Cited by 202Abdominal vascular conditions and treatmentsIntestinal and Peritoneal AdhesionsGastrointestinal Bleeding Diagnosis and Treatment

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Survival in Nonocclusive Mesenteric Ischemia: Early Diagnosis by Multidetector Row Computed Tomography and Early Treatment With Continuous Intravenous High-dose Prostaglandin E1

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Mitsuyoshi, Akira, Obama, Kazutaka, Shinkura, Nobuhiko, Ito, Takashi, Zaima, Masazumi·2007·Annals of Surgery

DOI 10.1097/01.sla.0000263157.59422.76PMC PMC1933563

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Abstract

In Brief Objectives: The aim of the study was to establish a procedure for early diagnosis and treatment of nonocclusive mesenteric ischemia (NOMI). Background: NOMI has a high mortality rate, and early diagnosis and treatment are important for improving survival in patients with this condition. Methods: The subjects were 22 patients treated at our hospital over 13 years. Diagnostic criteria for NOMI were established based on the first 13 cases. In the 9 more recent cases, we performed abdominal contrast multidetector row computed tomography (MDCT) upon suspicion of NOMI based on these criteria. Imaging allowed definite diagnosis of NOMI, and continuous intravenous high-dose PGE1 administration was initiated immediately after diagnosis (dose, 0.01–0.03 μg/kg per min; mean administration period, 4.8 days). Results: Nine of the first 13 patients died of multiple organ failure associated with multiple intestinal necrosis. These cases suggested that NOMI may develop when 3 of the following 4 criteria are met after cardiovascular surgery or maintenance dialysis in elderly patients: symptoms of the ileus develop slowly from abdominal symptoms, such as an unpleasant abdominal feeling or pain; a requirement for catecholamine treatment; an episode of hypotension; and slow elevation of the serum transaminase level. In the 9 recent cases, definite diagnosis was made from spasm of the principal arteries in arterial volume rendering and curved planar reformation MDCT images. Early treatment with PGE1 prevented acute-stage NOMI in 8 of the 9 cases. Conclusions: Early diagnosis of NOMI is possible using the above criteria and MDCT, and initiation of PGE1 treatment may increase survival in patients with NOMI. Nonocclusive mesenteric ischemia (NOMI) has a high mortality rate, and early diagnosis and treatment are important for improving survival. Upon suspicion of NOMI, based on criteria reported here, diagnosis using abdominal contrast multidetector row computed tomography and immediate initiation of continuous intravenous high-dose prostaglandin E1 administration may increase survival in NOMI patients.

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Authors: Mitsuyoshi, A., Obama, K., Shinkura, N., Ito, T., & Zaima, M.
Affiliations: Mitsubishi Kyoto Hospital (JP)
Shiga Medical Center for Adults (JP)
Corresponding author: Mitsuyoshi, Akira
Obama, Kazutaka
Shinkura, Nobuhiko
Ito, Takashi
ORCID: Mitsuyoshi, Akira
Obama, Kazutaka
Ito, Takashi
Venue: Annals of Surgery
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2007-08
Volume: 246
Issue: 2
Pages: 229-235
ISSN: 0003-4932 (ISSN-L)
DOI: 10.1097/01.sla.0000263157.59422.76
PMC: PMC1933563
OpenAlex: W2024216568
Cited by: 202
References: 10
Citations by year: 2026: 5 · 2025: 6 · 2024: 12 · 2023: 8 · 2022: 11 · 2021: 17 · 2020: 9 · 2019: 9 · 2018: 13 · 2017: 16 · 2016: 13 · 2015: 15 · 2014: 15 · 2013: 11 · 2012: 12
FWCI: 6.99
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Annals of Surgery (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
Keywords: nonocclusive mesenteric ischemia, early diagnosis, prostaglandin E1, multidetector computed tomography, intestinal necrosis, multiple organ failure, postoperative ileus, cardiovascular surgery, dialysis, diagnostic criteria, survival
MeSH terms: Aged, Aged, 80 and over, Alprostadil, Diagnosis, Differential, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Humans, Infusions, Intravenous, Intestines, Ischemia, Male, Mesenteric Arteries, Middle Aged, Time Factors, Tomography, X-Ray Computed, Vasodilator Agents, Survival Rate, Treatment Outcome

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Survival in Nonocclusive Mesenteric Ischemia: Early Diagnosis by Multidetector Row Computed Tomography and Early Treatment With Continuous Intravenous High-dose Prostaglandin E1

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