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Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Diagnostic laparoscopy for early detection of acute mesenteric ischaemia in patients with aortic dissection
Y Tshomba1, G Coppi, E M Marone
1Vascular Surgery, Scientific Institute H. San Raffaele, Vita-Salute University School of Medicine, Via Olgettina 60, Milan, Italy.
Introduction:
Recognition of acute mesenteric ischaemia (AMesI) in patients with aortic dissection (AoD) may be a challenge and exploratory laparotomy is often performed.
Methods:
We retrospectively analysed our experience with the use of diagnostic laparoscopy (DL) for the early detection of AMesI in patients with AoD, either undergoing medical treatment or after open/endovascular interventions.
Results:
Between 2004 and 2011, 202 consecutive AoDs were treated in our centre (71 acute type A AoD; 131 acute and chronic type B AoD). Among the 17 (8.4%) patients in which AMesI was suspected, nine (52.9%) were selected for DL. Three DLs were performed during medical treatment of patients with acute type B AoD, six after treatment of AoD (both surgical and endovascular). Three second-look DLs were also performed. Eight DLs were negative, three showed AMesI and the patients underwent successful emergent revascularisation. One DL was not conclusive and laparotomy was required. Among the eight patients not submitted to DL, one case of bowel infarction was recorded.
Conclusions:
In our series DL was feasible and safe. The low invasiveness and repeatability were the main advantages. Although additional experience is mandatory, DL seems a promising technique for the detection of AMesI in patients with AoD.
Insights
Diagnostic laparoscopy (DL) is a safe and effective tool for detecting acute mesenteric ischemia (AMesI) in patients with aortic dissection (AoD). This minimally invasive approach aids in early diagnosis and treatment, improving patient outcomes.
Area of Science:
- Vascular Surgery
- Gastrointestinal Surgery
- Diagnostic Imaging
Background:
- Acute mesenteric ischemia (AMesI) is challenging to diagnose in patients with aortic dissection (AoD).
- Exploratory laparotomy is a common, but invasive, diagnostic method.
Purpose of the Study:
- To evaluate the utility of diagnostic laparoscopy (DL) for early AMesI detection in AoD patients.
- To assess the safety and feasibility of DL in this patient cohort.
Main Methods:
- Retrospective analysis of 202 AoD patients treated between 2004-2011.
- Inclusion of patients undergoing medical treatment or post-intervention for AoD.
- DL performed for suspected AMesI, with outcomes compared to non-DL patients.
Main Results:
- Of 17 patients with suspected AMesI, nine underwent DL.
- DL correctly identified AMesI in three patients, leading to successful revascularization.
- One DL was inconclusive, requiring laparotomy; one non-DL patient developed bowel infarction.
Conclusions:
- Diagnostic laparoscopy is a feasible and safe method for AMesI detection in AoD patients.
- Its minimally invasive nature and repeatability are key advantages.
- DL shows promise for improving AMesI diagnosis in AoD, though further experience is needed.
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