Purpose
Acute mesenteric ischemia (AMI) is a life threatening vascular emergency that encompasses a broad spectrum of diseases,
with reported mortality rate between 60% and 90% (1,
2).
The poor prognosis of gut ischemia is partially due to the lack of specific findings,
either clinical or radiological,
that leads to delayed or misunderstood diagnosis and consequent ineffective treatment (3-7).
AMI may present occlusive (arterial/venous) or non-occlusiveethiopathogenesis(8).
It has been estimated that the majority of cases (65%) are caused by arterial embolism or thrombosis,
25% by non-occlusiveaetiologyand...
Methods and Materials
After midline laparotomy,
in each rat a silk thread 3/0 was used to bind a loop around the superior mesenteric artery (SMA) (Group 1 and Group 3) or vein (SMV) (Group 2),
not jettightingthe loop.
The tips of the thread were brought into a silicon pipe and,
through it,
carried out to the back of the animal,
between its shoulders.
The thread tips were fixed to the pipe using medical plaster.
Muscles and skin were closed in two layers using aVicryl2/0 thread.
10 mg/Kg ofBaytril10%...
Results
In all type of AMI the mesentery is the first to react.
In the arterial ischemia it appears the contraction of bowel wall followed by hypotony and a bowel wall thinning is distinctive.
In case of SMV ligation the spasm is absent due to bowel wall congestion but thickening and early chromatic change of the intestinal wall,
mesenteric ulcers and thumbprinting are typical.
In case of reperfusion the appearance steer the course of SMV ligation (Fig.
2-14).
Conclusion
Since the early diagnosis represents the key to reduce mortality,
as far as the correct definition of findings,
it is also crucial to establish the elapsed time from the insult.
This is possible only if the temporal evolution of radiologic findings is known.
From our experience brings out that mesentery findings,
consisting in caliber of mesenteric vessels and integrity of adipose tissue,
appear in the early phase,
followed by peritoneal findings,
represented by peritoneal free fluid.
Loops findings,
like wall chromatic changes,
wall thickness,
wall...
References
1.Mansour MA.
Management of acute mesenteric ischemia.
Arch Surg 1999;134:328-302.Iacobellis F,
Berritto D,
Somma F,
Cavaliere C,
Corona M, Cozzolino S,
Fulciniti F,
Cappabianca S, Rotondo A, Grassi R.
MRI: a new tool for diagnosis of acute ischemic colitis? World J Gastroenterol 2012 In Press3.Heys SD,
Brittenden J,
Crofts TJ.
Acute mesenteric ischaemia: the continuing difficulty in early diagnosis.
Postgrad Med J.
1993;69:48-514.Shih MC P.
CTA and MRA in mesenteric ischemia: part I,
role in diagnosis and differential diagnosis.
AJR 2007;188:452-4615.Rha SE et al.
CT...