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Challenges in diagnosing mesenteric ischemia

World Journal of Gastroenterology 2013年第9期19卷 1338-1341页

作者： Teun C van den Heijkant Bart AC Aerts joep a teijink Wim A Buurman Misha DP Luyer Department of Surgery Catharina Hospital Eindhoven 5623 EJ Eindhoven The Netherlands Department of Surgery Amphia Hospital 4818 CK Breda The Netherlands Institute Nutrim Maastricht University 6200 MD Maastricht The Netherlands

Early identification of acute mesenteric ischemia (AMI) is challenging. The wide variability in clinical presentation challenges providers to make an early accurate diagnosis. Despite major diagnostic and treatment advances over the past decades, mortality remains high. Arterial embolus and superior mesenteric artery thrombosis are common causes of AMI. Non-occlusive causes are less common, but vasculitis may be important, especially in younger people. Because of the unclear clinical presentation and non-specific laboratory findings, low clinical suspicion may lead to loss of valuable time. During this diagnostic delay, progression of ischemia to transmural bowel infarction with peritonitis and septicemia may further worsen patient outcomes. Several diagnostic modalities are used to assess possible AMI. Multi-detector row computed tomographic angiography is the current gold standard. Although computed tomographic angiography leads to an accurate diagnosis in many cases, early detection is a persistent problem. Because early diagnosis is vital to commence treatment, new diagnostic strategies are needed. A non-invasive simple biochemical test would be ideal to increase clinical suspicion of AMI and would improve patient selection for radiographic evaluation. Thus, AMI could be diagnosed earlier with follow-up computed tomographic angiography or high spatial magnetic resonance imaging. Experimental in vitro and in vivo studies show promise for alpha glutathione S transferase and intestinal fatty acid binding protein as markers for AMI. Future research must confirm the clinical utility of these biochemical markers in the diagnosis of mesenteric ischemia.

关键词： Acute mesenteric ischemia Diagnosis Biological markers Intestinal fatty acid binding protein Alpha-glutathione S transferase

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