Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb;48(1):87-96.
doi: 10.1007/s00068-020-01500-3. Epub 2020 Sep 19.

The role of bed-side laparoscopy in the management of acute mesenteric ischemia of recent onset in post-cardiac surgery patients admitted to ICU

Carlo Bergamini  1 , Giovanni Alemanno  2 , Alessio Giordano  2 , Desiré Pantalone  3 , Giovanni Fontani  3 , Anna Maria Di Bella  3 , Veronica Iacopini  3 , Paolo Prosperi  2 , Jacopo Martellucci  2
Affiliations

The role of bed-side laparoscopy in the management of acute mesenteric ischemia of recent onset in post-cardiac surgery patients admitted to ICU

Carlo Bergamini et al. Eur J Trauma Emerg Surg. 2022 Feb.

Abstract

Purpose: Acute mesenteric ischemia with non-occlusive mechanism (NOMI) is a possible complication after cardiac surgery in patients admitted to Intensive Care Unit (ICU). Since the diagnosis is often difficult with CT-scan, some authors have evaluated the role of bed-side diagnostic laparoscopy (DL). We aimed to contribute to this topic with a personal series.

Methods: We retrospectively evaluated patients admitted to ICU after cardiac surgery since 2009 up to 2019, successively operated on for a suspected NOMI of recent onset with non-conclusive CT. They were divided into laparoscopic (Ls) and laparotomic (Lt) group, depending on whether or not they had a DL. They were compared for the CT false-positive (FP) and true-positive (TP) rate and the surgical outcome.

Results: Seventy-three patients were enrolled. Lt included 30 patients (41%), Ls 43 (59%). The overall FP were 38 (52%), with a higher incidence in Ls. There was no difference in the mortality rate. The morbidity rate was higher in Lt, and especially in Lt-FP. The TP were 35 (47.9%). The mean operating time (OT) in the Lt-TP group was similar to the sum of the mean OT of the laparotomies plus that of the laparoscopies in the Ls-TP group. Conversely, when considering only laparotomic procedures, the Lt-TP had higher mean OT, such as an increased blood loss CONCLUSIONS: Post-cardiosurgical patients admitted to ICU have a relatively high rate of NOMI, in which CT-scan is often initially non-conclusive. Our data and those from the literature seem to show that in such cases bed-side DL may be an advantageous and safe procedure to avoid needless laparotomy and enables a more tailored open surgery.

Keywords: Acute mesenteric ischemia; Bed-side laparoscopy; Intensive care unit; NOMI.

PubMed Disclaimer

References

    1. Gupta PK, Natarajan B, Gupta H, Fang X, Fitzgibbons RJ Jr. Morbidity and mortality after bowel resection for acute mesenteric ischemia. Surgery. 2011;150(4):779–87. - DOI
    1. Kassahun WT, Schulz T, Richter O, Hauss J. Unchanged high mortality rates from acute occlusive intestinal ischemia: six year review. Langenbecks Arch Surg. 2008;393:163–71. - DOI
    1. Mastoraki A, Mastoraki S, Tziava E, Touloumi S, Krinos N, Danias N, Lazaris A, Arkadopoulos N. Mesenteric ischemia: Pathogenesis and challenging diagnostic and therapeutic modalities. World J Gastrointest Pathophysiol. 2016;15(7):125–30. - DOI
    1. Savlania A, Tripathi RK. Acute mesenteric ischemia: current multidisciplinary approach. J Cardiovasc Surg (Torino). 2017;58:339–50.
    1. Guillaume A, Pili-Floury S, Chocron S, Delabrousse E, De Parseval B, Koch S, Samain E, Capellier G, Piton G. Acute mesenteric ischemia among postcardiac surgery patients presenting with multiple organ failure. Shock. 2017;47:296–302. - DOI

LinkOut - more resources