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Overview Of Mesenteric Artery Bypass Surgery
A mesenteric artery bypass is a procedure used to treat a blockage in your superior mesenteric artery. It involves using a graft sourced from another blood vessel or a synthetic material to create a new pathway for blood to flow.
Your superior mesenteric artery provides blood to parts of your intestines and pancreas. It branches off the aorta, the largest artery in your body. A blockage to your superior mesenteric artery can be fatal if left untreated.
A mesenteric artery bypass can be a lifesaving procedure, but it's a major surgery that comes with some risks. Read on to learn more about this procedure.
A mesenteric artery bypass aims to treat mesenteric ischemia, a lack of blood supply to your intestines.
Mesenteric ischemia can occur suddenly, often due to a blood clot, or chronically over many years. Atherosclerosis, plaque buildup in your blood vessels, is the underlying cause in more than 95% of chronic cases.
Research indicates that people living with chronic mesenteric ischemic have a 5-year chance of dying approaching 100% if not treated.
Other causes of mesenteric ischemia include:
Mesenteric artery bypass may be used to treat mesenteric artery syndrome, where the aorta and superior mesenteric artery compress your small intestines.
It may also be used to treat a superior mesenteric artery aneurysm when endovascular surgery may be difficult. An aneurysm is a bulging and weakened section of a blood vessel.
Potential complications include:
In a small 2018 Turkish study, respiratory failure and infection were the most common complications among 22 people with chronic mesenteric ischemia who received celiac artery bypass or mesenteric artery bypass. One of the 22 people in the study died in the hospital.
Mesenteric bypass failureOne potential risk of a bypass is that the graft will fail, meaning that blood won't flow through your artery properly. If this happens, you'll likely need another surgery.
The rates of graft failure vary depending on the artery they're used to treat. For example, research indicates the failure rate for bypasses in the lower extremities is about 20% within a year and 50% within 5 years.
Mesenteric bypass is associated with excellent long-term survival based on the available research. In one study, all 10 people who received a bypass to treat a tear in the superior mesenteric artery survived. None of them developed death of intestinal tissue. It should be noted that this is a very small sample size and may not be representative of overall effectiveness.
Here's a general idea of what you can expect.
Before the procedureA mesenteric artery bypass is typically performed under general anesthesia, meaning you'll be asleep during your procedure.
If your surgery is planned, you'll receive tests like imaging and a fitness assessment to see if you're healthy enough to receive general anesthesia.
General anesthesia is usually administered through an IV inserted into a vein in your wrist or arm.
During the procedureHere's a general idea of what to expect during your procedure.
You'll wake up from your procedure in the recovery area in the hospital. You'll likely be connected to an IV and have a catheter in your bladder. You'll likely also be connected to other machines to measure your vitals.
It's important to tell your doctor about any medications or supplements you're taking. You may have to clear out your bowel the night before your procedure by drinking a special liquid.
You will not be able to eat for at least 6 hours and drink at least 2 hours before your procedure.
In the 2018 Turkish study, researchers found that the average hospital stay was 10.5 days.
Full recovery from major vascular surgeries can take 2–3 months, according to the United Kingdom's National Health Service (NHS). You may be able to return to your job after about 6–12 weeks.
The cost of your surgery can depend on factors like where the procedure is performed and the extent of your procedure.
The nonprofit FAIR Health estimates that 80% of procedures to repair an aneurysm of the liver, kidney, stomach, or intestines with a graft cost less than $6,836 in Boston with anesthesia potentially costing another $6,009.
Your insurance may pay for most of your procedure. For example, Medicare Part A covers the cost of inpatient hospital care after you pay a deductible.
Alternative treatments for mesenteric ischemia include:
Endovascular surgeries are performed using a long tube inserted into your bloodstream. They've become more common to treat mesentery ischemia than bypass surgery.
Here are some frequently asked questions people have about mesenteric artery bypass.
What happens when the mesenteric artery is blocked?A blockage to your superior mesenteric artery can lead to poor blood flow to your intestines. Left untreated, your bowel tissue may die, which may cause gastrointestinal symptoms or life threatening complications.
What is the survival rate of mesenteric artery bypass?In the 2018 Turkish study, 1 out of 22 people treated with celiac or mesenteric artery bypass died in the hospital. The long-term survival of a mesenteric artery bypass is excellent.
Mesenteric bypass is used to treat superior mesenteric artery blockages. This artery supplies your pancreas and your intestines with blood. Left untreated, a blockage in this artery can be life threatening.
Endovascular surgery is now more common than a bypass for treating blockages in your superior mesenteric artery, but a bypass may still be performed if the blockage occurs in an area difficult to treat.
A New Approach To Early Diagnosis?
A comprehensive overview of acute mesenteric ischemia was long overdue, because awareness of this complex disease entity, which clinicians often think about too late, especially in the intensive care setting, urgently needs improving (1). The authors mention the problems in capturing symptoms in critically ill patients in intensive care: analgesic sedation, mechanical ventilation, volume replacement, and vasopressor therapy rarely allow for targeted diagnostic evaluation. On the other hand increasingly ageing and comorbid patients would lead us to expect a higher estimated number of unknown cases of mesenteric underperfusion—but exact data are currently lacking.
The authors emphasize that urgent imaging (contrast-enhanced computed tomography/angiography) is the diagnostic method of choice. For ventilated, critically ill patients in intensive care, this requires huge efforts with an inherent (transport) risk. Furthermore, the incidence of contrast-induced renal failure with subsequent need for renal substitution treatment is some 16%, associated with longer-term intensive care and hospital treatment and higher mortality (2).
Contrast-enhanced ultrasound might offer an innovative diagnostic approach: injecting a contrast medium that is free from side effects (phospholipid coated, sulphur hexafluoride gas containing microbubbles as reflectors for ultrasound waves) increases the imaging resolution of vessels many times. Encouraging reports are available for the reliable diagnosis of complex vascular structures, for example, after surgery for abdominal aortic aneurysm (3), and a convincing prospective evaluation has been undertaken for the early detection of intestinal ischemia (4). Our own positive experiences have convinced us that contrast-enhanced ultrasound could replace "traditional" imaging—which is expensive and takes time, while also having a higher side effect profile—at least in some cases.
DOI: 10.3238/arztebl.2012.0710a
Prof. Dr. Med. Thomas Bein
Klinik für Anästhesiologie
Klinik für Chirurgie
PD Dr. Med. Karin Pfister
PD Dr. Med. Piotr Kasprzak
Abteilung für Gefäßchirurgie
Prof. Dr. Med. Hans Jürgen Schlitt
Klinik für Chirurgie
Prof. Dr. Med. Bernhard M. Graf
Klinik für Anästhesiologie
Prof. Dr. Med. Ernst-Michael Jung
Institut für Röntgendiagnostik
Universitätsklinikum Regensburg
thomas.Bein@klinik.Uni-regensburg.De
Conflict of interest statement
Dr Pfister has received delegate fees for attending a conference. She has also received travel and hotel expenses and a lecture honorarium from Bracco Altana.
Dr Kasprzak has received honoraria for preparing continuing medical educational events from Bracco Altana.
Professors Bein, Schlitt, Graf, and Jung declare that no conflict of interest exists.
Non-Ischemic Pneumatosis Coli In Acute Abdomen
Figure
Erect abdominal radiograph showing pneumatosis intestinalis with intramural gas projected onto the left upper abdomen.
A 75-year-old female patient presented at the emergency department with upper abdominal pain that had been present for 1 day. Right hemicolectomy had been performed 8 years previously for colon cancer. Pain upon pressure to the upper abdomen and early abdominal guarding was clinically striking. CRP was elevated at 161.3 mg/L, while white blood cell count was normal. Abdominal radiography revealed pneumatosis intestinalis in the left upper abdomen. Computed tomography confirmed the suspected diagnosis of pneumatosis coli. Cholecystitis and formation of mucocele of the gallbladder was also visualized. Apart from gangrenous cholecystitis, no signs of intestinal ischemia were seen intraoperatively. The patient was discharged without symptoms on the sixth postoperative day. Non-ischemic pneumatosis intestinalis is a differential diagnosis of unknown incidence to acute mesenteric ischemia, which requires immediate treatment. Causes include immunosuppression, steroid use, intestinal infection, inflammatory bowel disease, or reduced gastrointestinal motility. Since the non-ischemic etiology of pneumatosis intestinalis cannot be definitively confirmed on imaging, a correlation with symptoms and relevant laboratory parameters is always required.
Dr. Med. Rafael Heiss, Dr. Med. Marco Wiesmüller, Prof. Dr. Med. Michael Uder, Radiologisches Institut, Universitätsklinikum Erlangen, rafael.Heiss@uk-erlangen.De
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by Christine Rye.
Cite this as: Heiss R, Wiesmüller M, Uder M: Non-ischemic pneumatosis coli in acute abdomen. Dtsch Arztebl Int 2020; 117: 877. DOI: 10.3238/arztebl.2020.0877
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