Modern opportunities for early diagnosis of acute mesenteric circulatory disorders

Introduction. The acute form of mesenteric ischemia is still an urgent and important problem of modern surgery, especially its early diagnosis. There is no tendency to decrease mortality rates from this form of the disease. Over the years, it has been 65–95 %. Due to the need to minimize the time of diagnosis of mesenteric ischemia, research is underway aimed at creating and evaluating the effectiveness of new diagnostic markers that could indicate ischemia of the intestinal wall by changing their concentration and make it possible to perform surgical treatment at the earliest possible time. According to the literature, a new clinical and laboratory indicator has similar characteristics – the intestinal form of fatty acid binding protein (Intestinal Fatty Acid Banding Protein, (I-FABP).

The purpose of the study. To evaluate the diagnostic value of the fatty acid binding protein (I-FABP) as the primary marker of ischemic small intestine lesion based on our observations.

Materials and methods. A single-center clinical and laboratory comparative study included 31 patients from 34 to 91 years old who were admitted to the State Medical Institution “State Clinical Hospital named after V.V. Veresaev DZM”, urgently with the clinic of acute mesenteric circulatory disorders in the period 2022-2023.

Results. The maximum concentrations of I-FABP in the blood serum are detected 2–3 days after the onset of the vascular “catastrophe”. In all cases, thrombosis was the cause of ONMpC. Mesenteric arterial thrombosis as the cause of OMI occupied a leading place, accounting for 71 % of cases (n = 22), whereas venous thrombosis was diagnosed in 29 % of patients (n = 9). The value of I-FABP in patients with arterial thrombosis was not much higher than the value of the marker in patients with venous OMI. The average concentration of I-FABP in deceased patients was significantly higher than that in survivors.

Conclusion. Laboratory determination of the intestinal form of fatty acid binding protein in blood serum has every chance of being introduced into the diagnostic algorithm for patients with suspected forms of mesenteric circulatory disorders, which will reduce the diagnostic time, choose the optimal treatment tactics and improve treatment results. 

1. Demchenko V.I., Kukosh M.V., Kolesnikov D.L., Trukhalev V.A. Mesenteric thrombosis and elective relaparotomy. Surgical Practice, 2015, № 2, pp. 8–11.

2. Zatevakhin I. I., Kiriyenko A. I., Kubyshkin V. A. Abdominal surgery: National guidelines: a short edition. M. : GEOTAR-Media, 2016, 912 p.

3. Kochetkov F.D., Suchkov I.A., Zaitsev O.V., Koshkina A.V. Modern biochemical markers of acute mesenteric ischemia. Surgery. N.I. Pirogov Journal, 2024, № 1, pp. 58–63.

4. Koshelev E.G., Belyaev G.Yu., Egorov A.A. Computed tomographic diagnosis of acute and chronic mesenteric ischemia. Surgery. Journal named after N.I. Pirogov, 2023, № 12, pp. 67–82.

5. Timerbulatov Sh.V., Gafarova A.R. Acute violation of mesenteric circulation. Medical Bulletin of Bashkortostan, 2020, v. 15, № 2 (86).

6. Khripun A.I., Shurygin S.N., Mironkov A. B., Pryamikov A.D. Venous form of acute mesenteric circulatory disorder: diagnosis and treatment. Surgery, 2017, № 12, pp. 95–102, https://doi.org/10.17116/hirurgia20171295-102

7. Yaroshchuk S.A., Baranov A.I., Katasheva L.Yu., etc. Acute mesenteric ischemia: approaches to diagnosis and surgical treatment. Medicine in Kuzbass, 2018, Vol. 17, № 2, pp. 35–42.

8. Bala M., Kashuk J., Moore E.E., Kluger Y., Biffl W., Gomes C.A., BenIshay O., Rubinstein C., Balogh Z.J., Civil I., Coccolini F., Leppaniemi A., Peitzman A., Ansaloni L., Sugrue M., Sartelli M., Di Saverio S., Fraga G.P., Catena F. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World Journal Emergency Surgery, 2017, Vol. 38, № 12, рр. 1 – 11.

9. Bjorck M., Acosta S., Bastos Goncalves F., Kölbel T., Kolkman J.J., Lees T., Lefevre J.H., Menyhei G., Oderich G., ESVS Guidelines Committee, Kolh P., de Borst G.J., Chakfe 107 N., Debus S., Hinchliffe R., Kakkos S., Koncar I., Sanddal Lindholt J., Vega de Ceniga M., Vermassen F., Verzini F. Editor’s Choice - Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). European Journal of Vascular and Endovascular Surgery, 2017, Vol. 53, № 4, рр. 460–510.

10. Kärkkäinen J.M. Acute Mesenteric Ischemia: A Challenge for the Acute Care Surgeon. Scand J Surg., 2021, Jun; № 110(2), рр. 150–158. https://doi.org/10.1177/14574969211007590

11. Karkkainen J.M., Lehtimaki T.T., Manninen H., Paajanen H. Acute mesenteric ischemia is a more common cause than expected of acute abdomen in the elderly. J Gastrointest Surg., 2015, № 19(8), рр. 1407e14.

12. Liu K., Meng J., Yang S. et al. Transcatheter thrombolysis combined with damage control surgery for treatment of acute mesenteric venous thrombosis associated with bowel necrosis: a retrospective study. World J Emerg Surg., 2015, № 10, рр. 50. https://doi.org/10.1186/s13017015-0045-2

13. Singal A.K., Kamath P.S., Tefferi A. Mesenteric venous thrombosis. Mayo Clin Proc., 2013, № 88, рр. 85–294. https://doi.org/10.1016/j.mayocp.2013.01.012.

14. Sun D.L., Cen Y.Y., Li S.M., Li W. M., Lu Q. P., Xu P. Y. Accuracy of the serum intestinal fatty-acid-binding protein for diagnosis of acute intestinal ischemia: a meta-analysis. Sci. Rep, 2016, № 6, pp. 34–37. https://doi.org/10.1038/srep34371.

15. Treskes N., Persoon A. M., Zanten A. R. H. Diagnostic accuracy of novel serological biomarkers to detect acute mesenteric ischemia: a systematic review and meta-analysis. Intern Emerg Med, 2017, № 12, pp. 821–836.