Role of Multidetector Computed Tomography in Patients of Acute Mesenteric Ischaemia and its Comparison with Clinicosurgical Outcome: A Cross-sectional Study
Introduction: Acute mesenteric ischaemia is an abdominal emergency occurring in nearly 1% of patients presenting with acute abdomen. Early diagnosis is very important for the improved survival of the patient. Acute mesenteric ischaemia frequently presents with non specific features such as vomit...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2021-07-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/15126/49524_CE[Ra1]_F[SK]_PF1(PS_SK_KM)_PFA(PS_KM)_PN(KM).pdf |
| Summary: | Introduction: Acute mesenteric ischaemia is an abdominal
emergency occurring in nearly 1% of patients presenting
with acute abdomen. Early diagnosis is very important for the
improved survival of the patient. Acute mesenteric ischaemia
frequently presents with non specific features such as vomiting,
loose stools and abdominal distension. The classical triad of
fever, haematochezia and abdominal pain is seen in only 30% of
the patients so, it is difficult to diagnose clinically. Multidetector
Computed Tomography (MDCT) is gold standard and first line
test to diagnose intestinal ischaemia.
Aim: To assess the efficacy of MDCT in the diagnosis of acute
mesenteric ischaemia and to compare its outcome with surgical
and/or clinical findings.
Materials and Methods: In this cross-sectional descriptive study
conducted from 1st November 2018 to 31st May 2020, MDCT
was performed on 40 patients (23 male; 17 female, age range:
28-93 years). Axial and reconstructed images of each patient
were evaluated for evidence of bowel wall thickening, bowel
wall attenuation, abnormal wall enhancement, bowel dilatation,
mesenteric stranding, ascites, solid organ infarcts, pneumatosis
intestinalis or portomesenteric gas, and mesenteric arterial or
venous thrombosis. Multidetector CT findings were compared
with the surgical findings and clinical outcome. Results were
expressed in terms of frequency and percentages.
Results: Out of 40 patients, most common cause of acute
mesenteric ischaemia was arterial thrombosis, seen in 20
patients (50%) while 13 patients (32.5%) had portomesenteric
venous thrombosis and 7 (17.5%) patients were diagnosed
with non occlusive mesenteric ischaemia. CT finding of bowel
wall thickening and bowel dilatation however non specific were
seen in majority of patients (62.5% and 70%, respectively).
Mesenteric fat stranding and ascites were seen in 95% and
77.5% cases respectively. Specific signs of acute mesenteric
ischaemia includes hypoenhancing and non enhancing bowel
walls seen in 27 patients (67.5%). Pneumatosis intestinalis
and portomesenteric pneumatosis in 20% patients. A total
of 27 patients underwent surgery and 13 patients were
managed conservatively. On comparing the CT findings with
intraoperative/histopathological findings, accuracy of MDCT
in the diagnosis of acute mesenteric ischaemia in this study
was 96.39%.
Conclusion: MDCT should be the first line imaging modality
to diagnose acute mesenteric ischaemia and to exclude other
causes of acute abdomen. It is an excellent and fast modality to
diagnose bowel ischaemia, as it can visualise both the bowel and
mesenteric changes as well as accurately depict the mesenteric
vasculature. |
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| ISSN: | 2249-782X 0973-709X |