title: Diagnosis of non-occlusive acute mesenteric ischemia in the intensive care unit.
abstract: BACKGROUND
  Non-occlusive mesenteric ischemia (NOMI) is a common complication and accounts for a major cause of death in critically ill patients. The diagnosis of NOMI with respect to the eventual indications for surgical treatment is challenging. We addressed the performance of the diagnostic strategy of NOMI in the intensive care unit, with emphasis on contrast-enhanced abdominal CT-scan.
  
  
  METHODS
  This was a retrospective monocenter study. Patients with clinically suspected acute mesenteric ischemia were included if a comprehensive diagnostic workup was carried out including surgical and/or endoscopic digestive explorations. Patients with evidence of occlusive mesenteric ischemia were excluded. A definite diagnosis of NOMI only relied on surgical or endoscopic findings. Abdominal CT-scans were reviewed by two radiologists blinded from the final diagnosis.
  
  
  RESULTS
  A diagnosis of NOMI could be definitely confirmed or ruled out through surgical or endoscopic explorations of the digestive tract in 147 patients. With respect to their clinical characteristics, only a history of atrial fibrillation was an independent predictor of NOMI (odds ratio 8.3, 95% confidence interval 2.0-35.2, p = 0.004). Among them, 114 patients (75 with and 39 without NOMI) had previously been subjected to contrast-enhanced abdominal CT-scan. Portal venous gas, pneumatosis intestinalis and, to a lesser extent, abnormal contrast-induced bowel wall enhancement were poorly sensitive, but exhibited good specificities of 95, 85 and 71%, respectively. Nineteen out of 75 patients (25.3%) without any suggestive radiological signs finally exhibited mesenteric ischemia, including ten with intestinal necrosis.
  
  
  CONCLUSIONS
  The performance of abdominal CT-scan for the diagnosis of NOMI is limited. Radiological signs of advanced-stage ischemia are good predictors of definite mesenteric ischemia, while their absence should not be considered sufficient to rule out the diagnosis.
authors.affiliation: Service de Réanimation Médicale, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.|Faculté de Médecine, Université Paris Descartes, Paris, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Bourcier
authors.affiliation: Service de Radiologie A, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Ammar
authors.initials: A
authors.lastname: Oudjit
authors.affiliation: Service de Chirurgie Digestive, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France.|Faculté de Médecine, Université Paris Descartes, Paris, France.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Goudard
authors.affiliation: Service de Réanimation Médicale, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Charpentier
authors.affiliation: Service de Gastro-entérologie, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Leblanc
authors.affiliation: Service de Gastro-entérologie, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France.|Faculté de Médecine, Université Paris Descartes, Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Coriat
authors.affiliation: Service de Radiologie A, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Gouya
authors.affiliation: Service de Chirurgie Digestive, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France.|Faculté de Médecine, Université Paris Descartes, Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dousset
authors.affiliation: Service de Réanimation Médicale, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.|Faculté de Médecine, Université Paris Descartes, Paris, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.affiliation: Service de Réanimation Médicale, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. frederic.pene@aphp.fr.|Faculté de Médecine, Université Paris Descartes, Paris, France. frederic.pene@aphp.fr.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pène
keywords: CT-scan; Endoscopy; Intensive care unit; Ischemia; Mesenteric; Surgery