Nonoсclusive mesenteric ischemia (literature review)

Non-occlusive mesenteric ischemia is a relatively rare but extremely complex pathology in terms of diagnosis. A wide range of reasons for the development of non-occlusive impression dramatically complicates the diagnosis and differentiation with other abdominal pathology. The vast majority of publications in the domestic literature on acute disorders of mesenteric blood flow, mostly address the problems of diagnosis and treatment of occlusive types of mesenteric ischemia, while the topic of non-occlusive ischemia remains insufficiently covered. Given that in half of the cases NOMI is diagnosed at the stage of irreversible necrotic changes of the intestine – there is a real need to generalize the root causes and mechanisms of neoclustive mesenteric ischemia, modern methods of diagnosis and treatment. Purpose – to analyze of the causes, prevalence, classification, diagnosis and treatment of non-occlusive disorders of mesenteric blood flow. This research, based on literature review, showed that acute non-occlusive mesenteric ischemia (NOMI) is associated with poor prognosis due to the lack of accurate diagnostic measures. First of all, clarity regarding biochemical markers. Therefore, the research and development of the latter is seen as a priority. Contrast methods of examination (computed tomography, angiography) are the only possible diagnostic tools. Pharmacological correction is fundamental and presupposes the use of drugs with a vasodilating effect systemically or locally (catheter-associated). An important issue is the development of pharmacological agents that allow targeted action on the pathogenetic mechanisms of the development of NOMI. A multidisciplinary approach involving a specialized doctor, a surgeon, an X-ray endovascular surgeon and an intensive care physician in the treatment of a patient with suspected NOMI is the foundation for the success of therapy. The question of the use of laparoscopy remains controversial, given the invasiveness of the method and the difficulty of interpreting the changes detected in the early phase of the disease. No conflict of interests was declared by the authors. Key words: acute mesenteric ischemia, non-occlusive disorders of mesenteric blood flow.

Endovascular therapy in acute mesenteric ischemia after coronary artery bypass grafting: a case report and literature review

In the pattern of abdominal complications after cardiac surgery, acute mesenteric ischemia is rare but high-mortality pathology. In the initial stages, the disease has no specific signs, which makes it difficult to perform early multislice computed tomography to diagnose it. Risk stratification and an individual approach to the choice of diagnostic and therapeutic measures aimed at early restoration of mesenteric blood flow will reduce the mortality in this complication.

THE CAUSES OF INTESTINAL ANASTOMOTIC LEAKAGE IN EXPERIMENTAL PERITONITIS

Objective. To determine the leading factor in the pathogenesis of intestinal anastomotic failure in peritonitis. Methods. The experiment was carried out on non-linear white rats (n=40), divided into 4 equal groups: with peritonitis (group 1), with hypovolemia (group 2), with peritonitis in combination with hypovolemia (group 3) and comparison (group 4). Colonic “end-to-end” anastomosis was performed in all rats. Peritonitis caused by injection of 10% unfiltered feces into the abdominal cavity. Hypovolemia was modeled during the operation by creating bleeding from the branch of the iliocolic artery.The rats were taken out of the experiment on the 3^rd day after the operation, the state of the anastomosis and the abdominal cavity was assessed. The histological examination of the anastomotic sites was performed. The content of hypoxia biomarkers (HIF-1a, VEGF-C, VEGF-R1) in the intestinal tissue was also evaluated by ELISA. The experiment was approved by the local ethics committee. Results. In group 1, anastomotic failure was detected in rats characterized by a severe general condition due to peritonitis. In groups 2 and 3 statistically significant relationship was found between a decrease of rectal temperature (>2 °C) due to bleeding and colonic anastomotic failure (p<0.05). Morphological analysis showed the most pronounced inflammatory and microcirculatory changes in the group 3. Statistically significant differences in the level of the VEGF-C (p=0.0034) and VEGF-R1 (p=0.04795) were found between groups. Maximal ischemia of the anastomotic zone was found in rats of group 3. Conclusion. The leading factor in the pathogenesis of intestinal anastomotic failure is considered to be as a result of impairedblood supply of the anastomotic zone due to hypovolemia and depletion of mesenteric blood flow. Monitoring and successful correction of hemodynamic disturbances in the perioperative period may become a prospect for the treatment of patients with peritonitis requiring intestinal anastomosis under these conditions. What this paper adds For the first time determination of the leading factor in the pathogenesis of intestinal anastomotic failure in peritonitis has been studied. The leading factor in the pathogenesis of intestinal anastomotic failure has been found out to be the impairedblood supply of the anastomotic zone due to hypovolemia and depletion of mesenteric blood flow.

Involvement of intestinal hypoperfusion related with Indoleamine 2,3-peroxidase activation and 5-HT metabolism abnormality in intestinal dysfunction after acute myocardial infarction

Background To investigate the intestinal dysfunction after acute myocardial infarction (AMI) and discuss the underlying mechanism. Methods Rats were divided into three groups randomly, including AMI group, Sham group and Normal (N) group. An AMI model was established with ligating the left anterior descending artery (LAD) without ventilator assisted. The body surface electrocardiogram (ECG), HE staining of myocardial tissues and echocardiogram were used to evaluate whether the model was established successfully. The HE staining for ileum tissue was applied to evaluate the structure of the ileum, the intestinal propulsive rate were conducted to investigate the intestinal dysfunction, and laser speckle technique was developed in order to measure the mesenteric blood flow. immunohistochemical method was used to determined the expression of Indoleamine 2, 3-dioxygenase (IDO) in ileum, high-performance liquid chromatography was used to detected 5-hydroxytryptamine(5-HT) metabolism in rats plasma and ileum. Results After AMI in rats, the ECG shows ST segment elevation in lead Ⅱ for more than 30 minutes and pathological Q wave appeared at 4 weeks after surgery. HE staining showed at 4 weeks after AMI, the ventricular wall of the infarcted area of the rats became thin and white. Echocardiogram showed Left ventricular internal diameters of systole(LVIDs) and Left ventricular internal diameters of diastole(LVIDd) in the AMI group increased significantly, and Interventricular septal thickness at end diastole(IVSd) decreased significantly. Left ventricular ejection fraction(LVEF) and Fractional shortening(FS) values in the AMI group were significantly decreased. HE staining showed intestinal mucosa was hyperemia, edema, and it was infiltrated by a large number of neutrophils. The intestinal propulsive rate was increased in AMI group. Laser speckle technique shows the mesenteric blood flow was decreased in AMI group. Immunohistochemistry showed the expression of IDO was increased in AMI group. High-performance liquid chromatography showed the 5-HT content in the plasma was increased, and the content of 5-HT and 5-hydroxy indole acetic acid (5-HIAA) in the ileum was increased in AMI group. Conclusion Intestinal dysfunction after AMI may be achieved by decreased intestinal blood perfusion, IDO-related inflammation and the dysfunction of 5-HT metabolic pathway.

ROLE OF LABORATORY METHODS IN INTEGRATED DIAGNOSTICS OF ACUTE MESENTERIAL ISCHEMIA

The aim of the review: to present literature data on the role of laboratory methods in the complex diagnosis of acute mesenteric ischemia. The main provisions. To search for scientific publications, we used the PubMed database, the RSCI, the Google Scholar search engine, as well as cited references. Articles relevant to the purpose of the review were selected for the period from 1999 to 2019 in the following terms: “acute mesenteric ischemia”, “pathogenesis”, “diagnosis”, “biomarkers”. Inclusion criteria were limited to acute arterial mesenteric ischemia. Acute mesenteric ischemia is an emergency condition caused by a sudden violation of the blood flow through the mesenteric vessels, which rapidly progresses to a heart attack of the intestinal wall and is accompanied by high mortality. Four main mechanisms of OMI are distinguished: embolism from the left parts of the heart or aorta, thrombosis of arteries or veins of the intestine, non-occlusive acute mesenteric ischemia (NOMI), due to vascular spasm. In this case, destructive disorders occur in the intestinal wall, starting from the mucous membrane to the serous, which leads to bacterial translocation and the development of a systemic inflammatory response syndrome. Early bowel revascularization is a key factor in reducing complications and mortality associated with it. However, in the initial stages of the disease has no specific signs, which complicate its diagnosis. The only way to detect mesenteric blood flow disorders is MSCT with angiography, and with non-occlusive lesions, mesenteric angiography, which in normal clinical practice is not always possible. Conclusion. It can be assumed that the use of laboratory methods will expand the range of diagnostic measures and will make it possible to conduct timely treatment aimed at restoring the mesenteric blood flow and improve the prognosis in patients with acute mesenteric ischemia.

Correction of impairments of visceral blood flow and oxygen-carrying function of the portal blood in diffuse purulent peritonitis

OBJECTIVE. The authors assessed an efficacy of correction of visceral blood flow and oxygen-carrying function of portal blood in patients with diffuse purulent peritonitis. The intraportal infusion therapy was applied using ozone-saturated solutions. MATERIAL AND METHODS. There were investigated the dynamics of index changes in blood flow of the portal vein, common hepatic artery, superior mesenteric artery and main parameters of oxygenation of system and portal blood. RESULTS. There was found that the application of intraportal infusion therapy facilitated to hepatic and mesenteric blood flow, oxygen-carrying function of portal blood and liver oxygenation. The method helped to restore liver function and eliminated enteral disfunction and it decreased severity of patients’ state that allowed doctors to improve treatment outcomes. CONCLUSIONS. The intraportal infusion therapy using ozone-saturated solutions is an important part of treatment management in severe forms of purulent peritonitis.