23. BT Anjiografi: Multidete k t ö r BT akut ve kronik mezenterik iskeminin tanısında idealdir Horton KM, et al. Radiol Clin North Am. 2007 Mar;45(2):275-88. Review
24. BT bulguları Kirkpatrick IDC et al., Radiology 2003 Pneumatosis intestinalis 11 0 42 100 Arterial embolism 3 0 12 100 SMA or portal venous gas 3 0 12 100 Focal lack of bowel wall 11 1 42 97 enhancement Free intraperitoneal air 5 2 19 94 Mesenteric vein thrombosis 4 2 15 94 Bowel dilatation 17 6 65 83 Bowel wall thickening 22 10 85 72 CT Finding n=26 n=36 (%) (%) Patients with AMI Control Group Sensitivity Specifity
150 yıl önce tanımlanmış ancak 30 gün mortalite günümüzde %32-60 arasında. Bu oran sadece gecikmiş tanı ve eşlik eden hastalıklardan değil barsak iskemisinin lokal ve sistemik etkilerinden kaynaklanır. Barsaklar low flow sonrası metabolik, hormaonal ve vazoaktif düzenleyici görevlerini yerine getiremez.
Why worry about it? TPN dependence 30% Early diagnosis improved these rates and hallmark of care of these patients Incidence likely to increase with care of older population Underestimation: subclinical disease Mortality high because diagnosis made after infarciton, gut damage proceeds even after revascularization, concomitant medcal problems and poor distal mesenteric circulation
Can become irreversible even after cause reversed (esp in presence of atherosclerotic disease). Often stenotitc arteries present (acute on chronic disease)
Limited clinical utility due to low sensitivity, low specificity, and markers only appear after gut infarction.
pneumatosis venous gas SMA/celiac/IMA occlusion w/distal disease arterial embolism OR bowel wall thickening + one of following: lack of bowel wall enhancement solid organ infarction venous thrombosis
In 1996 the U.S. Food and Drug Administration (FDA) approved the use of tPA to treat ischemic stroke in the first three hours after the start of symptoms.
Kontrol angiografi: SMA’ da %70 rekanalizasyon, proksimal jejunal ve ileokolik dalların açıldığı görüldü
Department of Surgery, School of Medicine, Gazi University, Ankara
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