Materiały źródłowe

• #1 The Dangerous Miss: Recognizing Acute Mesenteric Ischemia | Emergency Physicians Monthly

  https://epmonthly.com/article/the-dangerous-miss/

  80% of acute mesenteric ischemia cases result in mortality because of missed diagnosis. The wide variety of presentations and symptoms of this disease creates a diagnostic challenge. The often quoted Time is bowel is a sentiment that speaks to the danger of this disease and need for diagnosis. The annual incidence of this disease is 0.09-0.2% per year and ~1% of acute abdomen hospitalizations, but this rarity is offset with a 60-80% mortality within the first 24 hours especially if the disease is missed. The symptoms and presentation vary based on the type and etiology of the disease. The typical presentation is an elderly patient (median age 74 years) with multiple comorbidities who presents with pain out of proportion to exam, meaning the patient is experiencing intense pain, while there is little to no tenderness on palpation. The key to diagnosis is evaluating risk factors such as critical illness, comorbidities (hypertension, diabetes, PAD), dialysis, VTE history and considering this disease in the differential. The patient with minimal tenderness on palpation but severe, intense pain requires consideration for AMI. Laboratory tests include white blood cell count (WBC), pH, D-dimer, lactate, and urine intestinal fatty acid binding protein (I-FABP). However, this is a pitfall. Approximately 75% of patients will have a WBC greater than 15,000 cells/mm3. The D-dimer is sensitive at 96%, but as usual, it is not specific. With today’s imaging, CT angiography of the abdomen and pelvis with IV contrast is most commonly used. Sensitivity of the new multidetector row technology CT angiography (MDRCT) is 95%, with specificity of 95% in one meta-analysis. However, this test can miss 5% of patients. The key to management is initiation of treatment while diagnostic evaluation is underway. Optimal treatment requires a multidisciplinary approach: general surgery, vascular surgery, and interventional radiology. Surgical intervention that can be initiated in less than six hours from symptom onset adds significant increase in survival. Ultimately, the physician at the bedside is the best diagnostic tool.

• #2 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. […] Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. […] Prompt diagnosis and intervention are essential to reduce the mortality rates that exceed 50%. […] The key to early diagnosis is a high level of clinical suspicion. […] The clinical scenario of a patient complaining of excruciating abdominal pain with an unrevealing abdominal examination is classic for early AMI. […] If the physical examination demonstrates signs of peritonitis, there is likely irreversible intestinal ischemia with bowel necrosis.

• #3 The Dangerous Miss: Recognizing Acute Mesenteric Ischemia | Emergency Physicians Monthly

  https://epmonthly.com/article/the-dangerous-miss/

  80% of acute mesenteric ischemia cases result in mortality because of missed diagnosis. The wide variety of presentations and symptoms of this disease creates a diagnostic challenge. The often quoted Time is bowel is a sentiment that speaks to the danger of this disease and need for diagnosis. The annual incidence of this disease is 0.09-0.2% per year and ~1% of acute abdomen hospitalizations, but this rarity is offset with a 60-80% mortality within the first 24 hours especially if the disease is missed. The symptoms and presentation vary based on the type and etiology of the disease. The typical presentation is an elderly patient (median age 74 years) with multiple comorbidities who presents with pain out of proportion to exam, meaning the patient is experiencing intense pain, while there is little to no tenderness on palpation. The key to diagnosis is evaluating risk factors such as critical illness, comorbidities (hypertension, diabetes, PAD), dialysis, VTE history and considering this disease in the differential. The patient with minimal tenderness on palpation but severe, intense pain requires consideration for AMI. Laboratory tests include white blood cell count (WBC), pH, D-dimer, lactate, and urine intestinal fatty acid binding protein (I-FABP). However, this is a pitfall. Approximately 75% of patients will have a WBC greater than 15,000 cells/mm3. The D-dimer is sensitive at 96%, but as usual, it is not specific. With today’s imaging, CT angiography of the abdomen and pelvis with IV contrast is most commonly used. Sensitivity of the new multidetector row technology CT angiography (MDRCT) is 95%, with specificity of 95% in one meta-analysis. However, this test can miss 5% of patients. The key to management is initiation of treatment while diagnostic evaluation is underway. Optimal treatment requires a multidisciplinary approach: general surgery, vascular surgery, and interventional radiology. Surgical intervention that can be initiated in less than six hours from symptom onset adds significant increase in survival. Ultimately, the physician at the bedside is the best diagnostic tool.

• #4 The Dangerous Miss: Recognizing Acute Mesenteric Ischemia | Emergency Physicians Monthly

  https://epmonthly.com/article/the-dangerous-miss/

  80% of acute mesenteric ischemia cases result in mortality because of missed diagnosis. The wide variety of presentations and symptoms of this disease creates a diagnostic challenge. The often quoted Time is bowel is a sentiment that speaks to the danger of this disease and need for diagnosis. The annual incidence of this disease is 0.09-0.2% per year and ~1% of acute abdomen hospitalizations, but this rarity is offset with a 60-80% mortality within the first 24 hours especially if the disease is missed. The symptoms and presentation vary based on the type and etiology of the disease. The typical presentation is an elderly patient (median age 74 years) with multiple comorbidities who presents with pain out of proportion to exam, meaning the patient is experiencing intense pain, while there is little to no tenderness on palpation. The key to diagnosis is evaluating risk factors such as critical illness, comorbidities (hypertension, diabetes, PAD), dialysis, VTE history and considering this disease in the differential. The patient with minimal tenderness on palpation but severe, intense pain requires consideration for AMI. Laboratory tests include white blood cell count (WBC), pH, D-dimer, lactate, and urine intestinal fatty acid binding protein (I-FABP). However, this is a pitfall. Approximately 75% of patients will have a WBC greater than 15,000 cells/mm3. The D-dimer is sensitive at 96%, but as usual, it is not specific. With today’s imaging, CT angiography of the abdomen and pelvis with IV contrast is most commonly used. Sensitivity of the new multidetector row technology CT angiography (MDRCT) is 95%, with specificity of 95% in one meta-analysis. However, this test can miss 5% of patients. The key to management is initiation of treatment while diagnostic evaluation is underway. Optimal treatment requires a multidisciplinary approach: general surgery, vascular surgery, and interventional radiology. Surgical intervention that can be initiated in less than six hours from symptom onset adds significant increase in survival. Ultimately, the physician at the bedside is the best diagnostic tool.

• #5 Delayed Diagnosis of Mesenteric Ischemia | PSNet

  https://psnet.ahrq.gov/web-mm/delayed-diagnosis-mesenteric-ischemia

  Mesenteric ischemia occurs when there is reduced blood flow to the small or large intestines from multiple potential etiologies involving interruptions of either the arterial or venous systems. […] Given the potential for devastating outcomes when not diagnosed in a timely fashion, as in the presented case, mesenteric ischemia is an important diagnosis to consider in all patients with severe abdominal pain. […] The most common universal presenting symptom is abdominal pain; for acute ischemia this is classically described as pain out of proportion to exam with an abdominal bruit on auscultation, although this is not present in all patients. […] Physical exam and laboratory studies can be relatively unrevealing early in the disease process, until frank bowel ischemia progresses to intestinal infarction and acute abdominal pain develops.

• #6 Acute Mesenteric Ischemia: Diagnosis & Treatment – EM Board Bombs Podcast

  https://www.emboardbombs.com/study-guide/2020-3-9-the-abominable-pain-acute-mesenteric-ischemia-7sjmx/

  Intestinal ischemia is any process that causes reduced blood flow to the small or large bowel. They are a collection of various syndromes that are; all often difficult to diagnose but can lead to catastrophic consequences. Overall, the incidence has been increasing, likely due to an elderly population in the US as well as higher clinician awareness. […] The most common presenting complaint is sudden abdominal pain. […] Classically, abdominal pain out of proportion to physical exam. Easier said than done. This is only seen in ~40% of patients. […] Blood in stool (often hematochezia), is concerning and should really raise suspicion. However, it is unreliable- present in less than 50% of patients. […] Everyone talks about lactate elevation, and its sensitivity is 86% for acute mesenteric ischemia (specificity 44%). However, lactates will not be elevated until late disease, so a normal lactate cannot reliably exclude the diagnosis.

• #7 Intestinal Ischemia | Abdominal Key

  https://abdominalkey.com/intestinal-ischemia/

  Early identification of AMI requires a high index of suspicion, especially in patients older than 50 years who have long-standing congestive heart failure, cardiac arrhythmias, recent myocardial infarction, or hypotension. […] The development of sudden abdominal pain in a patient with any of these risk factors should suggest the diagnosis of AMI. […] On admission to the hospital, approximately 75% of patients with AMI have leukocytosis greater than 15,000 cells/mm3 and about 50% have metabolic acidemia. […] Although they are poorly sensitive (30%) and nonspecific, plain films of the abdomen still are obtained in evaluating patients with suspected AMI. […] CT has largely replaced plain film study of the abdomen for diagnosis and is used to identify arterial and venous thromboses as well as ischemic bowel.

• #8 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. […] Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. […] Prompt diagnosis and intervention are essential to reduce the mortality rates that exceed 50%. […] The key to early diagnosis is a high level of clinical suspicion. […] The clinical scenario of a patient complaining of excruciating abdominal pain with an unrevealing abdominal examination is classic for early AMI. […] If the physical examination demonstrates signs of peritonitis, there is likely irreversible intestinal ischemia with bowel necrosis.

• #9

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-gastrointestinal/mesenteric-ischemia

  A 78-year-old female with a history of atrial fibrillation presents with sudden onset of abdominal pain for the past 4 hours. […] Recognize the importance of early consideration for mesenteric ischemia in the differential diagnosis of abdominal pain. […] Discuss the utility of laboratory and radiographic testing in diagnosing mesenteric ischemia. […] The importance of early consideration and diagnosis of mesenteric ischemia cannot be overemphasized. […] The classic presentation for mesenteric ischemia will be in a patient over the age of 60. […] One of the distinctive findings in mesenteric ischemia is that the abdominal pain is out of proportion to their physical exam. […] The treatment of choice for mesenteric artery embolus is embolectomy and bowel visualization to assess for signs of necrosis.

• #10 Intestinal ischemia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-ischemia/symptoms-causes/syc-20373946

  Chronic mesenteric ischemia is due to the buildup of fatty deposits on an artery wall, called atherosclerosis. The disease process most often is slow. It’s also called intestinal angina because it’s due to less blood flow to the intestines after eating. […] A possible dangerous complication of chronic mesenteric ischemia is having a blood clot within a narrowed artery. This can cause a sudden blockage, which can cause acute mesenteric ischemia.

• #11 Ischemic bowel disease – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/818

  Ischemic bowel disease encompasses a heterogeneous group of disorders caused by acute or chronic processes, arising from occlusive or nonocclusive etiologies, which result in decreased blood flow to the gastrointestinal tract. The clinical course may range from transient and reversible to fulminant. […] Key diagnostic factors include abdominal pain and abdominal tenderness. […] Other diagnostic factors include hematochezia/melena, diarrhea, weight loss, abdominal bruit, vasculitis, light headedness, pallor, dyspnea, and food fear (sitophobia). […] 1st tests to order include CT angiogram, CBC, chemistry panel including CRP, coagulation panel, type and screen, cross match, arterial blood gas/lactate level, ECG, erect CXR, abdominal x-rays, sigmoidoscopy or colonoscopy, and upper gastrointestinal endoscopy. […] Tests to consider include magnetic resonance angiography, mesenteric angiography, and mesenteric duplex ultrasound. […] Emerging tests include abdominal near-infrared spectroscopy.

• #12 Acute Mesenteric Ischemia Workup: Approach Considerations, Laboratory Studies, Plain Abdominal Radiography

  https://emedicine.medscape.com/article/189146-workup

  Various laboratory studies may be performed for suspected acute mesenteric ischemia (AMI), but in general, such studies will not establish the diagnosis. At most, they suggest the diagnosis; they do not exclude it. […] If serious suspicion of AMI exists, the clinician should order diagnostic imaging studies (eg, plain radiography, classic angiography, computed tomography [CT] angiography [CTA], magnetic resonance angiography [MRA], or ultrasonography [US]) without waiting for laboratory results. […] Laboratory findings in AMI are nonspecific and generally unreliable. No serum marker is sensitive or specific enough to establish or exclude the diagnosis of AMI. […] Although plain abdominal films can yield a presumptive diagnosis in 20-30% of patients with AMI, they often appear normal in this setting and therefore should not be used to rule out AMI.

• #13 Improving the ED Diagnosis of Mesenteric Ischemia – emDocs

  https://www.emdocs.net/improving-the-ed-diagnosis-of-mesenteric-ischemia/

  No laboratory parameters have demonstrated adequate performance for the diagnosis of mesenteric ischemia. […] Accurate and timely diagnosis significantly improves mortality in this deadly disease. Strategies to avoid missing the diagnosis include recognizing the presentations of the four main etiologies (arterial embolism, arterial thrombosis, nonocclusive, venous thrombosis), maintaining a high index of suspicion and communicating this to the radiologist, raising your clinical suspicion in the elderly, and relying only on CTA to rule out the diagnosis.

• #14 The Dangerous Miss: Recognizing Acute Mesenteric Ischemia | Emergency Physicians Monthly

  https://epmonthly.com/article/the-dangerous-miss/

  80% of acute mesenteric ischemia cases result in mortality because of missed diagnosis. The wide variety of presentations and symptoms of this disease creates a diagnostic challenge. The often quoted Time is bowel is a sentiment that speaks to the danger of this disease and need for diagnosis. The annual incidence of this disease is 0.09-0.2% per year and ~1% of acute abdomen hospitalizations, but this rarity is offset with a 60-80% mortality within the first 24 hours especially if the disease is missed. The symptoms and presentation vary based on the type and etiology of the disease. The typical presentation is an elderly patient (median age 74 years) with multiple comorbidities who presents with pain out of proportion to exam, meaning the patient is experiencing intense pain, while there is little to no tenderness on palpation. The key to diagnosis is evaluating risk factors such as critical illness, comorbidities (hypertension, diabetes, PAD), dialysis, VTE history and considering this disease in the differential. The patient with minimal tenderness on palpation but severe, intense pain requires consideration for AMI. Laboratory tests include white blood cell count (WBC), pH, D-dimer, lactate, and urine intestinal fatty acid binding protein (I-FABP). However, this is a pitfall. Approximately 75% of patients will have a WBC greater than 15,000 cells/mm3. The D-dimer is sensitive at 96%, but as usual, it is not specific. With today’s imaging, CT angiography of the abdomen and pelvis with IV contrast is most commonly used. Sensitivity of the new multidetector row technology CT angiography (MDRCT) is 95%, with specificity of 95% in one meta-analysis. However, this test can miss 5% of patients. The key to management is initiation of treatment while diagnostic evaluation is underway. Optimal treatment requires a multidisciplinary approach: general surgery, vascular surgery, and interventional radiology. Surgical intervention that can be initiated in less than six hours from symptom onset adds significant increase in survival. Ultimately, the physician at the bedside is the best diagnostic tool.

• #15 Intestinal ischemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-ischemia/diagnosis-treatment/drc-20373950

  If your healthcare professional suspects intestinal ischemia after a physical exam, you may have several diagnostic tests based on your symptoms. […] Although blood tests alone can’t diagnose intestinal ischemia, certain blood test results might suggest the condition. An example of such a result is a high white cell count. […] Imaging tests let your healthcare professional see your internal organs and rule out other causes for your symptoms. Imaging tests may include an X-ray, an ultrasound, a CT scan or an MRI. […] To look at the blood flow in your veins and arteries, your health professional may use an angiogram using a certain type of CT scan or MRI. […] This involves putting a lighted, flexible tube with a camera on its tip into your rectum to view your digestive tract. The scope can look at the last 2 feet of your colon, a test called sigmoidoscopy. When the test looks at your whole colon, it’s called colonoscopy.

• #16 Acute Mesenteric Ischemia: Diagnosis & Treatment – EM Board Bombs Podcast

  https://www.emboardbombs.com/study-guide/2020-3-9-the-abominable-pain-acute-mesenteric-ischemia-7sjmx/

  Intestinal ischemia is any process that causes reduced blood flow to the small or large bowel. They are a collection of various syndromes that are; all often difficult to diagnose but can lead to catastrophic consequences. Overall, the incidence has been increasing, likely due to an elderly population in the US as well as higher clinician awareness. […] The most common presenting complaint is sudden abdominal pain. […] Classically, abdominal pain out of proportion to physical exam. Easier said than done. This is only seen in ~40% of patients. […] Blood in stool (often hematochezia), is concerning and should really raise suspicion. However, it is unreliable- present in less than 50% of patients. […] Everyone talks about lactate elevation, and its sensitivity is 86% for acute mesenteric ischemia (specificity 44%). However, lactates will not be elevated until late disease, so a normal lactate cannot reliably exclude the diagnosis.

• #17 Ischaemic bowel clinical tool | Emergency Care Institute

  https://aci.health.nsw.gov.au/networks/eci/clinical/tools/ischaemic-bowel

  Ischaemic bowel can be classified anatomically into ischaemia of small bowel (mesenteric ischaemia) and large bowel (ischaemic colitis). […] Diagnosis of both conditions is challenging and requires a high index of clinical suspicion. […] Mesenteric ischemia is a medical emergency and will often lead to bowel necrosis. Early diagnosis and intervention are key. […] An elevated or rising lactate is suggestive of ischaemic bowel. However it is non-specific and a normal lactate does not exclude the diagnosis (sensitivity 77-100%, specificity 42%). […] Normal D-dimer levels may help to exclude acute intestinal ischemia, but elevated levels are less useful for making a diagnosis. […] X-rays not diagnostic of ischaemic bowel but may help in exclusion of differential diagnoses. […] CT scan may show: focal or segmental bowel wall thickening, intestinal pneumatosis with portal vein gas, bowel dilation, mesenteric stranding, portomesenteric thrombosis, or solid organ infarction. […] An elevated or rising lactate is suggestive of ischaemic bowel but not specific. […] Patients with colonic infarction and necrosis require urgent surgical intervention, which can be lifesaving.

• #18

  https://journals.lww.com/md-journal/fulltext/2017/03310/accuracy_of_using_serum_d_dimer_for_diagnosis_of.10.aspx

  The purpose of this meta-analysis is to comprehensively assess the accuracy of serum D-dimer for the diagnosis of acute intestinal ischemia. […] The combined sensitivity and specificity of plasma D-dimer assay were 0.94 (95% CI: 0.870.97) and 0.50 (95% CI: 0.400.61), respectively. In addition, the AUC of 0.81 and DOR of 16 suggested that D-dimer had high diagnostic accuracy for acute intestinal ischemia. […] The combined diagnostic odds ratio (DOR) of plasma D-dimer was 16 (95% CI: 739; Table S2, https://links.lww.com/MD/B629). The area under the curve (AUC) of the summary receiver operating characteristic curve (SROC) was 0.81 (95% CI: 0.780.84; Fig. 3), suggesting a high diagnostic accuracy of D-dimer for acute intestinal ischemia. […] Despite the limitations of this meta-analysis, the present data supported that D-dimer had the sufficient diagnostic value for the identification of acute intestinal ischemia from acute abdomen in the emergency department. However, this result will need further validation in a high-quality, large-sample, multi-center clinical study.

• #19 The Dangerous Miss: Recognizing Acute Mesenteric Ischemia | Emergency Physicians Monthly

  https://epmonthly.com/article/the-dangerous-miss/

  80% of acute mesenteric ischemia cases result in mortality because of missed diagnosis. The wide variety of presentations and symptoms of this disease creates a diagnostic challenge. The often quoted Time is bowel is a sentiment that speaks to the danger of this disease and need for diagnosis. The annual incidence of this disease is 0.09-0.2% per year and ~1% of acute abdomen hospitalizations, but this rarity is offset with a 60-80% mortality within the first 24 hours especially if the disease is missed. The symptoms and presentation vary based on the type and etiology of the disease. The typical presentation is an elderly patient (median age 74 years) with multiple comorbidities who presents with pain out of proportion to exam, meaning the patient is experiencing intense pain, while there is little to no tenderness on palpation. The key to diagnosis is evaluating risk factors such as critical illness, comorbidities (hypertension, diabetes, PAD), dialysis, VTE history and considering this disease in the differential. The patient with minimal tenderness on palpation but severe, intense pain requires consideration for AMI. Laboratory tests include white blood cell count (WBC), pH, D-dimer, lactate, and urine intestinal fatty acid binding protein (I-FABP). However, this is a pitfall. Approximately 75% of patients will have a WBC greater than 15,000 cells/mm3. The D-dimer is sensitive at 96%, but as usual, it is not specific. With today’s imaging, CT angiography of the abdomen and pelvis with IV contrast is most commonly used. Sensitivity of the new multidetector row technology CT angiography (MDRCT) is 95%, with specificity of 95% in one meta-analysis. However, this test can miss 5% of patients. The key to management is initiation of treatment while diagnostic evaluation is underway. Optimal treatment requires a multidisciplinary approach: general surgery, vascular surgery, and interventional radiology. Surgical intervention that can be initiated in less than six hours from symptom onset adds significant increase in survival. Ultimately, the physician at the bedside is the best diagnostic tool.

• #20 Intestinal Ischemia | AMBOSS Rotation Prep

  https://resident360.amboss.com/adult-medicine/gastroenterology/intestinal-ischemia/intestinal-ischemia.html

  Although laboratory studies are nonspecific, lactic acidosis, leukocytosis, and an elevated D-dimer level may be seen in patients with suspected mesenteric ischemia. […] Definitive diagnostic tests should be initiated immediately in patients with suspected mesenteric ischemia and risk factors (e.g., atherosclerosis, atrial fibrillation). Imaging options include: Computed tomography angiography (CTA) is the diagnostic study of choice. […] Evaluation and diagnosis of colonic ischemia is similar to that of mesenteric ischemia except that large-vessel thrombus or embolus are seldom the cause of colonic ischemia. […] Clinically, patients present with mild, cramping abdominal pain (typically left lower quadrant), fecal urgency, and bloody bowel movements. In patients with typical clinical features, risk factors that should raise suspicion for colonic ischemia include cardiovascular disease, diabetes, and prior aortic surgery.

• #21 Biochemical markers of acute intestinal ischemia: possibilities and limitations

  https://atm.amegroups.org/article/view/20595/html

  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), -glutathione S-transferase (-GST), interleukin-6 (IL-6), citrulline and smooth muscle protein of 22 kDa (SM22).

• #22 Accuracy of the serum intestinal fatty-acid-binding protein for diagnosis of acute intestinal ischemia: a meta-analysis | Scientific Reports

  https://www.nature.com/articles/srep34371

  Numerous studies have investigated the utility of serum intestinal fatty-acid binding protein (I-FABP) in differentiating acute intestinal ischemia from acute abdomen. […] The aim of this meta-analysis is to determine the overall accuracy of serum I-FABP in the diagnosis of acute intestinal ischemia. […] The overall diagnostic performance was assessed using a summary receiver operating characteristic curve (SROC) and area under curve (AUC). […] The pooled sensitivity, specificity, DOR, PLR and NLR were 0.80 (95% CI: 0.720.86), 0.85 (95% CI: 0.730.93), 24 (95% CI: 965), 5.5 (95% CI: 2.810.8) and 0.23 (95% CI: 0.150.35), respectively. […] The AUC was 0.86 (95% CI: 0.830.89). […] The meta-analysis carried out in this report suggests that the I-FABP may be a useful diagnostic tool to confirm acute intestinal ischemia in acute abdomen, but better-designed trials are still required to confirm our findings.

• #23 Accuracy of the serum intestinal fatty-acid-binding protein for diagnosis of acute intestinal ischemia: a meta-analysis | Scientific Reports

  https://www.nature.com/articles/srep34371

  Fast, accurate diagnosis is vital to improving the clinical outcomes of patients with acute intestinal ischemia. […] In recent years, many circulating biomarkers including intestinal fatty-acid binding protein (I-FABP) have been investigated as potentially effective biomarkers for acute intestinal ischemia. […] An increasing number of studies have shown that the serum I-FABP level is elevated in patients with intestinal ischemia. […] Systematic analysis of these data may be valuable to finally confirm the application of serum I-FABP as a potential biomarker for acute intestinal ischemia. […] This is the first meta-analysis of the accuracy of serum I-FABP for diagnosis of acute intestinal ischemia. […] The pooled sensitivity for serum I-FABP was 0.80 while the pooled specificity was 0.85.

• #24 Biochemical markers of acute intestinal ischemia: possibilities and limitations

  https://atm.amegroups.org/article/view/20595/html

  The aim of this narrative review is hence to provide an overview on traditional laboratory biomarkers of acute intestinal ischemia and summarize current evidence regarding some emerging and potentially useful biomarkers. […] The most clinically interesting oxidative stress-related biomarkers appear indeed lactate, IMA and -GST. […] D-lactate is normally produced at very low concentrations in humans. […] In the meta-analysis of Treskes et al. (10), including six studies, the pooled sensitivity and specificity of D-lactate for diagnosing acute mesenteric ischemia were 0.72 (95% CI: 0.590.82) and 0.74 (95% CI: 0.690.79), respectively. […] IMA is a biologic marker that can be easily and inexpensively measured in clinical laboratories by using the albumin cobalt binding (ACB) assay or with an enzyme-linked immunosorbent assay (ELISA).

• #25 Biochemical markers of acute intestinal ischemia: possibilities and limitations

  https://atm.amegroups.org/article/view/20595/html

  The aim of this narrative review is hence to provide an overview on traditional laboratory biomarkers of acute intestinal ischemia and summarize current evidence regarding some emerging and potentially useful biomarkers. […] The most clinically interesting oxidative stress-related biomarkers appear indeed lactate, IMA and -GST. […] D-lactate is normally produced at very low concentrations in humans. […] In the meta-analysis of Treskes et al. (10), including six studies, the pooled sensitivity and specificity of D-lactate for diagnosing acute mesenteric ischemia were 0.72 (95% CI: 0.590.82) and 0.74 (95% CI: 0.690.79), respectively. […] IMA is a biologic marker that can be easily and inexpensively measured in clinical laboratories by using the albumin cobalt binding (ACB) assay or with an enzyme-linked immunosorbent assay (ELISA).

• #26 Biochemical markers of acute intestinal ischemia: possibilities and limitations

  https://atm.amegroups.org/article/view/20595/html

  The first preliminary investigation in patients with intestinal ischemia was published in 2008, and showed that IMA values were significantly higher in seven patients with acute mesenteric ischemia compared to seven healthy subjects. […] Notably, the peculiar IMA kinetics is characterized by an early increase in parallel with the onset of ischemia, with values then further increase for hours afterwards. […] In a recent meta-analysis including nine studies, Sun et al. calculated obtained an AUC of 0.86 (95% CI: 0.830.89) of I-FABP for diagnosing acute intestinal ischemia, with pooled sensitivity and specificity of 0.80 (95% CI: 0.720.86) and 0.85 (95% CI: 0.730.93), respectively. […] Although acute intestinal ischemia remains a relative rare condition, a timely and accurate diagnosis is needed to prevent the development of serious complications, up to death. […] A vast array of laboratory biomarkers has been evaluated in the diagnosis of acute intestinal ischemia, but an ideal biomarker (i.e., rapid, stable, highly specific and sensitive, inexpensive and easy to be measured) is still seemingly missing.

• #27 Biochemical markers of acute intestinal ischemia: possibilities and limitations

  https://atm.amegroups.org/article/view/20595/html

  The aim of this narrative review is hence to provide an overview on traditional laboratory biomarkers of acute intestinal ischemia and summarize current evidence regarding some emerging and potentially useful biomarkers. […] The most clinically interesting oxidative stress-related biomarkers appear indeed lactate, IMA and -GST. […] D-lactate is normally produced at very low concentrations in humans. […] In the meta-analysis of Treskes et al. (10), including six studies, the pooled sensitivity and specificity of D-lactate for diagnosing acute mesenteric ischemia were 0.72 (95% CI: 0.590.82) and 0.74 (95% CI: 0.690.79), respectively. […] IMA is a biologic marker that can be easily and inexpensively measured in clinical laboratories by using the albumin cobalt binding (ACB) assay or with an enzyme-linked immunosorbent assay (ELISA).

• #28 The Impact of Biomarkers on the Early Detection of Acute Mesenteric Ischemia

  https://www.mdpi.com/2227-9059/12/1/85

  Acute mesenteric ischemia (AMI) is a life-threatening condition characterized by inadequate blood flow in the mesenteric vessels, leading to ischemia and eventual necrosis of the intestines. […] According to the current guidelines, computed tomography angiogram (CTA) is recognized as the most efficacious diagnostic tool for detecting AMI, with a sensitivity of 85–98% and a specificity of 91–100%. […] While definitive and accurate biomarkers have not been pinpointed, laboratory findings can help corroborate clinical suspicions. Potential markers like serum lactate levels, D-dimer, amylase, I-FABP, and alpha-GST could augment diagnostic precision. […] This study’s objective is to systematically review the existing literature to extract crucial insights regarding potential biomarkers for the early detection of acute mesenteric ischemia in the human population.

• #29 The Impact of Biomarkers on the Early Detection of Acute Mesenteric Ischemia

  https://www.mdpi.com/2227-9059/12/1/85

  Different biomarkers showed different accuracies in detecting AMI. I-FABP and D-dimer have been the most researched and shown to be valuable in the diagnosis of AMI, whereas L-lactate could be used as an additional tool. […] However, further research needs to be done on larger sample sizes and with controls to reduce bias. […] Current guidelines for AMI indicate a lack of reliable markers to definitively determine the presence or absence of ischemic or necrotic bowel. However, elevated levels of L-lactate and D-dimer may offer improved diagnostic accuracy. […] In this systematic review, 46 studies were included, investigating various markers such as I-FABP, D-dimer, L-lactate, IMA, αGST, IL-6, citrulline, PCT, NLR, MPV, PLR, RDW, DNI, and IGs.

• #30 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Blood tests will not aid in the diagnosis of AMI, though essential in patient management. CTA is the diagnostic modality of AMI along with clinical correlation. […] Delay in diagnosis is the dominant factor that accounts for high mortality rates of 30-70% despite increased knowledge of this entity. […] Computed tomography angiography (CTA) should be performed without delay in any patient with suspicion for AMI. […] Non-occlusive mesenteric ischemia (NOMI) should be suspected in critically ill patients with abdominal pain or distension requiring vasopressor support and evidence of multiorgan dysfunction. […] When the diagnosis of AMI is made, fluid resuscitation should commence immediately to enhance visceral perfusion. […] Broad-spectrum antibiotics should be immediately administered.

• #31 Diagnostic Role of Multi-Detector Computed Tomography in Acute Mesenteric Ischemia

  https://www.mdpi.com/2075-4418/14/12/1214

  Imaging is necessary for acute mesenteric ischemia (AMI) diagnosis; however, there are significant differences in sensitivity among imaging techniques, with multiphasic CT being considered the best diagnostic tool. […] Therefore, a sudden onset of acute abdominal pain and the need for morphine are considered suggestive of AMI. In these patients, a prompt multiphasic CT should be performed. […] Contrast-enhanced Multi-Detector CT Angiography (MDCTA) is the imaging of choice for the diagnosis of intestinal ischemia. […] The identification of the subtype of intestinal ischemia is mandatory to achieve the most appropriate management. […] The prognostic role of MDCT in AMI has been recently proposed based on the skeletal muscle index (SMI), supporting the prognostic capabilities of CT that could help discriminate between survivors and non-survivors.

• #32 The Impact of Biomarkers on the Early Detection of Acute Mesenteric Ischemia

  https://www.mdpi.com/2227-9059/12/1/85

  Acute mesenteric ischemia (AMI) is a life-threatening condition characterized by inadequate blood flow in the mesenteric vessels, leading to ischemia and eventual necrosis of the intestines. […] According to the current guidelines, computed tomography angiogram (CTA) is recognized as the most efficacious diagnostic tool for detecting AMI, with a sensitivity of 85–98% and a specificity of 91–100%. […] While definitive and accurate biomarkers have not been pinpointed, laboratory findings can help corroborate clinical suspicions. Potential markers like serum lactate levels, D-dimer, amylase, I-FABP, and alpha-GST could augment diagnostic precision. […] This study’s objective is to systematically review the existing literature to extract crucial insights regarding potential biomarkers for the early detection of acute mesenteric ischemia in the human population.

• #33 Radiological diagnosis of acute mesenteric ischemia in adult patients: a systematic review and meta-analysis | Scientific Reports

  https://www.nature.com/articles/s41598-025-94846-w

  Computed tomography (CT) is widely used in diagnosing acute mesenteric ischemia (AMI), but robust identification of distinctive subtypes and stages of progression is lacking. […] Diagnostic accuracy of CT angiography (CTA) was high – sensitivity of 92.0% and specificity of 98.8% (I2 45% and 79%, respectively), but lower for other CT protocols (sensitivity 75.8 and specificity 90.5; I2 83%). […] CTA is the method of choice for diagnosing AMI with high diagnostic accuracy. […] None of the non-vascular features alone is sufficiently reliable to diagnose AMI or its progression to transmural necrosis, whereas a combination of different radiological features conveys a potential. […] We aimed to assess the accuracy of CT in the diagnosis of AMI and its different subtypes in adult patients.

• #34 Intestinal ischemia (summary) | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/intestinal-ischaemia-summary?lang=us

  Intestinal ischemia refers to vascular compromise of the bowel which in the acute setting has a very high mortality if not treated expediently. Diagnosis is often straight forward provided appropriate imaging is obtained. […] CT angiography is the test of choice. CTA requires rapid contrast infusion and therefore, an appropriate cannula. […] CT has replaced catheter angiography as the gold standard for assessment for intestinal ischemia. It allows assessment of the whole abdomen in multiple vascular phases, e.g. arterial, portal venous, delayed. It also has the added advantage of being able to diagnose alternative causes of acute abdominal pain.

• #35 Acute Mesenteric Ischemia: Diagnosis & Treatment – EM Board Bombs Podcast

  https://www.emboardbombs.com/study-guide/2020-3-9-the-abominable-pain-acute-mesenteric-ischemia-7sjmx/

  CT angiogram (CTA) of the abdomen and pelvis with IV contrast: this is the best test in the ED. […] Findings specific for mesenteric ischemia: focal or segmental bowel thickening, intestinal pneumatosis, bowel dilation, mesenteric stranding, organ infarction. […] If the CTA is negative but suspicion remains high, a mesenteric arteriogram should be performed. […] The mainstay is unfractionated heparin to limit thrombus propagation. […] Survival for acute ischemia is worse for arterial etiology rather than venous. These patients are very ill after surgery and often they stay in the hospital for a month with poor prognosis. Mortality rates exceed 60%!

• #36 Intestinal Ischemia: US-CT findings correlations | The Ultrasound Journal | Full Text

  https://theultrasoundjournal.springeropen.com/articles/10.1186/2036-7902-5-S1-S7

  Computed tomography (CT) and ultrasonography (US) are the most commonly used imaging modalities in patients with acute abdomen, and even if CT represents the gold standard in the evaluation of patients with AMI, with sensitivity ranging from 82 to 96% and specificity of 94%. […] The results reported in literature suggest that in the early phase of bowel ischemia US examinations may show SMA occlusion, and bowel spasm. […] In late phase US may show a fluid-filled lumen, bowel wall thinning, evidence of extraluminal fluid and decreased or absent peristalsis. […] At present, the reference diagnostic modality for intestinal ischaemia is contrast-enhanced CT. However, there are some disadvantages associated with these techniques, such as radiation exposure, potential nephrotoxicity and the risk of an allergic reaction to the contrast agents. Thus, not all patients with suspected bowel ischaemia can be subjected to these examinations.

• #37 Mesenteric ischemia | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/mesenteric-ischaemia?lang=us

  Mesenteric ischemia, also commonly referred to as bowel or intestinal ischemia, refers to vascular compromise of the bowel and its mesentery that in the acute setting has a very high mortality if not treated expediently. […] Although historically catheter angiography was the gold standard for imaging of suspected intestinal ischemia, CT has replaced it, with its ability to volumetrically assess the whole abdomen in multiple vascular phases, e.g. arterial, portal venous, delayed. […] As such CT is now the investigation of choice for patients with suspected intestinal ischemia. […] It is important to note that bowel wall thickness is not increased in all cases, and can in fact be thinned in complete arterial occlusion or bowel obstruction. […] Although treatment will vary according to the severity and cause of the ischemia, in general the treatment is surgical.

• #38 Intestinal Ischemia | Abdominal Key

  https://abdominalkey.com/intestinal-ischemia/

  Selective mesenteric angiography, often with papaverine infusion, currently is the mainstay of diagnosis and initial treatment of both occlusive and nonocclusive forms of AMI, and it should be performed promptly if AMI is suspected or diagnosed on other imaging tests. […] The cornerstones of our approach, therefore, are the earlier and more liberal use of angiography and the incorporation of intra-arterial papaverine in the treatment of both occlusive AMI and NOMI. […] Diagnosis before intestinal infarction occurs is the most important factor in improving survival of patients with AMI.

• #39 Intestinal ischemia

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20373931

  During this test, called angiography, a long, thin tube called a catheter goes into an artery in your groin or arm. A dye injected through the catheter flows to your intestinal arteries. […] The dye moving through the arteries lets narrowed areas or blockages show up on X-rays. Angiography also lets a healthcare professional treat a blockage in an artery. The health professional can remove a clot, put in medicine or use special tools to widen an artery. […] In some cases, you may need surgery to find and remove damaged tissue. Opening the belly allows diagnosis and treatment during one procedure.

• #40 Intestinal ischemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-ischemia/diagnosis-treatment/drc-20373950

  During this test, called angiography, a long, thin tube called a catheter goes into an artery in your groin or arm. A dye injected through the catheter flows to your intestinal arteries. […] The dye moving through the arteries lets narrowed areas or blockages show up on X-rays. Angiography also lets a healthcare professional treat a blockage in an artery. The health professional can remove a clot, put in medicine or use special tools to widen an artery. […] In some cases, you may need surgery to find and remove damaged tissue. Opening the belly allows diagnosis and treatment during one procedure.

• #41 Acute Mesenteric Ischemia Workup: Approach Considerations, Laboratory Studies, Plain Abdominal Radiography

  https://emedicine.medscape.com/article/189146-workup

  Angiography has been the criterion standard for diagnosis and preoperative planning in AMI. […] Contrast CT has proved very valuable for the assessment of mesenteric ischemia; current multiarray spiral scanners allow detailed examination of both the small bowel and the mesenteric vessels. […] MRA has a sensitivity of 100% and a specificity of 91%. It is particularly effective for evaluating MVT. […] Duplex US is highly specific (92-100%), but its sensitivity (70-89%) does not match that of angiography. […] ECG may show myocardial infarction or atrial fibrillation. […] DPL may recover the serosanguineous fluid associated with bowel infarction; with the availability of CTA or MRA, DPL is now very rarely (if ever) used when AMI is suspected.

• #42 Acute Mesenteric Ischemia Workup: Approach Considerations, Laboratory Studies, Plain Abdominal Radiography

  https://emedicine.medscape.com/article/189146-workup

  Angiography has been the criterion standard for diagnosis and preoperative planning in AMI. […] Contrast CT has proved very valuable for the assessment of mesenteric ischemia; current multiarray spiral scanners allow detailed examination of both the small bowel and the mesenteric vessels. […] MRA has a sensitivity of 100% and a specificity of 91%. It is particularly effective for evaluating MVT. […] Duplex US is highly specific (92-100%), but its sensitivity (70-89%) does not match that of angiography. […] ECG may show myocardial infarction or atrial fibrillation. […] DPL may recover the serosanguineous fluid associated with bowel infarction; with the availability of CTA or MRA, DPL is now very rarely (if ever) used when AMI is suspected.

• #43 Bowel Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554527/

  The diagnostic approach in patients with intestinal ischemia depends on the severity of symptoms. In patients with peritonitis signs, the diagnosis will be made by abdominal exploration. Plain radiographs, computed tomography angiography (CTA) or magnetic resonance angiography (MRA), invasive angiography, and duplex ultrasound are common radiology studies in patients with suspicion of intestinal ischemia. […] The role of duplex ultrasound is just limited to the detection of clots in the proximal of the main vessels. In addition to that, peritoneal gas, previous abdominal surgical intervention, obesity can decrease the sensitivity of duplex ultrasound. […] In hemodynamically stable patients with clinical features of acute colonic ischemia, including abdominal pain, urgent desire to defecation, diarrhea, and lower gastrointestinal bleeding in addition to common imaging studies (plain radiography, CTA) may require sigmoidoscopy or colonoscopy and biopsy for definitive diagnosis. If colonic ischemia is suspected, colonoscopy preferred to be performed within 48 hours of initial symptoms rather than later.

• #44 Acute Mesenteric Ischemia Workup: Approach Considerations, Laboratory Studies, Plain Abdominal Radiography

  https://emedicine.medscape.com/article/189146-workup

  Angiography has been the criterion standard for diagnosis and preoperative planning in AMI. […] Contrast CT has proved very valuable for the assessment of mesenteric ischemia; current multiarray spiral scanners allow detailed examination of both the small bowel and the mesenteric vessels. […] MRA has a sensitivity of 100% and a specificity of 91%. It is particularly effective for evaluating MVT. […] Duplex US is highly specific (92-100%), but its sensitivity (70-89%) does not match that of angiography. […] ECG may show myocardial infarction or atrial fibrillation. […] DPL may recover the serosanguineous fluid associated with bowel infarction; with the availability of CTA or MRA, DPL is now very rarely (if ever) used when AMI is suspected.

• #45 Intestinal Ischemia | Abdominal Key

  https://abdominalkey.com/intestinal-ischemia/

  Early identification of AMI requires a high index of suspicion, especially in patients older than 50 years who have long-standing congestive heart failure, cardiac arrhythmias, recent myocardial infarction, or hypotension. […] The development of sudden abdominal pain in a patient with any of these risk factors should suggest the diagnosis of AMI. […] On admission to the hospital, approximately 75% of patients with AMI have leukocytosis greater than 15,000 cells/mm3 and about 50% have metabolic acidemia. […] Although they are poorly sensitive (30%) and nonspecific, plain films of the abdomen still are obtained in evaluating patients with suspected AMI. […] CT has largely replaced plain film study of the abdomen for diagnosis and is used to identify arterial and venous thromboses as well as ischemic bowel.

• #46 Acute Mesenteric Ischemia Workup: Approach Considerations, Laboratory Studies, Plain Abdominal Radiography

  https://emedicine.medscape.com/article/189146-workup

  Various laboratory studies may be performed for suspected acute mesenteric ischemia (AMI), but in general, such studies will not establish the diagnosis. At most, they suggest the diagnosis; they do not exclude it. […] If serious suspicion of AMI exists, the clinician should order diagnostic imaging studies (eg, plain radiography, classic angiography, computed tomography [CT] angiography [CTA], magnetic resonance angiography [MRA], or ultrasonography [US]) without waiting for laboratory results. […] Laboratory findings in AMI are nonspecific and generally unreliable. No serum marker is sensitive or specific enough to establish or exclude the diagnosis of AMI. […] Although plain abdominal films can yield a presumptive diagnosis in 20-30% of patients with AMI, they often appear normal in this setting and therefore should not be used to rule out AMI.

• #47 Ischemic Diseases of the Intestine – Physician’s Channel – Mount Sinai New York

  https://physicians.mountsinai.org/videos/ischemic-diseases-of-the-intestine

  The best step in the management of this patient would be a C. T. Angiogram, be hospitalization and I. V. Antibiotics. See surgical consultation or D. Colonoscopy. And the answer here is the oh and ask colonoscopy is indicated early in the evaluation of suspected ischemic colitis. […] Other endoscopic findings that are sometimes seen in colonic ischemia include uh pseudo membranes, sparing of the rectum, a single stripe sign and a fairly abrupt transition from diseased to normal intestine. […] The classic triad of symptoms of colon cancer leukemia consists of cramping, abdominal pain, rectal urgency and bloody stools. […] Consequently imaging generally does not require the use of C. T. Angio or camera says vascular occlusion and the need for subsequent intervention are not part of the treatment algorithm for the vast majority of patients with colonic ischemia.

• #48 Bowel Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554527/

  The diagnostic approach in patients with intestinal ischemia depends on the severity of symptoms. In patients with peritonitis signs, the diagnosis will be made by abdominal exploration. Plain radiographs, computed tomography angiography (CTA) or magnetic resonance angiography (MRA), invasive angiography, and duplex ultrasound are common radiology studies in patients with suspicion of intestinal ischemia. […] The role of duplex ultrasound is just limited to the detection of clots in the proximal of the main vessels. In addition to that, peritoneal gas, previous abdominal surgical intervention, obesity can decrease the sensitivity of duplex ultrasound. […] In hemodynamically stable patients with clinical features of acute colonic ischemia, including abdominal pain, urgent desire to defecation, diarrhea, and lower gastrointestinal bleeding in addition to common imaging studies (plain radiography, CTA) may require sigmoidoscopy or colonoscopy and biopsy for definitive diagnosis. If colonic ischemia is suspected, colonoscopy preferred to be performed within 48 hours of initial symptoms rather than later.

• #49 Ischemic Diseases of the Intestine – Physician’s Channel – Mount Sinai New York

  https://physicians.mountsinai.org/videos/ischemic-diseases-of-the-intestine

  C. T. Scan with ivy and peel contrast should be the first imaging modality. […] Multiphasic C. T. Angio should be performed on any patient with suspected isolated right colon ischemia or patients in whom the possibility of acute message eric insufficiency or small bowel involvement cannot be excluded. […] Early colonoscopy should be performed. That is within 48 hours. In patients that are suspected of having colonic ischemia for surgical intervention should be considered in the presence of colonic ischemia when accompanied by hypertension, tachycardia, abdominal pain, isolated right cohen isolated right cohen involvement or those individuals will pan colonic ischemia and northern presence of canned green. […] Finally antibiotic therapy should be considered for patients with moderate to severe disease as we indicated earlier.

• #50 Intestinal ischemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-ischemia/diagnosis-treatment/drc-20373950

  If your healthcare professional suspects intestinal ischemia after a physical exam, you may have several diagnostic tests based on your symptoms. […] Although blood tests alone can’t diagnose intestinal ischemia, certain blood test results might suggest the condition. An example of such a result is a high white cell count. […] Imaging tests let your healthcare professional see your internal organs and rule out other causes for your symptoms. Imaging tests may include an X-ray, an ultrasound, a CT scan or an MRI. […] To look at the blood flow in your veins and arteries, your health professional may use an angiogram using a certain type of CT scan or MRI. […] This involves putting a lighted, flexible tube with a camera on its tip into your rectum to view your digestive tract. The scope can look at the last 2 feet of your colon, a test called sigmoidoscopy. When the test looks at your whole colon, it’s called colonoscopy.

• #51 Ischemic Diseases of the Intestine – Physician’s Channel – Mount Sinai New York

  https://physicians.mountsinai.org/videos/ischemic-diseases-of-the-intestine

  The best step in the management of this patient would be a C. T. Angiogram, be hospitalization and I. V. Antibiotics. See surgical consultation or D. Colonoscopy. And the answer here is the oh and ask colonoscopy is indicated early in the evaluation of suspected ischemic colitis. […] Other endoscopic findings that are sometimes seen in colonic ischemia include uh pseudo membranes, sparing of the rectum, a single stripe sign and a fairly abrupt transition from diseased to normal intestine. […] The classic triad of symptoms of colon cancer leukemia consists of cramping, abdominal pain, rectal urgency and bloody stools. […] Consequently imaging generally does not require the use of C. T. Angio or camera says vascular occlusion and the need for subsequent intervention are not part of the treatment algorithm for the vast majority of patients with colonic ischemia.

• #52 Ischemic colitis – Wikipedia

  https://en.wikipedia.org/wiki/Ischemic_colitis

  Endoscopic evaluation, via colonoscopy or flexible sigmoidoscopy, is the procedure of choice if the diagnosis remains unclear. Ischemic colitis has a distinctive endoscopic appearance; endoscopy can also facilitate alternate diagnoses such as infection or inflammatory bowel disease. Biopsies can be taken via endoscopy to provide more information. Visible light spectroscopy, performed using catheters placed through the 5 mm channel of the endoscope, is diagnostic (see Diagnosis).

• #53 Ischemic Colitis Causes, Symptoms, and Treatment Explained – Los Angeles Times

  https://www.latimes.com/doctors-scientists/medicine/specialized-care/story/ischemic-colitis-causes-symptoms-treatment

  Ischemic Colitis occurs when blood flow to part of the colon is reduced or blocked, causing inflammation and potential tissue damage. […] Diagnosis often involves imaging tests like CT scans, lab work, and endoscopy procedures. […] IC can be tricky to diagnoseespecially in ICU settings where patients are already dealing with multiple issues. Thats why doctors take a multi-step approach for the diagnosis of ischemic colitis: […] Imaging Tests: A CT scan is often the first tool to show wall thickening or pneumatosis (gas in the wall of the colon). It may reveal thickening of the descending colon and proximal sigmoid colon, which are key for diagnosis and management. […] Diagnostic tests are essential to identify the condition accurately, allowing for proper treatment. […] Since IC can mimic infections like C. difficile colitis or inflammatory bowel disease, ruling those out is a key step.

• #54 Ischemic colitis – Wikipedia

  https://en.wikipedia.org/wiki/Ischemic_colitis

  Ischemic colitis is usually suspected on the basis of the clinical setting, physical examination, and laboratory test results; the diagnosis can be confirmed by endoscopy or by using sigmoid or endoscopic placement of a visible light spectroscopic catheter (see Diagnosis). […] There are devices which test the sufficiency of oxygen delivery to the colon. The first device approved by the U.S. FDA in 2004 uses visible light spectroscopy to analyze capillary oxygen levels. Use during aortic aneurysm repair detected when colon oxygen levels fell below sustainable levels, allowing real-time repair. […] Ischemic colitis must be differentiated from the many other causes of abdominal pain and rectal bleeding (for example, infection, inflammatory bowel disease, diverticulosis, or colon cancer). It is also important to differentiate ischemic colitis, which often resolves on its own, from the more immediately life-threatening condition of acute mesenteric ischemia of the small bowel.

• #55 Ischaemic bowel disease – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/818

  Other diagnostic factors include haematochezia/melaena, diarrhoea, nausea, weight loss, abdominal bruit, vasculitis, light headedness, pallor, dyspnoea, and food fear (sitophobia). […] 1st investigations to order include CT scan with contrast/CT angiogram, FBC, arterial blood gases and serum lactate, urea and electrolytes, liver function tests, CRP, coagulation studies, group and save and crossmatch, ECG, erect CXR, sigmoidoscopy or colonoscopy, upper gastrointestinal endoscopy, and D-dimer. […] Investigations to consider include mesenteric angiography, mesenteric duplex ultrasound, magnetic resonance angiography, amylase, studies for ova, cysts, and parasites, faecal culture, Clostridium difficile toxin assay, and abdominal x-rays.

• #56 Ischemic Colitis Causes, Symptoms, and Treatment Explained – Los Angeles Times

  https://www.latimes.com/doctors-scientists/medicine/specialized-care/story/ischemic-colitis-causes-symptoms-treatment

  Ischemic Colitis occurs when blood flow to part of the colon is reduced or blocked, causing inflammation and potential tissue damage. […] Diagnosis often involves imaging tests like CT scans, lab work, and endoscopy procedures. […] IC can be tricky to diagnoseespecially in ICU settings where patients are already dealing with multiple issues. Thats why doctors take a multi-step approach for the diagnosis of ischemic colitis: […] Imaging Tests: A CT scan is often the first tool to show wall thickening or pneumatosis (gas in the wall of the colon). It may reveal thickening of the descending colon and proximal sigmoid colon, which are key for diagnosis and management. […] Diagnostic tests are essential to identify the condition accurately, allowing for proper treatment. […] Since IC can mimic infections like C. difficile colitis or inflammatory bowel disease, ruling those out is a key step.

• #57 Ischemic colitis – Wikipedia

  https://en.wikipedia.org/wiki/Ischemic_colitis

  Ischemic colitis is usually suspected on the basis of the clinical setting, physical examination, and laboratory test results; the diagnosis can be confirmed by endoscopy or by using sigmoid or endoscopic placement of a visible light spectroscopic catheter (see Diagnosis). […] There are devices which test the sufficiency of oxygen delivery to the colon. The first device approved by the U.S. FDA in 2004 uses visible light spectroscopy to analyze capillary oxygen levels. Use during aortic aneurysm repair detected when colon oxygen levels fell below sustainable levels, allowing real-time repair. […] Ischemic colitis must be differentiated from the many other causes of abdominal pain and rectal bleeding (for example, infection, inflammatory bowel disease, diverticulosis, or colon cancer). It is also important to differentiate ischemic colitis, which often resolves on its own, from the more immediately life-threatening condition of acute mesenteric ischemia of the small bowel.

• #58 Bowel Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554527/

  The diagnostic approach in patients with intestinal ischemia depends on the severity of symptoms. In patients with peritonitis signs, the diagnosis will be made by abdominal exploration. Plain radiographs, computed tomography angiography (CTA) or magnetic resonance angiography (MRA), invasive angiography, and duplex ultrasound are common radiology studies in patients with suspicion of intestinal ischemia. […] The role of duplex ultrasound is just limited to the detection of clots in the proximal of the main vessels. In addition to that, peritoneal gas, previous abdominal surgical intervention, obesity can decrease the sensitivity of duplex ultrasound. […] In hemodynamically stable patients with clinical features of acute colonic ischemia, including abdominal pain, urgent desire to defecation, diarrhea, and lower gastrointestinal bleeding in addition to common imaging studies (plain radiography, CTA) may require sigmoidoscopy or colonoscopy and biopsy for definitive diagnosis. If colonic ischemia is suspected, colonoscopy preferred to be performed within 48 hours of initial symptoms rather than later.

• #59 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Prompt laparoscopy/laparotomy should be done for patients with an overt peritonitis. […] Damage control surgery (DCS) with temporary abdominal closure is an important adjunct for patients who require intestinal resection allowing reassessment of bowel viability and in situations of severe abdominal sepsis. […] Mesenteric venous thrombosis can often be successfully treated with a continuous infusion of unfractionated heparin. […] When NOMI is suspected, the focus is to correct the underlying cause and improve mesenteric perfusion. […] Postoperative intensive care of AMI patients is directed toward the improved intestinal perfusion and the prevention of a multiple organ failure. […] Treatment of AMI is optimal in a dedicated center using a focused care bundle and a multidisciplinary team.

• #60 Acute Mesenteric Ischemia – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/acute-mesenteric-ischemia

  Acute mesenteric ischemia is interruption of intestinal blood flow by embolism, thrombosis, or a low-flow state. […] Early diagnosis is difficult, but angiography and exploratory laparotomy have the most sensitivity; other imaging modalities often become positive only late in the disease. […] Diagnosis of Acute Mesenteric Ischemia: Clinical diagnosis more important than diagnostic tests. […] Early diagnosis of mesenteric ischemia is particularly important because mortality increases significantly once intestinal infarction has occurred. […] Patients with clear peritoneal signs should proceed directly to the operating room for both diagnosis and treatment. […] For others, selective mesenteric angiography or CT angiography is the diagnostic procedure of choice. […] Other imaging studies and serum markers can show abnormalities but lack sensitivity and specificity early in the course of the disease when diagnosis is most critical.

• #61 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Blood tests will not aid in the diagnosis of AMI, though essential in patient management. CTA is the diagnostic modality of AMI along with clinical correlation. […] Delay in diagnosis is the dominant factor that accounts for high mortality rates of 30-70% despite increased knowledge of this entity. […] Computed tomography angiography (CTA) should be performed without delay in any patient with suspicion for AMI. […] Non-occlusive mesenteric ischemia (NOMI) should be suspected in critically ill patients with abdominal pain or distension requiring vasopressor support and evidence of multiorgan dysfunction. […] When the diagnosis of AMI is made, fluid resuscitation should commence immediately to enhance visceral perfusion. […] Broad-spectrum antibiotics should be immediately administered.

• #62 Ischemic bowel disease – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/818

  Ischemic bowel disease encompasses a heterogeneous group of disorders caused by acute or chronic processes, arising from occlusive or nonocclusive etiologies, which result in decreased blood flow to the gastrointestinal tract. The clinical course may range from transient and reversible to fulminant. […] Key diagnostic factors include abdominal pain and abdominal tenderness. […] Other diagnostic factors include hematochezia/melena, diarrhea, weight loss, abdominal bruit, vasculitis, light headedness, pallor, dyspnea, and food fear (sitophobia). […] 1st tests to order include CT angiogram, CBC, chemistry panel including CRP, coagulation panel, type and screen, cross match, arterial blood gas/lactate level, ECG, erect CXR, abdominal x-rays, sigmoidoscopy or colonoscopy, and upper gastrointestinal endoscopy. […] Tests to consider include magnetic resonance angiography, mesenteric angiography, and mesenteric duplex ultrasound. […] Emerging tests include abdominal near-infrared spectroscopy.

• #63 Acute Mesenteric Ischemia: Diagnosis & Treatment – EM Board Bombs Podcast

  https://www.emboardbombs.com/study-guide/2020-3-9-the-abominable-pain-acute-mesenteric-ischemia-7sjmx/

  CT angiogram (CTA) of the abdomen and pelvis with IV contrast: this is the best test in the ED. […] Findings specific for mesenteric ischemia: focal or segmental bowel thickening, intestinal pneumatosis, bowel dilation, mesenteric stranding, organ infarction. […] If the CTA is negative but suspicion remains high, a mesenteric arteriogram should be performed. […] The mainstay is unfractionated heparin to limit thrombus propagation. […] Survival for acute ischemia is worse for arterial etiology rather than venous. These patients are very ill after surgery and often they stay in the hospital for a month with poor prognosis. Mortality rates exceed 60%!

• #64 Intestinal ischemia – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/intestinal-ischemia/

  Dye that tracks blood flow through the arteries. During this test (angiography), a long, thin tube (catheter) is inserted into an artery in your groin or arm, then passed through the artery to the aorta. A dye injected through the catheter flows directly to your intestinal arteries. As the dye moves through your arteries, a narrowed areas or blockage is visible on X-ray images. Angiography also allows the doctor to treat a blockage in an artery by injecting medication or using special tools to widen an artery. […] Exploratory surgery. In some cases you may need exploratory surgery to find and remove damaged tissue. Opening the abdomen allows diagnosis and treatment during one procedure.

• #65 Intestinal Ischemia | AMBOSS Rotation Prep

  https://resident360.amboss.com/adult-medicine/gastroenterology/intestinal-ischemia/intestinal-ischemia.html

  Abdominal and pelvic CT scan with intravenous (IV) and oral contrast is the initial investigation of choice, followed by colonoscopy if needed for confirmation of the diagnosis. […] Most cases resolve spontaneously and thus treatment is generally supportive, with aggressive hydration, bowel rest, and occasionally antibiotics in moderate or severe disease due to risk for infection.

• #66 Ischemic Diseases of the Intestine – Physician’s Channel – Mount Sinai New York

  https://physicians.mountsinai.org/videos/ischemic-diseases-of-the-intestine

  C. T. Scan with ivy and peel contrast should be the first imaging modality. […] Multiphasic C. T. Angio should be performed on any patient with suspected isolated right colon ischemia or patients in whom the possibility of acute message eric insufficiency or small bowel involvement cannot be excluded. […] Early colonoscopy should be performed. That is within 48 hours. In patients that are suspected of having colonic ischemia for surgical intervention should be considered in the presence of colonic ischemia when accompanied by hypertension, tachycardia, abdominal pain, isolated right cohen isolated right cohen involvement or those individuals will pan colonic ischemia and northern presence of canned green. […] Finally antibiotic therapy should be considered for patients with moderate to severe disease as we indicated earlier.

• #67 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Blood tests will not aid in the diagnosis of AMI, though essential in patient management. CTA is the diagnostic modality of AMI along with clinical correlation. […] Delay in diagnosis is the dominant factor that accounts for high mortality rates of 30-70% despite increased knowledge of this entity. […] Computed tomography angiography (CTA) should be performed without delay in any patient with suspicion for AMI. […] Non-occlusive mesenteric ischemia (NOMI) should be suspected in critically ill patients with abdominal pain or distension requiring vasopressor support and evidence of multiorgan dysfunction. […] When the diagnosis of AMI is made, fluid resuscitation should commence immediately to enhance visceral perfusion. […] Broad-spectrum antibiotics should be immediately administered.

• #68 Diagnosis of non-occlusive acute mesenteric ischemia in the intensive care unit | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-016-0213-x

  Non-occlusive mesenteric ischemia (NOMI) is a common complication and accounts for a major cause of death in critically ill patients. The diagnosis of NOMI with respect to the eventual indications for surgical treatment is challenging. […] The diagnosis of AMI is often challenging in critically ill patients, most especially for NOMI. It can be suspected in the presence of clinical deterioration associated with digestive symptoms and biological manifestations suggestive of profound tissue ischemia or acute cell lysis. Contrast-enhanced abdominal CT-scan is the cornerstone of the diagnostic strategy and may provide direct or indirect arguments for impaired vascularization of the bowel. However, its accuracy for the diagnosis of NOMI in critically ill patients is questionable. A confirmatory diagnosis as well as the assessment of the extent of necrosis still commonly involves a direct visualization of the digestive tract by endoscopy and/or surgical exploration.

• #69 Diagnosis of non-occlusive acute mesenteric ischemia in the intensive care unit | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-016-0213-x

  The performance of abdominal CT-scan for the diagnosis of NOMI is limited. Radiological signs of advanced-stage ischemia are good predictors of definite mesenteric ischemia, while their absence should not be considered sufficient to rule out the diagnosis. […] The diagnostic contribution of abdominal CT-scan is limited in this setting. Radiological signs of advanced-stage ischemia represent undisputed indications for surgical intervention to assess the extent of bowel necrosis and the possibility of intestinal resection. The absence of radiological signs suggesting mesenteric ischemia should not be considered sufficient to rule out the diagnosis and still warrants further digestive explorations by endoscopy and/or laparotomy in case of high clinical suspicion.

• #70 Ischemic bowel disease – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/818

  Ischemic bowel disease can be classified into three types: acute mesenteric ischemia, chronic mesenteric ischemia, and colonic ischemia. […] Ischemic bowel disease may present clinically in a number of ways, including transient reversible ischemia, chronic irreversible ischemia, or acute fulminant ischemia. […] Mesenteric venous thrombosis may lead to acute or subacute intestinal ischemia and may also present across a spectrum of severity. […] Short-term complications include small bowel infarction, hemorrhagic shock, peritonitis, gangrenous colitis, fulminant universal colitis, colonic perforation, pneumoperitoneum, colon wall necrosis leading to the formation of pneumatosis linearis coli and portal venous gas seen on imaging. […] Long-term complications of ischemic bowel disease depend on the location and nature of the underlying pathology. Possible complications include stricture formation, short bowel syndrome, and food fear leading to malnutrition.

• #71 Small Bowel Ischemia – American College of Gastroenterology

  https://gi.org/topics/small-bowel-ischemia/

  Small bowel ischemia (also called mesenteric ischemia) is a potentially life-threatening group of conditions that reduce blood flow to the small intestine (e.g., duodenum, jejunum or ileum). Symptoms can range from mild to severe depending on the cause. […] Early diagnosis and treatment are essential for the best possible outcomes to restore digestive function. […] Small bowel ischemia requires prompt medical care to avoid damage to intestinal tissue that can lead to death. […] Small bowel ischemia can be a medical emergency, especially if it is acute. Seek immediate medical attention if you experience sudden, severe abdominal pain with or without bloody diarrhea, or any other possible symptoms. […] Early diagnosis and prompt treatment are essential to improve your chances for a good-outcome. The longer you go without treatment, the higher the chance of irreversible damage to the small bowel and, in an acute case, death.

• #72 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Blood tests will not aid in the diagnosis of AMI, though essential in patient management. CTA is the diagnostic modality of AMI along with clinical correlation. […] Delay in diagnosis is the dominant factor that accounts for high mortality rates of 30-70% despite increased knowledge of this entity. […] Computed tomography angiography (CTA) should be performed without delay in any patient with suspicion for AMI. […] Non-occlusive mesenteric ischemia (NOMI) should be suspected in critically ill patients with abdominal pain or distension requiring vasopressor support and evidence of multiorgan dysfunction. […] When the diagnosis of AMI is made, fluid resuscitation should commence immediately to enhance visceral perfusion. […] Broad-spectrum antibiotics should be immediately administered.

• #73 Ischemic Diseases of the Intestine – Physician’s Channel – Mount Sinai New York

  https://physicians.mountsinai.org/videos/ischemic-diseases-of-the-intestine

  The classic diagnosis of mesoamerica ischemia is based upon the uh the well known axiom. Pain add proportion to the physical examination, routine laboratory studies are usually non specific in these patients. […] The management of acute message eric insufficiency uh in all patients whether they arterial or venus uh occlusion. The management includes aggressive I. V. Fluid hydration. Anti coagulation is given to the vast majority of patients except those with active gi bleeding. […] The mortality across the board for patients with acute message Jerkins. Ischemia is 60%. That is 5-6 times greater than the mortality of patients with colonic ischemia. And the most important factor in the high mortality rate is a delay in the diagnosis and intervention.

• #74 Diagnosis and Management of Acute Mesenteric Ischemia – Endovascular Today

  https://evtoday.com/articles/2021-jan/diagnosis-and-management-of-acute-mesenteric-ischemia

  The Society for Vascular Surgery and the American College of Cardiology/American Heart Association consensus guidelines support the use of percutaneous revascularization in certain situations. […] If an endovascular-first approach is taken, percutaneous access can be achieved through either the brachial or femoral arteries. […] Although the endovascular approach frequently yields excellent technical results, potential pitfalls exist. […] If the decision is made to start with laparotomy, a transperitoneal incision is made to expose the entire abdominal contents. […] Therapy is initiated with systemic anticoagulation and bowel resection in the setting of necrosis. […] Although survival for all causes of mesenteric ischemia is relatively poor, prompt recognition and intervention are key to improving outcomes.

• #75 Improving the ED Diagnosis of Mesenteric Ischemia – emDocs

  https://www.emdocs.net/improving-the-ed-diagnosis-of-mesenteric-ischemia/

  No laboratory parameters have demonstrated adequate performance for the diagnosis of mesenteric ischemia. […] Accurate and timely diagnosis significantly improves mortality in this deadly disease. Strategies to avoid missing the diagnosis include recognizing the presentations of the four main etiologies (arterial embolism, arterial thrombosis, nonocclusive, venous thrombosis), maintaining a high index of suspicion and communicating this to the radiologist, raising your clinical suspicion in the elderly, and relying only on CTA to rule out the diagnosis.

• #76 Mesenteric ischemia: Recognizing an uncommon disorder and distinguishing among its causes | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/9/545

  Mesenteric ischemia occurs because of inadequate intestinal blood flow. Its severity depends on the vessels involved and whether collateral blood vessels are available to prevent malperfusion. Mesenteric ischemia is an uncommon cause of abdominal pain, but it is associated with high mortality and often poses a diagnostic challenge to clinicians because its symptoms are nonspecific. Early recognition and treatment are imperative to improve patient outcomes. […] Diagnosis requires a high index of suspicion with focused evaluation. […] Early recognition and intervention are key to preventing morbidity and mortality. […] The nonspecific nature of symptoms makes it difficult to differentiate acute mesenteric ischemia from other intra-abdominal pathologies such as acute cholecystitis, pancreatitis, and small-bowel obstruction. A high index of suspicion is critical to making the diagnosis and restoring blood flow, thereby improving patient outcomes. […] Mesenteric ischemia remains a diagnostic challenge to many clinicians because it is uncommon and its symptoms are nonspecific. Early recognition and focused evaluation are crucial for timely diagnosis and prevention of catastrophic complications.

• #77 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. […] Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. […] Prompt diagnosis and intervention are essential to reduce the mortality rates that exceed 50%. […] The key to early diagnosis is a high level of clinical suspicion. […] The clinical scenario of a patient complaining of excruciating abdominal pain with an unrevealing abdominal examination is classic for early AMI. […] If the physical examination demonstrates signs of peritonitis, there is likely irreversible intestinal ischemia with bowel necrosis.

• #78 Overview of intestinal ischemia in adults – UpToDate

  https://www.uptodate.com/contents/overview-of-intestinal-ischemia-in-adults

  Intestinal ischemia, which can affect the small or large intestine, can be caused by any process that reduces intestinal blood flow, such as arterial occlusion, venous occlusion, or arterial vasospasm. For patients with acute symptoms, a rapid diagnosis is imperative since the clinical consequences can be catastrophic, including sepsis, bowel infarction, and death. […] An overview of intestinal ischemia and differentiation of the various forms of intestinal ischemia are reviewed. Specific etiologies of intestinal ischemia are reviewed in more detail elsewhere. […] DIAGNOSIS […] Advanced abdominal imaging […] Differential diagnosis […] Diagnosis and initial management of intestinal ischemia […] Management of mesenteric venous thrombosis […] Management of nonocclusive mesenteric ischemia.

• #79 Biochemical markers of acute intestinal ischemia: possibilities and limitations

  https://atm.amegroups.org/article/view/20595/html

  The first preliminary investigation in patients with intestinal ischemia was published in 2008, and showed that IMA values were significantly higher in seven patients with acute mesenteric ischemia compared to seven healthy subjects. […] Notably, the peculiar IMA kinetics is characterized by an early increase in parallel with the onset of ischemia, with values then further increase for hours afterwards. […] In a recent meta-analysis including nine studies, Sun et al. calculated obtained an AUC of 0.86 (95% CI: 0.830.89) of I-FABP for diagnosing acute intestinal ischemia, with pooled sensitivity and specificity of 0.80 (95% CI: 0.720.86) and 0.85 (95% CI: 0.730.93), respectively. […] Although acute intestinal ischemia remains a relative rare condition, a timely and accurate diagnosis is needed to prevent the development of serious complications, up to death. […] A vast array of laboratory biomarkers has been evaluated in the diagnosis of acute intestinal ischemia, but an ideal biomarker (i.e., rapid, stable, highly specific and sensitive, inexpensive and easy to be measured) is still seemingly missing.

• #80 Diagnosis of non-occlusive acute mesenteric ischemia in the intensive care unit | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-016-0213-x

  The performance of abdominal CT-scan for the diagnosis of NOMI is limited. Radiological signs of advanced-stage ischemia are good predictors of definite mesenteric ischemia, while their absence should not be considered sufficient to rule out the diagnosis. […] The diagnostic contribution of abdominal CT-scan is limited in this setting. Radiological signs of advanced-stage ischemia represent undisputed indications for surgical intervention to assess the extent of bowel necrosis and the possibility of intestinal resection. The absence of radiological signs suggesting mesenteric ischemia should not be considered sufficient to rule out the diagnosis and still warrants further digestive explorations by endoscopy and/or laparotomy in case of high clinical suspicion.

• #81 Acute Mesenteric Ischemia – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/acute-mesenteric-ischemia

  If diagnosis is made during exploratory laparotomy, options are surgical embolectomy, revascularization, and resection. […] If diagnosis is made by angiography, infusion of the vasodilator papaverine through the angiography catheter may improve survival in nonocclusive ischemia. […] For arterial occlusion, thrombolysis or surgical embolectomy may be done. […] If diagnosis and treatment take place before infarction occurs, mortality is low; after intestinal infarction, mortality is high and varies depending on the etiology. […] For this reason, clinical diagnosis of mesenteric ischemia should supersede diagnostic tests, which may delay treatment. […] Early diagnosis is critical because mortality increases significantly once intestinal infarction has occurred. […] Surgical exploration is often the best diagnostic measure for patients with clear peritoneal findings. […] For other patients, mesenteric angiography or CT angiography is done.

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