Computed tomography diagnostics of acute and chronic mesenteric ischemia

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BACKGRAUND

Chronic mesenteric ischemia is more often accompanied by clinical signs characteristic of colitis. Acute mesenteric ischemia, unlike chronic, is accompanied by nonspecific symptoms and is a serious disease that requires urgent diagnosis.

AIMS

The aim of the study was to evaluate the effectiveness of MSCT in the diagnosis of acute and chronic mesenteric ischemia based on our observations.

MATERIALS AND METHODS

The retrospective study included 135 patients with abdominalgia and suspected mesenteric ischemia who underwent multiphase CT of the abdominal cavity with intravenous bolus contrast enhancement. Group 1 included 105 patients with mesenteric ischemia; group 2 included 30, without confirmed mesenteric ischemia, with the presence of a symptom of mesenteric ischemia in the form of abdominalgia

RESULTS

We studied 135 patients, including 105 patients with mesenteric ischemia, 59 women and 46 men of average age 60±14.9 years. The acute form of ischemia (58%) was determined 1.5 times more often than the chronic one. Occlusive and nonocclusive acute mesenteric ischemia occurred in equal proportions. Mesenteric arterial thrombosis was the cause of acute mesenteric ischemia in 23% of cases. Mesenteric venous thrombosis was the cause of chronic intestinal ischemia in 61%, in 5% — acute form. Mixed arterial-venous genesis of mesenteric ischemia was determined in 4% against the background of strangulation obstruction. Dunbar syndrome as a cause of chronic intestinal ischemia was diagnosed in 16%. Chronic ischemic enterocolitis accounted for 10% of all cases of mesenteric ischemia and 23% of chronic ischemia. Symptoms and symptom complexes characteristic of the studied series of diseases with acute or chronic mesenteric ischemia were delineated. Sensitivity, specificity and prognostic value of CT with intravenous bolus contrast enhancement in diagnostics of diseases accompanied by mesenteric ischemia reached 100%.

CONCLUSIONS

Multiphase CT of the abdominal cavity with bolus contrast enhancement is highly informative in the diagnosis of acute and chronic forms of mesenteric ischemia. Direct CT signs of impaired blood flow in the arteries or veins of the mesentery were indisputable. Indirect signs of mesenteric ischemia were aimed at a thorough analysis of the condition of mesenteric vessels.

Keywords:

computed tomography

mesenteric ischemia

median arcuate ligament syndrome

Authors:

Koshelev E.G.

Central State Medical Academy of Administrative Directorate of the President of the Russian Federation;
Clinical Hospital of Administrative Directorate of the President of the Russian Federation

SPIN RSCI: 1596-2537
ORCID: 0000-0002-5494-0327

Belyaev G.Yu.

Central State Medical Academy of Administrative Directorate of the President of the Russian Federation;
Polyclinic No. 2 of Administrative Directorate of the President of the Russian Federation

SPIN RSCI: 2169-5450
ORCID: 0000-0002-1119-9102

Egorov A.A.

Polyclinic No. 2 of Administrative Directorate of the President of the Russian Federation

SPIN RSCI: 9239-2671
ORCID: 0000-0002-8609-6319

Received:

20.08.2023

Accepted:

10.09.2023

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