A New Way in Diagnosis of Acute Mesenteric Ischemia

Abstract

Background: Despite advances over the past few decades in operative techniques and perioperative managements, acute mesenteric ischemia (AMI) is astonishingly associated with high mortality rate (around 75 to 90 percent). The diagnosis of mesenteric ischemia remains a challenge. Presently, there is no quick and easy test (or combination of tests) which are available, with few side effects, high positive and negative predictive values, which can be early indicative of acute bowel ischemia. In our study we suggest intestinal serosal color change as an early diagnostic sign. Methods: This experimental single blinded study was done on 16 male rabbits. Every day we operated five rabbits with one of them as control. In case group superior mesenteric artery was ligated and thirty minutes later, observers who did not know the control and cases, inspected and scored the color changes of intestinal loops in rabbits. All of cases, which were reported as cyanotic or pale, supposed to be ischemic. The time from the ligation to color change was recorded. Results: Superior mesenteric artery was ligated in 12 rabbits (cases). Three rabbits were used as controls. Color changes indicative of AMI (pale or cyanosis) appeared in nine case rabbits (75 percent of cases), 2 were pale and 7 were cyanotic. There were no false positive in our study and all of controls were true negative. Therefore sensitivity was about 75% and specificity was 100 percent. Intestinal serosal color change appeared in 1 hour after occlusion and infarction occured after 6 hours. Conclusion: The result of this study shows that serosal color change is an indicator of occlusion of superior mesenteric artery in rabbits. Considering the similarity between human and rabbits with respect to intestinal loops, data regarding the time profile and color changes can be extrapolated to human as an indicator of occlusion and a diagnostic test of superior mesenteric ischemia for early diagnosis of this pathology.
Keywords: Acute Mesenteric Ischemia, Diagnostic Tests, Occlusion.