Ultrasound Diagnosis of Acute Mesenteric Ischemia

Relevance. Acute mesenteric ischemia (AMI) is a life-threatening condition with a high mortality rate despite advances in diagnosis and treatment methods. There is a perception in the scientific community that the use of ultrasound to assess mesenteric vascular status is not sufficiently informative, and does not provide a complete picture of intestinal wall perfusion.

The Aim of the Study. To evaluate the effectiveness of ultrasound in diagnosis and its impact on treatment outcomes in patients with acute mesenteric ischemia.

Material and Methods. The work is based on the retrospective study of the results of examination and treatment of 36 patients with mesenteric ischemia at the N.V. Sklifosovsky Research Institute for Emergency Medicine for the period of 2022–2024. To assess the reliability of ultrasound data in diagnosing intestinal wall blood supply disorders in AMI with the results of the intraoperative picture, comparative information content with multispiral computed tomography (MSCT), all patients included in the retrospective study were divided into two groups: Group No. 1 — patients who underwent ultrasound examination by a physician with more than 10 years of experience; Group No. 2 — patients who underwent ultrasound examination by a specialist with less than 10 years of experience.

Results. In diagnosis of ischemic changes of the intestinal wall in acute intestinal failure (AIF), the MSCT method showed a sensitivity of 80% [60–90%], specificity of 81% [51–96%], which did not statistically significantly differ from the sensitivity and specificity of ultrasound in Group No. 1 (p=0.598 and p=0.572, respectively). In the diagnosis of intestinal wall necrosis in AIF, the MSCT method showed a sensitivity of 50% [2–95%], specificity of 95% [91–100%], which did not statistically significantly differ from the sensitivity and specificity of ultrasound in Group No. 2 (p=1.000 and p=0.411, respectively). The sensitivity of the ultrasound method in Group No. 2 was significantly lower than in Group No. 1 and MSCT (p=0.318).

Conclusion. The obtained data indicate that ultrasound is a more preferable method of diagnosis, especially in conditions of limited resources or the need for examination of non-transportable patients, patients with multiple organ failure. The key factor determining the quality of diagnosis when using the ultrasound method is the high qualification of sonographers.

1. Inoue A, Nitta N, Ota S, Takaki K, Imai Y, Misaki S, et al.MR Imagingbased Evaluation of Mesenteric Ischemia Caused by Strangulated Small Bowel Obstruction and Mesenteric Venous Occlusion: An Experimental Study Using Rabbits. Magn Reson Med Sci. 2020;19(2):125–134. PMID: 31061268 https://doi.org/10.2463/mrms.mp.2019-0010

2. Wadman M, Syk I, Elmståhl S. Survival after operations for ischaemic bowel disease. Eur J Surg. 2000;166(11):872–877. PMID: 11097154 https://doi.org/10.1080/110241500447263

3. Kanasaki S, Furukawa A, Fumoto K, Hamanaka Y, Ota S, Hirose T, et al. Acute mesenteric ischemia: multidetector CT findings and endovascular management. Radiographics. 2018; 38(3):945–961. PMID: 29757725 https://doi.org/10.1148/rg.2018170163

4. Bala M, Catena F, Kashuk J, De Simone B, Gomes CA, Weber D, et al. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2022;17(1):54. PMID: 36261857 https://doi.org/10.1186/s13017-022-00443-x

5. Björck M, Koelemay M, Acosta S, Bastos Goncalves F, Kölbel T, et al. Editor’s Choice – Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017;53(4):460–510. PMID: 28359440 https://doi.org/10.1016/j.ejvs.2017.01.010

6. Mizushima T, Udagawa E, Hasegawa M, Tazuke Y, Okuyama H, Fernandez J, et al. Etiologies and treatments of chronic intestinal failure-short bowel syndrome (SBS) in Japanese adults: a real-world observational study. Surg Today. 2022;52(9):1350–1357. PMID: 35195767 https://doi.org/10.1007/s00595-022-02469-9

7. Acosta S, Bjorck M. Modern treatment of acute mesenteric ischaemia. Br J Surg. 2014;101(1):e100–e108. PMID: 24254428 https://doi.org/10.1002/bjs.9330

8. Shavrina NV. Ul’trazvukovaya diagnostika narusheniya krovoobrashcheniya stenki kishki pri ostroy tonkokishechnoy neprokhodimosti: cand. med. sci. diss. synopsis. Moscow; 2024. (In Russ.) Available at: https://www.vishnevskogo.ru/download/dissertation_council/com_prot_ds_2/2024/ShavrinaNV-2024-avtoreferat.pdf [Accessed Mar 31, 2025]

9. Dolgina EV. Experience in the diagnosis of acute mesenteric ischemia abroad and in the Russian Federation. StudArctic forum. 2021;3(23):26– 28. (In Russ.) Available at: https://saf.petrsu.ru/journal/article.php?id=6341 [Accessed Mar 31, 2025]

10. Staroseltseva OA, Nudnov NV, Radutnaya ML, Kirchin AN, Bondar’ ЕА, Bessonova LV, et al. Difficulties in the Radiation Diagnosis of Acute Mesenteric Thrombosis in Patients with Chronic Critical Illness. Journal of Radiology and Nuclear Medicine. 2021;102(4):217–226. (In Russ.) https://doi.org/10.20862/0042-4676-2021-102-4-217-226

11. Sukharukov AS. Optimizatsiya diagnostiki, prognozirovanie riska razvitiya i profilaktika narusheniy mezenterial’nogo krovoobrashcheniya: cand. med. sci. diss. synopsis. Moscow; 2024. (In Russ.) Available at: https://old.med.ru/sites/default/files/docs/Suharukov_Avtoref.pdf [Accessed Mar 31, 2025]