Department of Radiology, University Hospitals Paris Nord Val-de-Seine, Beaujon, 92110 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France.
Department of Radiology, Groupe Hospitalier Paris Saint-Joseph, 75014 Paris, France.
Diagn Interv Imaging. 2018 Mar;99(3):123-134. doi: 10.1016/j.diii.2018.01.004. Epub 2018 Feb 9.
Acute mesenteric ischemia is defined as an inadequate blood supply to the gastrointestinal tract resulting in ischemic and inflammatory injury that may progress to necrosis of the bowel wall. Prognosis is poor with a mortality rate greater than 95% without treatment, dropping to around 70% when surgical treatment is performed. Contrast-enhanced computed tomography (CT) has become the cornerstone of the diagnosis by showing features of vascular disorders (occlusion and/or insufficient blood supply) and features of intestinal ischemic injury. CT should be performed as rapidly as possible. Imaging-based patient management is required, and multimodal and multidisciplinary management should be introduced. The treatment involves multidisciplinary management by gastroenterologists, vascular and digestive surgeons, cardiologists, intensivists, and diagnostic and interventional radiologists. Based on our experience at a dedicated mesenteric stroke center, this article gives an overview of the diagnosis of acute mesenteric ischemia. The goal of this review is to improve the understanding of the imaging-based diagnosis to further improve the management of this life-threatening condition.
急性肠系膜缺血定义为肠道的血液供应不足，导致缺血和炎症损伤，可能进展为肠壁坏死。如果不治疗，预后很差，死亡率大于 95%，如果进行手术治疗，死亡率约为 70%。增强 CT 已成为诊断的基石，可显示血管病变（闭塞和/或血液供应不足）和肠道缺血损伤的特征。应尽快进行 CT 检查。需要根据影像学进行患者管理，并引入多模式和多学科管理。治疗包括胃肠病学家、血管和消化外科医生、心脏病专家、重症监护医生以及诊断和介入放射科医生的多学科管理。基于我们在专门的肠系膜卒中中心的经验，本文概述了急性肠系膜缺血的诊断。本文的目的是提高对基于影像学的诊断的认识，以进一步改善这种危及生命的疾病的管理。
