From the Guidelines
A visceral crisis is a severe, life-threatening complication characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes, as defined by the World Society of Emergency Surgery 1.
Definition and Causes
A visceral crisis, also known as acute mesenteric ischemia (AMI), is a group of diseases that result from an interruption of the blood supply to the intestine, leading to ischemia and secondary inflammatory changes. This condition can progress to life-threatening intestinal necrosis if left untreated. The incidence of AMI is estimated to be around 0.09–0.2% of all acute surgical admissions, with a mortality rate of around 50% if untreated 1.
Symptoms and Diagnosis
Symptoms of a visceral crisis may include severe abdominal pain, nausea, vomiting, and bloody stools. Early diagnosis and timely surgical intervention are crucial to reduce the high mortality associated with this condition. The use of CT angiography is recommended to establish the diagnosis, and evaluation of the potential for revascularization to re-establish blood flow to ischemic bowel is essential 1.
Treatment and Management
Treatment of a visceral crisis typically involves prompt surgical intervention, including resection of necrotic intestine and use of damage control techniques when appropriate. The use of endovascular approaches in parallel with modern imaging techniques may provide new options for treatment. Fluid resuscitation, electrolyte correction, and nasogastric decompression are also essential components of management 1.
Prognosis and Outcome
Patients experiencing a visceral crisis generally have a poor prognosis, with treatment focused on stabilizing organ function while attempting to control the underlying disease process. Early diagnosis and timely intervention are critical to improving outcomes in this condition. The concept of a visceral crisis is important in emergency surgery because it often represents a turning point in disease management, where prompt intervention can significantly impact patient outcomes 1.
Key points to consider in the management of a visceral crisis include:
- Prompt use of CT angiography to establish the diagnosis
- Evaluation of the potential for revascularization to re-establish blood flow to ischemic bowel
- Resection of necrotic intestine
- Use of damage control techniques when appropriate
- Fluid resuscitation, electrolyte correction, and nasogastric decompression as essential components of management 1.
From the Research
Definition of Visceral Crisis
- A visceral crisis is not explicitly defined in the provided studies, but based on the context, it can be inferred that it refers to a severe and intense episode of abdominal pain or a life-threatening intra-abdominal pathology 2.
- The term "visceral crisis" is not directly mentioned in the studies, but the concept of acute abdominal pain and vaso-occlusive crisis in sickle cell disease is discussed in several studies 3, 4, 5, 6.
Related Concepts
- Acute abdominal pain is a common symptom that can have various underlying causes, including surgical and non-surgical conditions 3.
- Vaso-occlusive crisis in sickle cell disease is a condition characterized by severe pain episodes, which can be managed with multimodal analgesia and other treatments 4, 5, 6.
- The management of acute abdominal pain and vaso-occlusive crisis requires a rapid and accurate diagnosis, as well as timely referral to the appropriate specialist 3, 2.
Diagnostic Approach
- A clinical algorithm can be used to approach acute abdominal pain and identify patients who require emergency surgery 3.
- The diagnosis of vaso-occlusive crisis in sickle cell disease is based on patient-reported pain and other clinical indicators, and treatment should be tailored to the individual patient's needs 4, 5, 6.
- Simple laboratory and radiologic testing can be used to supplement the physical examination and history-taking in patients with acute abdominal pain 2.