia Mesentérica/diagnóstico por imagen , Isquemia Mesentérica/mortalidad , Procedimientos Endovasculares/métodos , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Intestinos/irrigación sanguínea , Intestinos/diagnóstico por imagen , Intestinos/cirugía , Enfermedad AgudaRESUMEN
OBJECTIVE: Retrograde open mesenteric stenting (ROMS) is an alternative to mesenteric bypass in patients with acute mesenteric ischemia (AMI) with variable reported 30-day mortality rates. Large studies evaluating patient outcomes following ROMS are scarce. Our study aims to assess the results of this approach among patients presenting with AMI. METHODS: We reviewed all the patients with AMI who were treated with ROMS (2011-2022). Patient demographics, presentation, operative details, and outcomes were analyzed. Primary end points were in-hospital, 30-day, and 1-year mortality. Kaplan-Meier estimate for 1-year mortality and primary patency loss were generated. Secondary end points included postoperative 30-day complications. RESULTS: Between 2011 and 2022, ROMS was attempted on a total of 42 patients. The median age was 70 ± 15 years and the majority of patients were female. Pain out of proportion to the physical examination was the most common presenting symptom (n = 18, 42.9%) followed by peritonitis (n = 14, 33.4%). All patients underwent preoperative intravenous contrast computed tomography imaging. In situ thrombosis was identified as the etiology of AMI in 36 patients (85.7%). Technical success was achieved in 40 patients (95.2%). Conventional, non-hybrid operating rooms were used for the majority of cases. Revascularization of all 40 patients involved angioplasty and stenting of superior mesenteric artery. A single stent was placed in 35 patients (87.5%) and the reminder had more than one stent. Eighty percent of patients required bowel resection. A second-look laparotomy was required in 34 patients (85.0%). The mean operative time, including both the general surgery and vascular surgery portions of the index procedure, was 192 ± 57 minutes. Sepsis was the most common complication observed within 30 days, occurring in 8 patients (20.0%). In terms of mortality, 13 patients (32.5%) died during their index hospitalization, and 9 died (22.5%) within 30 days. On Kaplan-Meier analysis, the 1-year overall patient survival rate was 58.6%, and the primary patency rate for stents was 51.4%. CONCLUSIONS: ROMS has an excellent technical success rate in management of AMI with lower than traditionally reported mortality rates for AMI. The dual benefits of rapid revascularization and bowel evaluation should make this surgical modality an alternative approach for treatment of AMI.
Asunto(s)
Procedimientos Endovasculares , Isquemia Mesentérica , Oclusión Vascular Mesentérica , Stents , Grado de Desobstrucción Vascular , Humanos , Femenino , Masculino , Isquemia Mesentérica/cirugía , Isquemia Mesentérica/mortalidad , Isquemia Mesentérica/fisiopatología , Isquemia Mesentérica/diagnóstico por imagen , Anciano , Resultado del Tratamiento , Estudios Retrospectivos , Persona de Mediana Edad , Factores de Tiempo , Anciano de 80 o más Años , Oclusión Vascular Mesentérica/fisiopatología , Oclusión Vascular Mesentérica/mortalidad , Oclusión Vascular Mesentérica/diagnóstico por imagen , Oclusión Vascular Mesentérica/cirugía , Oclusión Vascular Mesentérica/terapia , Enfermedad Aguda , Factores de Riesgo , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/mortalidad , Mortalidad Hospitalaria , Complicaciones Posoperatorias/etiología , Circulación EsplácnicaRESUMEN
BACKGROUND: This study was performed to summarize our experience in treating acute superior mesenteric artery embolism (SMAE) by percutaneous mechanical thrombectomy (PMT). METHODS: Between January 2023 and October 2023, 18 patients presenting with acute mesenteric ischemia were admitted to our center, including 11 cases of SMAE, 3 cases of superior mesenteric artery thrombosis, and 4 cases of superior mesenteric vein thrombosis. We retrospectively reviewed 8 patients (4 males and 4 females; range, 51-79 years; mean, 62.50 ± 9.67 years) who underwent treatment of acute SMAE using the AcoStream system. The patients had no obvious evidence of intestinal necrosis as shown by peritoneal puncture or computed tomography. Thrombectomy was performed on the superior mesenteric artery (SMA) using an 8F AcoStream thrombus aspiration system (Acotec, China). The demographics, risk factors, therapeutic effect, complications, mortality, and follow-up of the study population were assessed. RESULTS: The technical success rate was 100%. After 1-3 passes (2.38 ± 0.92) and aspiration thrombectomy, complete thrombus removal was achieved in 7 (87.50%) patients. One patient received an adjunctive catheter-directed thrombolysis due to partial thrombus removal. Thrombolysis was conducted for 2 days, resulting in complete resolution of the thrombus. The other 7 patients did not receive adjunctive endovascular intervention due to complete thrombus removal and no residual stenosis. No distal embolization or device-related complications were noted during the procedure. After the procedure, sufficient clinical improvement was seen in 6 patients within 1-2 days. Two patients showed no significant improvement of their symptoms. Laparotomy was performed on day 1 and day 2 after thrombectomy in patients 3 and 7, respectively. Intestinal necrosis was diagnosed operatively and intestinal resection was performed. All patients were discharged 6-15 days (9.50 ± 3.07) after admission without perioperative complication or death. The mean follow-up period was 5.00 ± 3.30 months (range, 1-10 months), and the follow-up rate was 100%. During the follow-up, all patients remained symptom-free. Computed tomography angiography images showed good flow in the trunk and branches of the SMA in all patients. CONCLUSIONS: PMT using the AcoStream system is a minimally invasive, safe, and effective technique for acute SMAE. Early application of PMT can achieve immediate revascularization of the SMA and have the potential advantage of avoiding laparotomy or reducing the extension of enterectomy, as it could theoretically restore intestinal perfusion in less time than open revascularization. If the symptoms do not improve after PMT, exploratory laparotomy should be scheduled as soon as possible. Further studies are necessary on this field to confirm these findings.
Asunto(s)
Arteria Mesentérica Superior , Isquemia Mesentérica , Oclusión Vascular Mesentérica , Trombectomía , Humanos , Masculino , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Anciano , Arteria Mesentérica Superior/diagnóstico por imagen , Arteria Mesentérica Superior/cirugía , Arteria Mesentérica Superior/fisiopatología , Oclusión Vascular Mesentérica/diagnóstico por imagen , Oclusión Vascular Mesentérica/fisiopatología , Oclusión Vascular Mesentérica/terapia , Oclusión Vascular Mesentérica/cirugía , Oclusión Vascular Mesentérica/mortalidad , Resultado del Tratamiento , Trombectomía/efectos adversos , Trombectomía/instrumentación , Isquemia Mesentérica/diagnóstico por imagen , Isquemia Mesentérica/cirugía , Isquemia Mesentérica/terapia , Isquemia Mesentérica/fisiopatología , Factores de Tiempo , Enfermedad Aguda , Embolia/etiología , Embolia/cirugía , Embolia/diagnóstico por imagen , Succión , Diseño de Equipo , ChinaRESUMEN
BACKGROUND: Mesenteric ischemia is a life-threatening condition with a complex etiology and diagnostics. OBJECTIVE: Etiology, incidence, symptoms, and diagnostics of acute and chronic mesenteric ischemia. MATERIAL AND METHODS: Literature search via PubMed with a focus on studies on the epidemiology and diagnostics of mesenteric ischemia and analysis of existing international guidelines. RESULTS: The incidence of acute mesenteric ischemia is given as 0.63-12.9 per 100,000 people per year. There are no sufficiently reliable figures for chronic mesenteric ischemia, but an incidence of up to 3 per 100,000 inhabitants per year is generally assumed. The three-phase computed tomography has the highest diagnostic specificity and sensitivity. CONCLUSION: In the presence of risk factors acute and chronic mesenteric ischemia should be considered as differential diagnoses in the presence of abdominal pain using three-phase computed tomography.
Asunto(s)
Isquemia Mesentérica , Humanos , Isquemia Mesentérica/diagnóstico por imagen , Isquemia Mesentérica/epidemiología , Intestinos , Isquemia/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Factores de RiesgoRESUMEN
Open revascularization for mesenteric ischemia has retained a significant value despite the increasing importance and use of endovascular techniques. Surgical procedures such as retrograde embolectomy, thromboendarterectomy and visceral bypass are indispensable components of the therapeutic armamentarium, particularly in cases of multisegmental vascular involvement, failure of previous endovascular treatment and concomitant presence of peritonitis, shock or multiorgan failure. In this context, preoperative multiphase computed tomography (CT) angiography is essential for the planning and outcome of visceral revascularization. This article summarizes the indications, technique, and results of the most important open surgical procedures.
Asunto(s)
Procedimientos Endovasculares , Isquemia Mesentérica , Humanos , Isquemia Mesentérica/diagnóstico por imagen , Isquemia Mesentérica/cirugía , Resultado del Tratamiento , Procedimientos Endovasculares/métodos , Embolectomía , ArteriasRESUMEN
Acute mesenteric ischemia (AMI) is still a time-critical and life-threatening clinical picture. If exploration of the abdominal cavity is necessary during treatment, an intraoperative assessment of which segments of the intestines have a sufficient potential for recovery must be made. These decisions are mostly based on purely clinical parameters, which are subject to high level of uncertainty. This review article provides an overview of how this decision-making process and the determination of resection margins can be improved using technical aids, such as laser Doppler flowmetry (LDF), indocyanine green (ICG) fluorescence angiography or hyperspectral imaging (HSI). Furthermore, this article compiles guideline recommendations on the role of laparoscopy and the value of a planned second-look laparotomy. In addition, an overview of strategies for preventing short bowel syndrome is given and other aspects, such as the timing and technical aspects of placement of a preternatural anus and an anastomosis are highlighted.
Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo , Laparoscopía , Isquemia Mesentérica , Humanos , Isquemia Mesentérica/diagnóstico por imagen , Isquemia Mesentérica/cirugía , Márgenes de Escisión , Intestinos/cirugía , Laparoscopía/métodosRESUMEN
BACKGROUND Chronic mesenteric ischemia (CMI) is defined as ischemic symptoms caused by insufficient supply of blood to the gastrointestinal tract. Patients diagnosed with advanced symptomatic CMI should be treated subsequently, as the transition from CMI to acute mesenteric ischemia can be unpredictable. However, there is little information regarding the management of potential procedural complications during endovascular therapy (EVT) for CMI. CASE REPORT A 70-year-old man was admitted to our hospital with recurrent abdominal pain just after hemodialysis. The angiogram showed significant stenosis with heavy calcification in the proximal of the superior mesenteric artery (SMA), leading to the diagnosis of CMI. To alleviate the symptom, EVT for the stenotic lesion of the SMA was indicated. During the procedure, a cutting balloon was inflated to facilitate vessel expansion in the target lesion. As a result, intravascular ultrasound (IVUS) imaging revealed dissection into the media with extension into the medial space without reentry and demonstrated a semilunar intramural hematoma. We were able to contain the intramural hematoma by covering the whole dissection in the SMA with implantation of self-expandable stents. CONCLUSIONS This case highlights the potential of EVT for heavy calcification of the SMA complicated by dissection without reentry. Intramural hematoma was observed with IVUS examination. We were able to contain the hematoma by the implantation of self-expandable stents over the whole length of the SMA dissection under IVUS-guided EVT.
Asunto(s)
Isquemia Mesentérica , Oclusión Vascular Mesentérica , Masculino , Humanos , Anciano , Arteria Mesentérica Superior/diagnóstico por imagen , Isquemia Mesentérica/diagnóstico por imagen , Isquemia Mesentérica/etiología , Isquemia Mesentérica/terapia , Intestinos , Ultrasonografía , Enfermedad Crónica , Isquemia , Stents , Resultado del TratamientoRESUMEN
We report herein a case of delayed bowel stenosis after surgery for non-occlusive mesenteric ischemia (NOMI), which was successfully treated with endoscopic stenting. The patient was a 78-year-old woman who underwent an emergency laparotomy for NOMI and duodeno-ileal anastomosis. Necrosis was observed in almost all areas of the small intestine except for the beginning of the jejunum and the end of the ileum. Postoperatively, the patient was discharged with central venous nutrition, but was readmitted on postoperative day 54 with a diagnosis of postoperative ileus. The patient failed to respond to conservative treatment. Fluoroscopic endoscopy revealed wall stiffness and circumferential stenosis in the ascending colon at a different site from that of the anastomosis. Based on this finding, delayed stenosis of the ascending colon after NOMI treatment was diagnosed. Bougie dilatation was performed for the stenosis, leading to temporary improvement. However, stenosis along with ileus soon recurred. To prevent restenosis, a metallic stent was endoscopically implanted at the stenotic site. Thereafter, the patient was discharged without any further episodes of restenosis. Delayed bowel stenosis may occur after a subtotal resection of the small intestine for NOMI. Endoscopic stenting is an effective treatment option if resection is difficult.
Asunto(s)
Ileus , Obstrucción Intestinal , Isquemia Mesentérica , Femenino , Humanos , Anciano , Isquemia Mesentérica/diagnóstico por imagen , Isquemia Mesentérica/etiología , Isquemia Mesentérica/cirugía , Constricción Patológica/etiología , Constricción Patológica/cirugía , Intestino Delgado/cirugía , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Isquemia/etiología , Isquemia/cirugíaRESUMEN
PURPOSE: Contrast enhancement of the adrenal gland defined by computed tomography (CT) was previously analyzed as a prognostic factor for critically ill patients in various diseases. However, no study investigated this quantitative parameter in patients with acute mesenteric ischemia. Therefore, the aim of this study was to evaluate the prognostic value of the contrast enhancement of the adrenal glands in patients with clinically suspected AMI. METHODS: All patients with clinically suspected AMI were retrospectively assessed between 2016 and 2020. All patients underwent surgical exploration after CT imaging. Overall, 134 patients (52 female patients, 38.8%) with a mean age of 69.2 ± 12.4 years were included into the present analysis. For all patients, the preoperative CT was used to calculate the contrast media enhancement of the adrenal glands and the spleen. RESULTS: A total of 27 patients (18.5%) died within the first 24 h and over the following 30-day 94 patients (68.6%) died. There were statistically significant differences regarding the mean values for adrenal-to-spleen ratio for 24-h mortality (p = 0.001) and 30-day mortality (p = 0.004), whereas the radiodensity of the inferior vena cava and the radiodensity of the spleen was statistically significant between survivors and non-survivors after 30 days (p = 0.037 and p = 0.028, respectively). In Cox regression analysis, mean adrenal radiodensity was associated with 24-h mortality (HR 1.09, 95% CI 1.02-1.16, p = 0.01) but not with 30-day mortality (HR 1.03, 95% CI 0.99-1.07, p = 0.13). CONCLUSION: The contrast media enhancement of the adrenal gland is associated with the 24-h and 30-day mortality in patients with AMI. However, the prognostic relevance for translation into clinical routine needs to be validated in other cohorts.
Asunto(s)
Glándulas Suprarrenales , Medios de Contraste , Isquemia Mesentérica , Bazo , Tomografía Computarizada por Rayos X , Humanos , Femenino , Masculino , Anciano , Estudios Retrospectivos , Glándulas Suprarrenales/diagnóstico por imagen , Glándulas Suprarrenales/irrigación sanguínea , Pronóstico , Bazo/diagnóstico por imagen , Isquemia Mesentérica/diagnóstico por imagen , Isquemia Mesentérica/mortalidad , Tomografía Computarizada por Rayos X/métodos , Vena Porta/diagnóstico por imagen , Persona de Mediana Edad , Enfermedad Aguda , Anciano de 80 o más AñosRESUMEN
Nonocclusive mesenteric ischemia (NOMI) is a life-threatening disorder. Early diagnosis is challenging because NOMI lacks specific symptoms. A 52-year-old man who received extended cholecystectomy with Roux-en-Y hepaticojejunostomy for gallbladder cancer (GBC) presented to our hospital with nausea and vomiting. Neither tender nor peritoneal irritation sign was present on abdominal examination. Blood test exhibited marked leukocytosis (WBC:19,800/mm3). A contrast-enhanced abdominal computed tomography (CT) scan revealed remarkable wall thickening and lower contrast enhancement effect localized to Roux limb. On hospital day 2, abdominal arterial angiography revealed angio-spasm at marginal artery and arterial recta between 2nd jejunal artery and 3rd jejunal artery, leading us to the diagnosis of NOMI. We then administered continuous catheter-directed infusion of papaverine hydrochloride until hospital day 7. Furthermore, the patient was anticoagulated with intravenous unfractionated heparin and antithrombin agents for increasing D-dimer level and decreasing antithrombin III level. On hospital day 8, diluted oral nutrition diet was initiated and gradually advanced as tolerated. On hospital day 21, the patient was confirmed of improved laboratory test data and discharged with eating a regular diet. We experienced a rare case of NOMI on Roux limb after 2 years of extended cholecystectomy with hepaticojejunostomy for GBC, promptly diagnosed and successfully treated by interventional radiology (IVR).
Asunto(s)
Anastomosis en-Y de Roux , Isquemia Mesentérica , Humanos , Masculino , Persona de Mediana Edad , Isquemia Mesentérica/diagnóstico por imagen , Isquemia Mesentérica/etiología , Isquemia Mesentérica/cirugía , Isquemia Mesentérica/terapia , Neoplasias de la Vesícula Biliar/diagnóstico por imagen , Neoplasias de la Vesícula Biliar/cirugía , Neoplasias de la Vesícula Biliar/complicaciones , Colecistectomía , Tomografía Computarizada por Rayos X , Complicaciones Posoperatorias/terapia , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Radiología Intervencionista/métodos , YeyunostomíaRESUMEN
BACKGROUND: The worldwide vaccination response to COVID-19 has been associated with rare thrombotic complications, including the case of postvaccination splanchnic venous thrombosis we report here. CASE PRESENTATION: An 80-year-old Japanese male with abdominal pain presented to our hospital six days after receiving a dose of the COVID-19 messenger ribonucleic acid vaccine. Abdominal computed tomography showed localized edema of the small intestine, increased density of the surrounding adipose tissue, and a thrombus in the superior mesenteric vein. Conservative inpatient treatment with unfractionated heparin relieved the thrombosis, and the patient is currently receiving oral apixaban as an outpatient. CONCLUSION: Reported cases of thrombosis after COVID-19 vaccination typically have been associated with viral vector vaccines, with few reports of thrombosis induced by mRNA vaccines. The potential for venous thrombosis should be explored when patients present with abdominal pain soon after COVID-19 vaccination.
Asunto(s)
Vacunas contra la COVID-19 , Isquemia Mesentérica , Trombosis de la Vena , Anciano de 80 o más Años , Humanos , Masculino , Dolor Abdominal/inducido químicamente , COVID-19/prevención & control , Vacunas contra la COVID-19/efectos adversos , Heparina/uso terapéutico , Isquemia Mesentérica/inducido químicamente , Isquemia Mesentérica/diagnóstico por imagen , Venas Mesentéricas/diagnóstico por imagen , Vacunación/efectos adversos , Trombosis de la Vena/inducido químicamente , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/tratamiento farmacológicoRESUMEN
Resumo A trombose de veia porta (TVP) é uma doença na qual ocorre trombose desde os ramos intra-hepáticos da veia porta, podendo se estender até a veia esplênica e/ou veia mesentérica superior, estando associada, na maioria das vezes, à cirrose hepática. A TVP não associada a cirrose é rara. O objetivo deste artigo foi relatar dois casos de TVP não associados à cirrose, que foram tratados com anticoagulação e tiveram evolução clínica satisfatória.
Abstract Portal vein thrombosis (PVT) is a disease in which thrombosis occurs from the intrahepatic branches of the portal vein, and may extend to the splenic vein and/or superior mesenteric vein. It is most often associated with liver cirrhosis. PVT not associated with cirrhosis is rare. The aim of this article is to report two cases of PVT in which it was not associated with cirrhosis. Both were treated with anticoagulation and clinical progress afterwards was good.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Vena Porta/patología , Isquemia Mesentérica/terapia , Angiografía por Resonancia Magnética , Isquemia Mesentérica/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Anticoagulantes/uso terapéuticoRESUMEN
Presentamos el caso de una paciente de 74 años con historia de isquemia mesentérica crónica asociada a múltiples comorbilidades que fue llevada a la sala hemodinámica para revascularización endovascular, que no fue efectiva, por lo que se decidió la realización de una laparotomía y retrograde open mesenteric stenting (ROMS). Durante el procedimiento se realizó una disección, para la que se utilizó el catéter de reentrada Outback® Elite. Se logró acceder al espacio luminal y posteriormente se implantó con éxito un stent, con lo que se obtuvo un adecuado paso de medio de contraste y la resolución de la oclusión.(AU)
We present the case of a 74-year-old patient with a history of chronic mesenteric ischemia with multiple comorbidities, which was taken to the hemodynamic room for endovascular revascularization which was not possible, so it is decided to make laparotomy and Retrograde Open Mesenteric Stenting (ROMS), presenting a dissection during the procedure for which the Outback® Elite re-entry catheter is used, achieving access to the true lumen and subsequently the successful deployment of a stent, getting adequate flow of contrast medium and resolution of the occlusion.(AU)
Asunto(s)
Humanos , Femenino , Anciano , Pacientes Internos , Resultado del Tratamiento , Examen Físico , Isquemia Mesentérica/complicaciones , Isquemia Mesentérica/diagnóstico por imagen , Isquemia Mesentérica/cirugía , Disección , Stents , Arteria Mesentérica Superior/anatomía & histología , Arteria Mesentérica Superior/cirugía , Sistema Cardiovascular , Vasos Linfáticos/anatomía & histología , Vasos Sanguíneos/anatomía & histología , Sistema LinfáticoRESUMEN
Las complicaciones de la apendicitis aguda ha sido ampliamente descrita en la literatura; la trombosis venosa mesenterica es una manifestación poco común de esta patologia correspondiento a menos del 1 % de frecuencia, esto puede desorientar al cirujano general al coexistir en el cuadro de apendicitis aguda. Presentamos el caso de un paciente masculino de 58 años, con dolor abdominal de 5 días de evolución, con sintomatologia poco especifica para el diagnóstico concreto de apendicitis. Se realizó una tomografía computarizada de abdomen con hallazgos de apendicitis aguda y trombososis venosa mesenterica con un coágulo de 11.5 cm. Se hizó también apendicectomia abierta y se inició anticoagulación al egreso hospitalario.
The complications of acute appendicitis have been widely described in the literature; Mesenteric venous thrombosis is a rare manifestation of this pathology corresponding to less than 1% frequency, this can confuse the general surgeon as it coexists with acute appendicitis. We present the case of a 58-year-old male patient, with abdominal pain of 5 days of evolution, with symptoms that are not very specific for the specific diagnosis of appendicitis. Computed tomography of the abdomen was performed with findings of acute appendicitis and mesenteric venous thrombosis with a clot of 11.5 cm. An open appendectomy was performed and anticoagulation was started on hospital discharge.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Apendicitis/complicaciones , Trombosis , Isquemia Mesentérica/etiología , Apendicectomía , Apendicitis/cirugía , Apendicitis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Isquemia Mesentérica/tratamiento farmacológico , Isquemia Mesentérica/diagnóstico por imagen , Anticoagulantes/uso terapéuticoRESUMEN
La isquemia mesentérica aguda (IMA) es consecuencia de la oclusión de la arteria mesentérica superior (AMS) por trombosis o embolia, y es considerada la más letal del síndrome de abdomen agudo. Se presenta el caso de paciente femenina de 69 años con clínica difusa y confirmación diagnóstica radiológica, El objetivo de este caso clínico es proporcionar una revisión bibliográfica actual del tema y facilitar la adecuada actuación ante este problema de salud de amplio compromiso sistémico, y de aparición no tan infrecuente. (AU)
Acute mesenteric ischemia (IMA) is a consequence of occlusion of the superior mesenteric artery (AMS) by thrombosis or embolism; and it is considered the most lethal of acute abdomen syndrome. The case of a 69 years old female patient with diffuse clinic and radiological diagnostic confirmation is presented. The objective of this clinical case is to provide a current bibliographic review of the topic and facilitate adequate action in the face of this health problem with a broad systemic commitment, and with no appearance so infrequent. (AU)
Asunto(s)
Humanos , Femenino , Anciano , Arteria Mesentérica Superior/diagnóstico por imagen , Isquemia Mesentérica/diagnóstico por imagen , Oclusión Vascular Mesentérica/complicaciones , Enfermedad Aguda , Arteria Mesentérica Superior/cirugía , Tomografía Computarizada Multidetector , Isquemia Mesentérica/etiología , Isquemia Mesentérica/terapiaRESUMEN
El cuadro de abdomen agudo en el paciente anciano presenta un reto para el profesional médico no solo por el manejo de la incer-tidumbre diagnostica sino también por la necesidad de poder seleccionar las mejores pruebas complementarias y los tratamientos más adecuados a los requerimientos de cada paciente de manera personalizada. La valoración geriátrica integral es fundamental ya que tiene en cuenta el estado clínico del paciente y su situación funcional, así como el estado cognitivo y el apoyo social/familiar
The acute abdomen in the elderly patient can present a challenge for the medical professional not only for the management of the uncertainty diagnose but also for the need to be able to select the best complementary tests and the most suitable to the require-ments of each patient in a personalized way. By means of to the integral geriatric assessment in which we consider, not only the clinical state, also the functional situation of the patient, as well as the cognitive state and the social support (Family)
Asunto(s)
Humanos , Masculino , Anciano de 80 o más Años , Isquemia Mesentérica/cirugía , Isquemia Mesentérica/diagnóstico por imagen , Abdomen Agudo/cirugía , Grupo de Atención al Paciente , Abdomen Agudo/diagnóstico por imagen , Resultado del Tratamiento , Tomografía Computarizada por Rayos XRESUMEN
La enterocolitis necrosante en adultos (ECNA) es una enfermedad de etiología incierta, muy infrecuente, con apenas casos descritos en la literatura y con elevada mortalidad. Existe una fuerte correlación entre eventos vasculares e infecciosos implicados en la patogenia de necrosis intestinal masiva en esta entidad.
Necrotizing enterocolitis in adults (ECNA) is a disease of uncertain etiology, very rare, with very few cases described in the literature and with high mortality. There is a strong correlation between vascular and infectious events involved in the pathogenesis of massive intestinal necrosis in this entity.