Mesenteric Ischemia Sesẽ, Dɔgbo ƒe Ʋuʋu, Kple Dɔgbo ƒe Ʋuʋu Kpata¶

Acute mesenteric ischemia (AMI) nye ʋukawo kple ƒodo ƒe amekoko ƒe nudzɔdzɔ kpata si gblẽa nu le ame ŋu si me ʋu si sina toa ʋuka alo ʋuka gã siwo naa dɔgbo sue kple gã (zi geɖe la, superior mesenteric artery [SMA]) me la, wotsoa ʋuka me ʋu ƒe sisi (embolism alo thrombosis), si nye ʋu ƒe sisi sesĩe si me ʋu sina tona le ʋuka me (non-occlusive mesenteric ischemia), alo ʋuka me ʋu ƒe sisi (mesenteric venous thrombosis). Abe alesi ahɔhɔ̃ ƒe ʋuka si xe na ʋusɔgbɔdɔ eye afɔ ƒe ʋuka si xe na abɔ kple afɔ ƒe ʋu ƒe sisi kpata ene la, dɔgbo ƒe ʋuka si xe hea "dɔgbo ƒe ʋusɔgbɔdɔ / dɔgbo ƒe dzidɔ" si me dɔgbo suea ƒe ememe lãkusi (mucosa) si le bɔbɔe la dzea kuku gɔme le aɖabaƒoƒo 30 va ɖo 60 me eye dɔgboa ƒe lãmeka ƒe gli bliboa toa eme gangrenous necrosis si womate ŋu atrɔ o (transmural bowel infarction) le gaƒoƒo 6 va ɖo 12 me. Ne ame tsitsi aɖe (vevietɔ amesiame si ŋu dzitodzito me ʋu ƒe sisi, dzidɔ, dzidɔ, alo ʋukawo ƒe dɔléle le nyitsɔ laa) va le veve sem kpata le ƒodo titina si nu sẽ ŋutɔ si kpe ɖe ʋuʋudedi alo aɖuɖɔtoedɔ kpata ŋu la, ƒo ka na miaƒe nutoa me tɔwo xexlẽdzesi siwo wozãna kpata enumake. Esi nèle kpekpeɖeŋunalawo lalam la, to ʋukawo kple ƒodo ƒe mɔfiame kpata siwo do ƒome kplii me le aortic dissection kple ƒodo ƒe aortic aneurysm si gbã, . dɔgbo ƒe xexe, ƒunukpeƒetetedɔ si woƒo, kple ʋuka si me ʋu sina tona, kple dɔdzẽ sesẽ kple aɖuɖɔtoe me nudzɔdzɔ kpatawo.

Esi wònye be dɔgbo ƒe ʋuʋu si womewɔ atike na o tsɔa ku ƒe agbɔsɔsɔme 60 va ɖo 80 le alafa me ta la, agbetsitsi nɔ te ɖe nɔnɔme kpata la léle le eƒe fesre si woate ŋu atrɔ kaba (gaƒoƒo 6 gbãtɔwo) me to dzesidede eƒe dɔdamɔnu ƒe dzesi ɖeka kolia si xɔ ŋkɔ wu me: ƒodo me vevesese 10/10 si le veve sem si to vovo kura na ŋutilã me dodokpɔ fafɛ si meɖe dzesi o ƒodo.

Wɔ esia fifia¶

1. Ƒo ka na wò nutoa me ƒe xexlẽdzesi kpata enumake eye nàbia be woatsɔ ye ayi kɔdzi si me Ʋukawo Kple Amekoko Gbãtɔ ƒe ŋutete le. Ƒo ka na 911 le United States kple Canada, 112 le Europa Dukɔwo ƒe Habɔbɔ bliboa me, 999 le United Kingdom, 000 le Australia, alo nàlé ŋku ɖe míaƒe xexlẽdzesiwo ŋu xexlẽdzesi siwo wozãna kpata. Gblɔe eme kɔ be: "Wosusu be acute mesenteric ischemia / gut blood clot: ƒodo me vevesese kpata si mesɔ gbɔ be woadoe kpɔ le dɔnɔ si ŋu atrial fibrillation (alo ʋukawo/dzidɔ) le ŋu o."
2. De dzesi "Soft Belly Trap" (Pain Out of Proportion to Physical Exam). Le gaƒoƒo 1 va ɖo 6 gbãtɔ siwo me ʋu ƒe sisi xe mɔ na mesenteric artery si le etame vɔ megbe la, dɔnɔa ʋuʋuna henɔa hũ ɖem le titina ƒodo ƒe vevesese 10/10 me, ke hã ne wò alo kpekpeɖeŋunala aɖe te woƒe dɔgbo blewuu la, ƒodoa senɛ le eɖokui me be yefa keŋkeŋ eye wòɖe dzi ɖi evɔ mesẽ o guarding alo rebound veveseseɖeamenu. Mègasusui gbeɖe be vevesesea nye "gas, nuɖuɖumadzroame, alo dɔgbo me dɔlékui ko" elabena ƒodoa senɛ le eɖokui me be yefa; kaka ƒodoa nasesẽ abe kpe ene eye wòasẽ la, dɔgboa ku xoxo eye wòdo do.
3. Na dɔnɔa nanɔ nu me keŋkeŋ (NPO: tsi zero, nuɖuɖu zero, antacids zero, vevesesenutsitike zero). Mègana tsi, ginger ale, bismuth/antacids, alo vevesesenutsitike siwo woano o. Gbã la, nuɖuɖu alo tsi ɖuɖu zia dɔgbo si dɔgbo le wuwum dzi be wòawɔ dɔ sesĩe wu eye wòabia ɔksidzin geɖe wu, si wɔnɛ be lãkusiwo kuna kabakaba. Evelia, dɔnɔa hiã CT Angiography (CTA) kpata enumake eye emegbe woawɔ catheter thrombectomy alo amekokoxɔ me laparotomy le general anesthesia me.
4. Tsɔ dɔnɔa mlɔ anyi alo nànɔ gbɔɖemeƒe si me wòafa le (klowo nabɔbɔ vie) eye nàna dzoxɔxɔ nanɔ wo ŋu. Ʋusɔgbɔdɔ kple ʋukawo ƒe ʋuʋu le vuvɔ me gaxea mɔ na ʋu ƒe sisi to celiac kple inferior mesenteric ʋukawo me.
5. Gblɔ Atrial Fibrillation (vevietɔ ʋumenugbagbeviɣidɔ ƒe agbɔsɔsɔme si woto), dzidɔ nyitsɔ laa, alo "nuɖuɖu vɔvɔ̃" (nuɖuɖu vɔ megbe vevesese atraɖii) ƒe ŋutinya ɖesiaɖe na kpekpeɖeŋunalawo enumake. Acute mesenteric artery emboli ƒe alafa memama 50 kple edzivɔ tsoa ʋuka si me ʋu sina tona le miame ƒe ʋuka me si le dɔnɔ si ŋu atrial fibrillation le si dzudzɔ apixaban, rivaroxaban, dabigatran, alo atike si woyɔna be warfarin. Gblɔ dzitodzito kple ʋumenugbagbeviɣitikewo katã ƒe ŋkɔ tututu kple ɣeyiɣi mamlɛtɔ si wozãe na kpekpeɖeŋunalawo.
6. Mègatsɔ dzoxɔxɔnamɔ̃ asisi ƒodoa gbeɖe o alo nàna aɖuɖɔtoe alo enemas gbeɖe o. Dzoxɔxɔ si tso gota doa oxygen si hiã le lãmenugbagbeviwo ƒe dɔwɔwɔ me le dɔgbo ƒe gli si me ʋu sina tona me, gake aɖuɖɔtoe alo enemas ya doa ŋusẽ peristalsis ŋutasesẽ eye woate ŋu ado do ɖe dɔgbo alo dɔgbo sue si me ʋu sina tona me.

Nyametsotsoti: ƒodo ƒe vevesese sesẽ kpata kple acute mesenteric ischemia triage¶

flowchart TD
    Start["Titina / Periumbilical Ƒodo Vevesese Sesẽ Kpata Le Dɔnɔ Si Si Atrial Fibrillation, Dzidɔ Si Nyitsɔ Laa, Dzidɔ, PAD, alo Clotting Disorder Le Me"] --> ClassicTriad{"Afɔɖeɖe 1: Kpɔ Classic Embolic Triad: Agonizing 10/10 pain OUT OF PROPORTION to a soft belly exam, dɔgbo ƒe ʋuʋu sesẽ (ʋuʋudedi/aɖuɖɔtoe), alo AFib si wonya / nuɖuɖu vɔvɔ̃ do ŋgɔ?"}

    ClassicTriad -->|"Ẽ na Vevesese si Mesɔ O alo Triad"| Emergency["WOBU BE MESENTERIC ISCHEMIA KPƆKPƆ KPƆKPƆ (GAƑOƑO 6 ƑE ƲUƲU ƑE FESRE): Ƒo ka na Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ (911 / 112 / 999) Enumake"]

    ClassicTriad -->|"Dɔgbo sesẽ si le abe ʋuƒo ene, aɖuɖɔ si me ʋu do viviti, tɔtɔ, gbɔgbɔ kabakaba, alo ʋu ƒe sisi le esi xoxo"| Infarction["LATE TRANSMURAL BOWEL INFARCTION & PERITONITIS: Amekoko ƒe Xaxa si Dea Agbe Afɔku Me Kpuie; Ƒo ka na 911 Enumake"]

    Emergency --> Prehospital["1. Kpekpeɖeŋu Gbãtɔ Do Ŋgɔ na Kɔdziyiyi: NPO sesẽ (tsi, nuɖuɖu, atike siwo wua acid, alo atike siwo woano mele o), mlɔ anyi le nɔnɔme si me nànɔ bɔbɔe me, nàxɔ dzo, eye nàgblɔ dometsotso siwo le AFib alo ʋumenugbagbeviɣidɔlékuiwutikewo ŋu"]
    Infarction --> Prehospital

    Prehospital --> HospitalCTA["2. Kɔdzi Diagnostic & Resuscitation Bundle Enumake: STAT Biphasic CT Angiography (CTA) of Abdomen/Pelvis evɔ womalala lactate, IV crystalloids, IV Heparin drip, kple Broad-spectrum IV dɔlékuiwutikewo o"]

    HospitalCTA --> Revasc["3. Hybrid OR Endovascular & Surgical Bowel Salvage: Endovascular Aspiration Thrombectomy / Stenting alo Amekoko ƒe Embolectomy, lã dɔgbo si me dzo le tẽ, kple Planned Second-Look Laparotomy le gaƒoƒo 24 va ɖo 48 me"]

Ŋutilã ƒe wɔwɔme kple dɔlélenutsiŋutete: nusitae Superior Mesenteric Artery (SMA) nye " bullseye" na dzi ƒe ʋuʋu¶

Ʋuka etɔ̃ siwo mewɔ ɖeka o la alɔ ɖe ƒodo ƒe ʋuka ƒe ŋgɔgbe be woatsɔ ana amegbetɔ ƒe dɔgbo bliboa:

1. The Celiac Trunk: Enaa dɔgbo, aklã, aɖuɖɔtoe, dɔgbo, dɔgbo, kple dzitodzito (fugboe ƒe ŋgɔgbedo).
2. The Superior Mesenteric Artery (SMA): Enaa dɔgbo sue bliboa (duodenum si le ete, jejunum, kple ileum) kpe ɖe dɔgbo gã la ƒe ɖusime afã bliboa (cecum, ascending colon, kple transverse colon, embryonic midgut ƒe akpa eve le etɔ̃ me ŋu.
3. The Inferior Mesenteric Artery (IMA): Enaa dɔgbo si ɖiɖina, dɔgbo si nye sigmoid, kple dɔgbo si le etame (fugboe ƒe ** megbedɔgbo**).

Nusitae ʋuka siwo me ʋu sina tona ƒe 85% nɔa Superior Mesenteric Artery me¶

Ne ʋu ƒe sisi do le dzia me (le kpɔɖeŋu me, tso miame ƒe dzitodzito ƒe akpa si le dzitodzito me ƒe ʋuʋu me alo le miameʋuka ƒe gli ŋu le dzidɔ si do ŋgɔ megbe) eye wòda tu ƒodo ƒe ʋuka si me ʋu sina tona la, ɣesiaɣi kloe la, edzona tẽ yia Superior Mesenteric Artery (SMA) me tsɔ wu be wòadzo ayi celiac trunk alo inferior mesenteric artery me. Nu ka ta? - Celiac-ti ƒe alɔwo dona le aorta la me le dzogoe ɖaɖɛ si le degree 90 kloe si le tsitrenu me, eye mesenteric ʋuka si le ete la le kpuie le eƒe lolome nu. - To vovo na ema la, Superior Mesenteric Artery ƒe nu keke eye wòɖea alɔwo tso aorta ƒe ŋgɔgbe le 45-degree oblique angle si le blewu, si le anyime, si sɔ kple aorta ƒe tɔsisi vevitɔ kloe. Ʋu si le ʋuʋum si le du dzi to ʋukaa me la zɔa mɔ si dzi womete ŋu tsia tre ɖo boo o la dzi tẽe toa mɔ si ƒe didime nye dzidzenu 45 dzi yia SMA la me, eye zi geɖe la, edzena sentimeta 3 va ɖo 8 to afisi wòtso ŋu le titina ʋuka si me ʋu sina tona la ƒe dzodzo godo tututu.

Nusita ƒodoa sena le eɖokui me be yefa esime dɔnɔa le ɣli dom le vevesese me (Visceral vs. Somatic Pain) .¶

Lãmetsi siwo le ƒodoa me ƒe ƒuƒoƒo eve gɔmesese ɖe dɔdamɔnu ƒe kpeɖodzi ɖeka kolia si le vevie wu le atikewɔwɔ kpata me, "vevesese si mesɔ kple ŋutilãmedodokpɔ o":

1. Gaƒoƒo 0 va ɖo 6 (Mucosal Ischemia kple Visceral Nerve Agony - ƑOƑO FAFA ƑE AKPAÐEKA):
2. Dɔgboa ƒe akpa si le eme wu (mucosa kple submucosa, si me nusuekpɔmɔ̃ miliɔn geɖe siwo xɔa nunyiame le) ɖua ʋu si sina katã le dɔgboa ƒe gli me ƒe alafa memama 70 eye eyae nye lãkusi si wɔa dɔ wu le ƒodoa me.
3. Le aɖabaƒoƒo 15 va ɖo 30 me le SMA ƒe xexe megbe la, lãkusia ƒe ʋukawo dzea gbɔgbɔtsixetsixe kple ʋuʋu gɔme, gake dɔgboa ƒe gli ƒe lãmeka gbadzaa ya yia ŋutasẽnuwɔwɔ, tetanic ischemic spasm me (si wɔnɛ be dɔnɔa ƒoa aɖuɖɔ sesẽe eye wòtoa aɖuɖɔtoe me be wòakɔ dɔgboa me).
4. Ischemic spasm sia doa vevesese sesẽ ƒe dzesiwo to autonomic visceral C-fibers siwo zɔa mɔ to mesenteric nerves me yia aklã me (T8-T11), si hea ƒodo ƒe titina vevesese sesẽ aɖe vɛ, si mele teƒe aɖeke o, si me goglo.
5. Gake dɔgboa ƒe gota gome (serosa) gakpɔtɔ le agbe, eyata **medoa dzo ɖe ƒodo ƒe gli ƒe gota gome (parietal peritoneum) me o. Eyata ne ɖɔkta alo kpekpeɖeŋunala te dɔnɔa ƒe ƒodo ƒe gota gome la, ƒodo ƒe gli ƒe lãmekawo medzɔna alo ʋuʋuna kura o: dɔnɔa le vevesese 10/10 me, ke hã ƒodoa senɛ le eɖokui me be yefa keŋkeŋ.
6. Gaƒoƒo 6 va ɖo 12+ (Transmural Necrosis kple Somatic Peritonitis - ƑUƑOƑO ƑE AKPAÐEKA SI KPƆKPƆ):
7. Le gaƒoƒo 6 va ɖo 12 ƒe ʋu ƒe sisi zero megbe la, lãmenugbagbeviwo ƒe ku fiãna to lãmeka ƒe gli la me vaseɖe dɔgboa ƒe gota serosal surface (transmural infarction / gangrene).
8. Dɔlékuiwo, endotoxin, kple necrotic fluid sina toa dɔgbo ƒe gli kukua me eye wokaa asi parietal peritoneum si le ƒodo ƒe gli ƒe eme, si wotsɔ ka bla kple somatic nerves ɖaɖɛwo ŋu.
9. Fifia koe ƒodoa trɔna board-hard, rigid, kple exquisitely tender ne woka asi stretcher la ŋu alo ƒoe vie (rebound tenderness and peritonitis), si kpe ɖe eŋu kple aɖuɖɔ siwo me ʋu do viviti siwo ʋẽna lilili ("currant-jelly" stool), septic shock, kple multi-organ failure.

Dɔnɔdzikpɔƒe ƒomevi vovovo 4 siwo nye acute mesenteric ischemia¶

Le WSES kple ESVS ƒe mɔfiamewo nu la, mɔnu vovovo ene gbɔe ʋuka me ʋu ƒe sisi kpata tsona, eye wo dometɔ ɖesiaɖe kple eƒe dɔnɔ ƒe nɔnɔme, eƒe gɔmedzedze kabakaba, kple kɔdzidada:

Vovototodede acute mesenteric ischemia kple ischemic colitis kple ƒodo me kuxi bubuwo dome¶

Dɔgbo me ʋu ƒe sisi ƒomevi vovovo eve li, eye wo tɔtɔ hea megbedede si me afɔku le vɛ: Acute Mesenteric Ischemia (AMI) gblẽa nu le dɔgbo sue (SMA) ŋu eye wòwua ame kabakaba ne womewɔ ʋukawo ƒe ʋuʋu kpata o, gake Ischemic Colitis ya gblẽa nu le dɔgbo gã la ƒe tsidzɔƒewo (colon) ŋu eye zi geɖe la, ekpɔa egbɔ kɔdzi beléle si kpena ɖe ame ŋu si menye amekoko o.

Nusita lactate ƒe agbɔsɔsɔ si sɔ le ʋu me meɖea acute mesenteric ischemia ɖa o¶

Nyakpakpa siwo wua ame wu le xɔ siwo me wowɔa dɔ kpata le dometɔ ɖekae nye be woalala be woakpɔ ʋu me serum lactate ƒe agbɔsɔsɔ si sɔ gbɔ (lactic acidosis) hafi abia be woawɔ CT angiogram hena wosusu be mesenteric ischemia.

Kɔdzi diagnostic sika dzidzenu kple hybrid amekoko / endovascular salvage¶

Ne èva ɖo dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ eye nèxlɔ̃ nu ƒuƒoƒoa be wosusu be acute mesenteric ischemia la, aɖabaƒoƒo ɖesiaɖe xɔa gaƒoƒo 6 ƒe dɔgbo ɖeɖeɖa ƒe fesre:

1. Enumake Biphasic Computed Tomography Angiography (CTA) .¶

Ƒodo ƒe X-ray gbadzawo kple ƒodo ƒe ultrasound siwo wozãna ɖaa mate ŋu agbe mesenteric ischemia o (kaka X-ray naɖe gas ƒe kuɖɔ siwo le dɔgboa ƒe gli me, si woyɔna be pneumatosis intestinalis, alo gas le ʋuka si le agbo me la afia la, dɔgboa ku xoxo). - Dodokpɔ ɖeka si wòle be woawɔe nye STAT Biphasic (Arterial + Portal Venous Phase) Multidetector CT Angiogram (CTA) of the Abdomen and Pelvis si me woɖea vovototo le ʋuka me (kple NO oral contrast, si hea scan la ɖe megbe gaƒoƒo ɖeka eye wòdoa viviti ɖe dɔgboa ƒe ʋukawo ŋu). - Ne creatinine dzi ɖe edzi alo ayikudɔ si nɔa anyi didi le dɔnɔa ŋu gɔ̃ hã la, mɔfiamewo bia be woana IV contrast enumake, elabena acute mesenteric ischemia si bu la wua ame le xexeame katã kloe, gake woate ŋu akpɔ contrast nephropathy gbɔ to IV hydration me.

2. Atikewɔwɔ me Gbugbɔgadzɔ Enumake ƒe Agbalẽvi¶

Hafi dɔnɔa naƒo eɖokui ɖe amekokoxɔa alo nudede nyawo me ƒe xɔ me la, ƒuƒoƒo si kpɔa nudzɔdzɔ kpatawo gbɔ dzea atikewɔwɔ ene gɔme enumake: 1. Aggressive Intravenous Crystalloid Resuscitation: Isotonic fluid (Ringer ƒe lactate alo normal saline) be woatsɔ agbugbɔ ʋukawo me ƒe lolome si bu ɖe dɔgboa ƒe gli si vuvu la me. 2. Heparin Bolus kple Drip si Wome Mama Ðe Ʋuka Me Enumake: Enaa ʋuka si le SMA alo SMV me la nagakaka ɖe arcade alɔdze suewo me o. 3. Broad-Spectrum Intravenous Antibiotics: Esi wònye be mucosal villi dzea kuku gɔme le miniti 30 me ta la, dɔgbo me dɔlékuiwo (E. coli, Klebsiella, Bacteroides) toa dɔgboa ƒe mɔxenu si gblẽ la me yia ʋukawo me enumake; mɔfiamewo bia be woazã dɔlékuiwutike siwo wodona ɖe ʋuka me enumake siwo axɔ Gram-negative bacilli kple anaerobes (e.g., ceftriaxone alo cefepime + metronidazole, alo piperacillin-tazobactam). 4. Asaƒoƒo na Alpha-Adrenergic Vasoconstrictors: Ne ʋu ƒe sisi gakpɔtɔ le sue le tsinono vɔ megbe la, atikewɔlawo dzea agbagba be yewoaƒo asa na norepinephrine alo vasopressin ƒe agbɔsɔsɔ gã (siwo léa dɔgbo ƒe ʋukawo sesĩe wu) eye wolɔ̃a inotropes abe dobutamine alo vasopressor support si ƒe agbɔsɔsɔme le sue ne wonya tsɔ volume-repleted zi ɖeka.

3. Revascularization, Damage-Control Resection, kple "Evelia-Kpɔɖeŋu Laparotomy".¶

Le egbegbe Hybrid Operating Room me la, ʋukawo kple amekolawo wɔa dɔ ɖekae: 1. Gbugbɔ ʋu ƒe sisi GBÃTƆ: Ɣesiaɣi si woate ŋu axɔ dɔgbo ɖesiaɖe la, wogagbugbɔa ʋu ƒe sisi ɖona gbã to endovascular catheter aspiration thrombectomy, mechanical thrombectomy, alo SMA stenting, alo to open surgical Fogarty balloon embolectomy / aorto-mesenteric bypass dzi. Dɔgbo geɖe siwo ƒe amadede nye blɔ eye woƒe amadede nye aŋutiɖiɖi la trɔna zua pink si klẽna eye wogadzea egɔme nɔa tetem ɖe wo nɔewo ŋu le miniti 15 me tso esime ʋukawo ƒe ʋu ƒe sisi gaɖo wo ŋu. 2. Ðe dɔgbo si ku (yibɔ/si me do le) anukwaretɔe MELE be mègalɔ̃ eƒe nugbɔwo ake haɖe o (Damage-Control Surgery): Wowɔa dɔ na dɔgboa ƒe akpa ɖesiaɖe si nye yibɔ xoxo, si le tsɛ abe pepa ene, alo do do ɖe eme la heɖenɛ ɖa. 3. The Mandatory 24-to-48-Hour "Second-Look Laparotomy": Esi wònye be zi geɖe la, manya wɔ le dɔwɔwɔ gbãtɔ me be woanya nenye be dɔgbo sue ƒe liƒo-doviviti ƒe ʋuƒoawo ahaya ne ʋu ƒe sisi trɔ gbɔ alo yi ŋgɔ va zu necrosis megbe o ta la, amekolawo ɖonɛ koŋ gblẽa dɔgbo ƒe nugbɔ siwo wotsɔ stapled la ɖe ƒodoa me le ɣeyiɣi kpui aɖe ƒe vacuum dressing (ʋu ƒodo / AABThera), afɔ dɔnɔa ɖe agbe le ICU hena gaƒoƒo 24 va ɖo 48, eye emegbe nàgbugbɔ dɔnɔa ava amekokoxɔa me hena Second-Look Laparotomy be woalé ŋku ɖe dɔgbo si susɔ ƒe sentimeta ɖesiaɖe ŋu hafi alɔ̃ dɔgbo ƒe nuwuƒe siwo le lãmesẽ me la ake. Mɔnu sia xɔa dɔgbo sue ƒe sentimeta veviwo ta eye wòxea mɔ na Adɔgbo Kpuie ƒe Dɔléle le eƒe agbemeŋkekewo katã me.

Mɔxexeɖedɔléle nu ƒe ɖaseɖigbalẽ: dzesidede "Dɔgbome Angina" kple ametakpɔkpɔ tso AFib ƒe ʋumenugbagbeviɣiwo me¶

• Mègaŋe aɖaba ƒu "Intestinal Angina" (Chronic Mesenteric Ischemia) dzi gbeɖe o: Ne ame tsitsi aɖe si si atamanono, ʋuka siwo le gota ƒe dɔléle, alo dzidɔ le ŋutinya me la xɔ ƒodo ƒe vevesese si me mekɔ o si woate ŋu agbugbɔ awɔ aɖabaƒoƒo 15 va ɖo 60 le nuɖuɖu ɖuɖu vɔ megbe (enɔa anyi gaƒoƒo 1 va ɖo 2 vaseɖe esime nuɖuɖumeŋusẽ wu enu), dzea nuɖuɖu vɔvɔ̃ gɔme (nuɖuɖu suewo kple suewo ɖuɖu be ƒo asa na vevesese), eye wòɖe eƒe lolo dzi kpɔtɔ le manyamanya me la, bia be woaɖo ye ɖe ʋukawo ƒe dɔwɔwɔ na ame kpata be woawɔ mesenteric duplex ultrasound alo CTA. Stenting si narrowed SMA dzɔtsoƒe xea mɔ na acute thrombotic infarction si wua ame le wo ɖokui si.
• Lé ʋumenugbagbeviɣitike siwo woŋlɔ na wò me ɖe asi sesĩe le Atrial Fibrillation me: Mègatɔ vie alo adzudzɔ apixaban, rivaroxaban, edoxaban, dabigatran, alo warfarin gbeɖe ne ɖɔkta ƒe mɔfiafia si me kɔ o.
• Tsi nɔ lãme na wò nyuie le dzoxɔxɔ alo dɔgbo ƒe dɔlélewo me ne ʋukawo me dɔléle sesẽ aɖe le ŋuwò alo ʋukawo me ʋu ƒe sisi le ŋuwò ŋutinya.

Nyatakaka siwo woaƒo ƒu na kɔdzi ƒe ʋukawo kple amekoko ƒe ƒuƒoƒoa¶

Esi wole dɔnɔdzikpɔʋua lalam la, atikewɔwɔ ŋutinya vevi ene dzadzraɖo ɖea aɖabaƒoƒo veviwo dzi kpɔtɔna le dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ:

1. Gaƒoɖokui si tututu ƒodo ƒe vevesesea dze egɔme: Abe alesi wòle le ʋusɔgbɔdɔ alo dzidɔ ƒe beléle ene la, ʋukawo ƒe amekolawo zãa gaƒoƒo si tututu dzesiawo dzea egɔme tsɔ dzidzea alesi dɔgboa te ɖe gaƒoƒo 6 ƒe transmural necrosis ƒe dzidzenu ŋu.
2. Dzitodzito ƒe ʋuʋu kple ʋukawo ƒe dɔlélewo ƒe xexlẽdzesi blibo: Ŋlɔ nenye be dzitodzito me ʋu ƒe sisi le dɔnɔa ŋu si nye paroxysmal alo permanent fibrillation, dzitodzito si wowɔ kple asi, dzitodzito me ʋuka si me ʋu sina tona nyitsɔ laa, ʋuka siwo le gota ƒe ʋuʋu, alo ʋuka me ʋu ƒe sisi alo aklã me ʋu ƒe sisi le ŋutinya ɖesiaɖe ŋu.
3. Atikewo ƒe tɔtrɔ nyitsɔ laa alo agbɔsɔsɔme si woda: Tsɔ atikewɔtu siwo katã woŋlɔ na wò la vɛ, eye nàlé ŋku ɖe ʋumenugbagbeviɣidɔlékuiwutike ɖesiaɖe si wolé nyitsɔ laa hena aɖudɔdada, dɔgbomekpɔkpɔ, alo amekoko, alo aɖuɖɔtoedɔlékuiwutike (tsitike) alo digoxin ɖesiaɖe si wodze egɔme yeyee ŋu etɔxɛe.
4. Ayiku ƒe dɔwɔwɔ do ŋgɔ alo vovototodedeameme ƒe nulɔdɔ ŋutinya: Nana atikewɔla kpata nanya dɔnɔa ƒe ayiku ƒe dɔwɔwɔ le gɔmedzedzea me kpena ɖe wo ŋu wodzraa tsi si wodona ɖe ʋuka me le dodokpɔ megbe ɖo esime wole edzi yim enumake kple biphasic CT angiogram si xɔa ame ɖe agbe.

Nutome ƒe xexlẽdzesi siwo ku ɖe nudzɔdzɔ kpatawo ŋu kple dɔwɔƒea ƒe ɖoɖowo¶

Acute mesenteric ischemia bia be woatsɔ dɔnɔdzikpɔʋu ayi kɔdzi gã aɖe enumake kple gaƒoƒo 24 ƒe CT Angiography, Vascular Surgery, Interventional Radiology, kple General/Trauma Surgery:

• United States kple Canada: Ƒo 911. Bia be woatsɔ ye ayi atikewɔƒe etɔ̃lia alo kɔdzi si le Dzeside ½ (mègayi atikewɔƒe si le eɖokui si gbeɖe be yeakpɔ dɔ kpata le ƒodo me vevesese sesẽ kpata o).
• United Kingdom: Ƒo ka na 999 hena dɔnɔdzikpɔʋu kpata alo yi kɔdzi gã aɖe si kpɔa dɔléle sesẽwo gbɔ enumake Emergency Department (A&E) si me Arterial Vascular Center kple Emergency General Surgery le le teƒea.
• Europa Dukɔwo ƒe Habɔbɔ: Ƒo 112. Wokpɔa edzi le Europa Habɔbɔ si Kpɔa Ʋukawo ƒe Amekoko Gbɔ (ESVS) ƒe Dɔdamɔnu ƒe Mɔfiamewo le Dɔlélewo Dzikpɔkpɔ le Mesenteric Ʋukawo Kple Veins kple WSES Mɔfiamewo te.
• Australia kple New Zealand: Ƒo 000 le Australia alo 111 le New Zealand.
• India kple Asia-Pacific: Ƒo 112 (alo 108 le India), 995 le Singapore, 119 le Japan kple South Korea, alo 999 le Malaysia kple Hong Kong. Yi kɔdzi etɔ̃lia tẽ kple gaƒoƒo 24 ƒe MDCT angiography kple ʋukawo/GI dɔwɔwɔ.

Nya siwo wobiaa amewo enuenu¶

Nukae "vevesese si mesɔ kple ŋutilãmedɔdada o" fia le acute mesenteric ischemia me?¶

Le ƒodo ƒe nɔnɔme kpata akpa gãtɔ me (abe appendicitis alo abi si me do le ene) la, ƒodoa ƒe gota gome (parietal peritoneum) xɔa abi enumake, eyata ne wozi dɔnɔa ƒe ƒodo dzi la, enaa vevesese sesẽ kple lãmekawo sesẽna le eɖokui si (edzɔna). Le acute mesenteric ischemia me la, ʋu si le dodom la nana dɔ wua dɔgboa ƒe akpa si le eme wu gbã esime gota gome ya nɔa anyi le gaƒoƒo 4 va ɖo 6 gbãtɔawo me. Esia hea vevesese sesẽ 10/10 vɛ le dɔgboa me si nana dɔnɔa ʋuʋuna le vevesese ta, ke hã ne ɖɔkta te ƒodoa ƒe gota gome la, ƒodoa fa keŋkeŋ eye wòɖea dzi ɖi. De dzesi masɔmasɔ sia le gaƒoƒo 6 gbãtɔawo me nye nusi xɔa dɔnɔa ƒe agbe.

Nukatae amesiwo ŋu dzitodzito me ʋu ƒe sisi le la le afɔku gã aɖe me be ʋu nado le dɔgboa me kpata?¶

Le dzitodzito ƒe ʋuʋu (AFib) me la, dzia ƒe akpa siwo le etame la ʋuʋuna madzemadzee le esi teƒe be woamimi nyuie, si wɔnɛ be ʋu si tsi anyi la ƒoa ƒu hetsia kotoku sue aɖe si woyɔna be miame dzitodzito ƒe kpeɖeŋutɔ me. Ne dɔnɔ aɖe to woƒe ʋumenugbagbeviɣidɔlékuiwutike ƒe agbɔsɔsɔmewo ŋu (alo AFib si womekpɔ dze sii o) la, ʋumenugbagbeviɣi ma ƒe akpa aɖe ate ŋu agbã, akɔe ado goe le dzia me ayi ʋuka si me ʋu sina tona me, eye wòaɖiɖi tẽe le dzitodzito me ʋuka si le etame ƒe dzogoe 45 dzi, si ana ʋu natso ɖe dɔgbo sue bliboa me le dzi ƒe tsotso ɖeka me.

Nukae nye "nuɖuɖu vɔvɔ̃" (sitophobia) alo "intestinal angina," eye nukatae wònye nuxlɔ̃amedzesi?¶

Abe alesi dzitodzito me ʋuka siwo xaxa naa akɔtave (angina) le kamedede me ne dzitodzito me lãmeka hiã ʋu geɖe ene la, nenema ke dɔgbo ƒe ʋuka siwo me ʋumemi le nana ƒodo ƒe titina veam le aɖabaƒoƒo 15 va ɖo 60 le nuɖuɖu ɖuɖu vɔ megbe, esime dɔgboa biaa ʋu bubu be wòaɖu nuɖuɖu. Le kwasiɖa alo ɣleti aɖewo megbe la, dɔnɔwo va kpɔnɛ be nuɖuɖu hea vevesese vɛ, eyata wovɔ̃na na nuɖuɖu (sitophobia) eye woƒe kpekpeme dzi ɖena kpɔtɔna kilogram 10 va ɖo 30 le manyamanya me. Dɔnɔ siwo ade 70 le alafa me siwo ŋu ʋuka siwo me ʋu sina tona kabakaba si wua ame la ƒe nuxlɔ̃amedzesi siawo nɔ wo ŋu do ŋgɔ; ʋuka si xaxa la léle kple stent dada kaba xea mɔ na dɔgbo ƒe ʋuʋu.

Ðe ʋu me lactic acid (lactate) dodokpɔ si sɔ ate ŋu agbe dɔgboa ƒe ʋuka si xea?¶

Ao, gbeɖe o. Le gaƒoƒo 2 va ɖo 6 gbãtɔ siwo me dɔgbo si me ʋu sina tona kabakaba la me la, lactic acid si dɔgbo si oxygen dɔ le wuwum la wɔna la tsia dɔgboa ƒe ʋuka siwo tsi anyi me alo aklãa ɖenɛ ɖa keŋkeŋ hafi ɖoa ʋuka siwo le alɔnu si me woɖea ʋu le gbɔ. Kaka lactate ƒe agbɔsɔsɔ le ʋu me nayi dzi la, zi geɖe la, dɔgbo ƒe gli la xɔ gangrene si womate ŋu atrɔ o xoxo. Ele be ɖɔktawo naɖe gbe be woawɔ CT angiogram si ana woawɔ vovototodedeameme enumake le atikewɔƒe ƒe ɖikeke nu evɔ womalala be lactate nadzi ɖe edzi o.

Nukatae amekolawo wɔa "Second-Look Laparotomy" le gaƒoƒo 24 va ɖo 48 le dɔgbo ƒe ʋuʋu ƒe dɔwɔwɔ vɔ megbe?¶

Ne amekolawo gagbugbɔ ʋu sina yia dɔgbo si me ʋu sina tona me eye woɖe akpa ɖesiaɖe si dze ƒã be enye yibɔ eye wòku la, zi geɖe la, dɔgbo sue susɔea ƒe akpa didiwo dzena viviti eye wovuvu, si wɔnɛ be womate ŋu anya kple kakaɖedzi le gaƒoƒo gbãtɔ me nenye be ka mawo ahaya alo aku o. Ne amekolawo lã dɔgbo siwo katã le liƒo dzi enumake la, ate ŋu agblẽ dɔgbo Kpuie ƒe Dɔléle (si mete ŋu xɔa nuɖuɖu o) ɖi na dɔnɔa. Ke boŋ amekolawo gblẽa ƒodoa ɖi wòdo awu hena ɣeyiɣi aɖe, wodoa alɔ dɔnɔa le ICU gaƒoƒo 24 va ɖo 48 be dɔgbo si wogbugbɔ do ʋu na la nahaya, eye emegbe wogaléa ŋku ɖe dɔgboa ŋu le amekokoxɔa me hafi gatsɔa nugbɔ siwo le lãmesẽ me la doa ka kple wo nɔewo.

Vovototo kae le acute mesenteric ischemia kple ischemic colitis dome?¶

Acute mesenteric ischemia nye ʋuka gã (superior mesenteric artery) si naa dɔgbo sue bliboa kple ɖusime dɔgbo la ƒe xexe si ate ŋu awu ame; enaa veve 10/10 le titina eye wòwua dɔnɔ 60 va ɖo 80 le alafa me negbe ɖe wowɔ dɔ na ʋu ƒe sisi le gaƒoƒo aɖewo megbe hafi. Ischemic colitis nye ʋu ƒe sisi si bɔ wu sã, zi geɖe la, ʋuka suewo ƒe sisi yi miame dɔgbo gã (dɔgbome) ƒe "tsidzɔƒe" ƒe gogloƒewo ƒe ɖiɖi hena ɣeyiɣi aɖe, si hea miame ƒodo ƒe ʋuʋu le mɔ si sɔ nu eye ʋu maroon alo dzĩ si le keklẽm le aɖuɖɔ me kplɔe ɖo le gaƒoƒo 24 me; ʋumenugbagbeviɣidɔlélawo dometɔ siwo wu 80 le alafa me hayana le ŋkeke ʋɛ aɖewo me ne wodo tsi ɖe ʋuka me eye wogbɔ ɖe eme le dɔgboa me.

Dzɔtsoƒewo kple dziɖuɖumegãwo ƒe mɔfiame¶

• Xexeame ƒe Amekoko Kpata Habɔbɔ (WSES, Dukɔwo Dome): Acute Mesenteric Ischemia: Xexeame ƒe Amekoko Kpata Habɔbɔ ƒe Mɔfiame yeyewo (Bala et al., Xexeame ƒe Amekoko Kpata ƒe Nyadzɔdzɔgbalẽ, 2022/2023 yeye: CTA enumake malala lactate, anticoagulation, broad-spectrum antibiotics, endovascular-gbãtɔ ƒe ʋukawo gbugbɔgawɔ, kple nusiwo gblẽ dzi ɖuɖu ƒe dzedzeme evelia ƒe laparotomy).
• Europa Habɔbɔ si Kpɔa Ʋukawo ƒe Amekoko Gbɔ (ESVS, Europa): Nuŋlɔla ƒe Tiatia - Mesenteric Ʋukawo Kple Veins ƒe Dɔlélewo Dzikpɔkpɔ: Europa Habɔbɔ si Kpɔa Ʋukawo ƒe Amekoko Gbɔ ƒe Dɔdamɔnu ƒe Mɔfiamewo (Björck et al., European Journal of Vascular and Endovascular Surgery).
• American College of Gastroenterology (ACG) & American Gastroenterological Association (AGA, United States): ACG ƒe Dɔlélenutsitsi ƒe Mɔfiame: Dɔvɔ̃ŋutinunya, Afɔku, Nusiwo Woɖena Ðe Go, Dzesidede, Kple Dɔgbo ƒe Ʋuʋu kple Acute Mesenteric Ischemia ƒe Dɔwɔnawo Dzi Kpɔkpɔ.
• Society for Vascular Surgery (SVS, United States): Dɔwɔƒe ƒe Mɔfiamewo na Mesenteric Ischemia si nɔa anyi didi kple esi nu sẽ.
• Dukɔa ƒe Lãmesẽnyawo Kple Belélename Ŋuti Nusrɔ̃ƒe (NICE) & England ƒe Amekolawo ƒe Fiaɖuƒe Kɔledzi (United Kingdom): Amekoko Gã Kpata kple Afɔku Gã ƒe Ƒodo Vevesese Sesẽwo Triage Mɔwo.

Mɔfiame siwo do ƒome kplii¶

• Afɔ si me ʋuʋudedi mele o si fa kpata kple ʋukawo ƒe ʋuʋu kpata ƒe vovototodedeameme
• Dɔgbo ƒe xexe, ƒunukpeƒetetedɔ si woƒo, kple volvulus ƒe dzesi siwo dzena kpata
• Aortic dissection kple ƒodo ƒe aortic aneurysm si gbã
• Aɖuɖɔtoedɔ, ƒunukpeƒetetedɔ si gbã, ƒodo me dɔdzẽ, kple ƒodo ƒe vevesese sesẽ
• Ʋu si dona le dɔgboa me, ʋu si dona le ame ŋu, kple melena