{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T06:46:17Z","timestamp":1782283577347,"version":"3.54.5"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute mesenteric ischemia (AMI) is a time-dependent condition associated with high mortality, frequently related to diagnostic delay and progression to irreversible bowel necrosis. Computed tomography (CT) plays a pivotal role not only in diagnosis but also in guiding therapeutic decision-making. However, the prognostic role of individual CT findings and their relationship with irreversible ischemic injury remain incompletely defined. This study evaluated predefined CT findings, AMI subtype, treatment pathways, intraoperative infarction or necrosis, and mortality in a real-world cohort of patients with CT-confirmed AMI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective single-center cohort study was conducted including 102 adult patients with CT-confirmed AMI admitted between January 2018 and February 2026. Patients were classified by AMI subtype as arterial occlusive AMI, venous AMI, non-occlusive mesenteric ischemia (NOMI), or secondary\/mechanical ischemia. Eight predefined CT findings were analyzed: pneumatosis intestinalis, porto-mesenteric venous gas, bowel wall thickening, colitis\/ileitis, occlusion\/volvulus\/intussusception, free intraperitoneal air, free peritoneal fluid, and vascular suffering or bowel wall hypoenhancement. Radiological diagnostic certainty was analyzed separately as a synthetic imaging variable. The primary endpoint was intraoperative evidence of bowel infarction, necrosis, or irreversible ischemia among surgically explored patients. Secondary endpoints included clinically significant ischemia, bowel resection, invasive treatment, in-hospital mortality, and 30-day mortality. Univariate associations, diagnostic performance measures, ROC\/AUC analysis, and parsimonious multivariable logistic regression models for mortality were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Arterial occlusive AMI was the most frequent AMI subtype (59\/102, 57.8%), followed by NOMI (23\/102, 22.5%), secondary\/mechanical ischemia (15\/102, 14.7%), and venous AMI (5\/102, 4.9%). In-hospital mortality was 41.2% (42\/102), while 30-day mortality was 46.5% (47\/101), including five deaths after discharge. The primary endpoint was assessable in 65 patients; intraoperative infarction or necrosis was present in 53 (81.5%). No individual CT finding showed strong standalone discriminatory performance for intraoperative infarction or necrosis. Pneumatosis showed the strongest descriptive performance for the primary endpoint (OR: 2.72, 95% CI: 0.76\u20139.80;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.188; AUC 0.62). Pneumatosis showed an exploratory association with 30-day mortality (OR: 2.42, 95% CI: 1.08\u20135.43;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.045). In the multivariable model for 30-day mortality, acute kidney injury was independently associated with death (adjusted OR: 9.26, 95% CI: 2.40\u201335.74;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), while non-surgical admission showed a borderline association after adjustment (adjusted OR: 2.70, 95% CI: 0.94\u20137.71;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.065). The model AUC was 0.82.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this heterogeneous AMI cohort, individual CT findings were clinically meaningful but showed limited standalone discriminatory performance for surgically confirmed infarction or necrosis. Pneumatosis showed an exploratory association with 30-day mortality, while porto-mesenteric venous gas and free air were specific but infrequent. CT remains essential for diagnosis, subtype classification, and treatment planning, but CT findings should be interpreted within an integrated clinical and multidisciplinary framework. The exploratory CT ischemic burden score should be considered descriptive and not a validated triage or prognostic tool.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1824037","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:46:30Z","timestamp":1782279990000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Computed tomography findings and surgical outcomes in acute mesenteric ischemia: a retrospective single-center cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Andrea","family":"Cavallaro","sequence":"first","affiliation":[{"name":"General Surgery III, Department of General Surgery and Medical-Surgical Specialties, University of Catania","place":["Catania, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Zangh\u00ec","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Medical-Surgical Specialties, Chief ChiSMaCoTA Research Center, AOU Policlinico \u201cG. Rodolico \u2013 San Marco\u201d","place":["Catania, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Cappellani","sequence":"additional","affiliation":[{"name":"General Surgery III, Department of General Surgery and Medical-Surgical Specialties, University of Catania","place":["Catania, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Leonforte","sequence":"additional","affiliation":[{"name":"Department of Integrated Hygiene, Organizational, and Service Activities (Structural Department), Health Management, University Hospital Polyclinic \u201cG. Rodolico-San Marco\u201d","place":["Catania, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Mistretta","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, AOU Policlinico \u201cG. Rodolico \u2013 San Marco\u201d","place":["Catania, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariacristina","family":"Micalizzi","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Helios Klinikum M\u00fcnchen West","place":["Munich, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Di Mattia","sequence":"additional","affiliation":[{"name":"General Surgery, Umberto I Hospital, Department of Medicine and Surgery, Kore University","place":["Enna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Veroux","sequence":"additional","affiliation":[{"name":"General Surgery III, Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, AOU Policlinico \u201cG. Rodolico \u2013 San Marco\u201d","place":["Catania, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenya","family":"Tiralongo","sequence":"additional","affiliation":[{"name":"General Surgery III, Department of General Surgery and Medical-Surgical Specialties, University of Catania","place":["Catania, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s13017-022-00443-x","article-title":"Acute mesenteric ischemia: updated guidelines of the world society of emergency surgery","volume":"17","author":"Bala","year":"2022","journal-title":"World J Emerg Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"20230232","DOI":"10.1259\/bjr.20230232","article-title":"Insights into acute mesenteric ischaemia: an up-to-date, evidence-based review from a mesenteric stroke centre unit","volume":"96","author":"Garzelli","year":"2023","journal-title":"Br J Radiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1097\/01.sla.0000154269.52294.57","article-title":"Clinical implications for the management of acute thromboembolic occlusion of the superior mesenteric artery: autopsy findings in 213 patients","volume":"241","author":"Acosta","year":"2005","journal-title":"Ann Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/j.diii.2018.01.004","article-title":"Acute mesenteric ischemia: a critical role for the radiologist","volume":"99","author":"Copin","year":"2018","journal-title":"Diagn Interv Imaging"},{"key":"B5","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1148\/radiol.13122654","article-title":"Increased unenhanced bowel-wall attenuation at multidetector CT is highly specific of ischemia complicating small-bowel obstruction","volume":"270","author":"Geffroy","year":"2014","journal-title":"Radiology"},{"key":"B6","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1007\/s00330-016-4348-9","article-title":"Clinical significance of pneumatosis intestinalis\u2014correlation of MDCT-findings with treatment and outcome","volume":"27","author":"Treyaud","year":"2017","journal-title":"Eur Radiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2347","DOI":"10.1007\/s00330-004-2462-6","article-title":"Accuracy of multidetector row computed tomography for the diagnosis of acute bowel ischemia in a non-selected study population","volume":"14","author":"Wiesner","year":"2004","journal-title":"Eur Radiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1097\/00000658-200106000-00010","article-title":"Surgical management of thrombotic acute intestinal ischemia","volume":"233","author":"Endean","year":"2001","journal-title":"Ann Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1056\/NEJMra1503884","article-title":"Mesenteric ischemia","volume":"374","author":"Clair","year":"2016","journal-title":"N Engl J Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1054","DOI":"10.1001\/archinte.164.10.1054","article-title":"Acute mesenteric ischemia: a clinical review","volume":"164","author":"Oldenburg","year":"2004","journal-title":"Arch Intern Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1016\/s0039-6109(05)70548-x","article-title":"History of mesenteric ischemia. The evolution of a diagnosis and management","volume":"77","author":"Boley","year":"1997","journal-title":"Surg Clin North Am"},{"key":"B12","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1016\/j.ejvs.2017.01.010","article-title":"Editor\u2019s choice\u2014management of the diseases of mesenteric arteries and veins: clinical practice guidelines of the European society of vascular surgery (ESVS)","volume":"53","author":"Bj\u00f6rck","year":"2017","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1374","DOI":"10.1007\/s00268-009-0074-7","article-title":"Systematic review and pooled estimates for the diagnostic accuracy of serological markers for intestinal ischemia","volume":"33","author":"Evennett","year":"2009","journal-title":"World J Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1174","DOI":"10.1097\/SLA.0b013e3181d778c4","article-title":"Non-invasive markers for early diagnosis and determination of the severity of necrotizing enterocolitis","volume":"251","author":"Thuijls","year":"2010","journal-title":"Ann Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1111\/acem.12254","article-title":"The diagnosis of acute mesenteric ischemia: a systematic review and meta-analysis","volume":"20","author":"Cudnik","year":"2013","journal-title":"Acad Emerg Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1007\/s11739-024-03808-z","article-title":"Precision medicine in intestinal ischemia: the emerging role of biomarkers","volume":"20","author":"Olivero","year":"2025","journal-title":"Intern Emerg Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"2705","DOI":"10.3390\/diagnostics14232705","article-title":"Diagnostic performance of clinical and routine laboratory data in acute mesenteric arterial occlusion-an international multicenter study","volume":"14","author":"Soltanzadeh-Naderi","year":"2024","journal-title":"Diagnostics (Basel)"},{"key":"B18","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1148\/radiol.10091938","article-title":"Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis","volume":"256","author":"Menke","year":"2010","journal-title":"Radiology"},{"key":"B19","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1148\/radiol.2263011540","article-title":"CT Of acute bowel ischemia","volume":"226","author":"Wiesner","year":"2003","journal-title":"Radiology"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1604","DOI":"10.2214\/AJR.06.1309","article-title":"Pneumatosis intestinalis in the adult: benign to life-threatening causes","volume":"188","author":"Ho","year":"2007","journal-title":"AJR Am J Roentgenol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1319","DOI":"10.2214\/ajr.177.6.1771319","article-title":"Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome","volume":"177","author":"Wiesner","year":"2001","journal-title":"AJR Am J Roentgenol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e946207","DOI":"10.12659\/MSM.946207","article-title":"Computed tomography parameters for prognosis prediction in non-occlusive mesenteric ischemia","volume":"30","author":"Alan","year":"2024","journal-title":"Med Sci Monit"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1405","DOI":"10.1007\/s00330-024-11217-1","article-title":"Dual-energy CT of acute bowel ischemia-influence on diagnostic accuracy and reader confidence","volume":"35","author":"Oberparleiter","year":"2025","journal-title":"Eur Radiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1007\/s00261-008-9392-8","article-title":"Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography","volume":"34","author":"Aschoff","year":"2009","journal-title":"Abdom Imaging"},{"key":"B25","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1038\/ajg.2017.38","article-title":"Predictive factors of intestinal necrosis in acute mesenteric ischemia: prospective study from an intestinal stroke center","volume":"112","author":"Nuzzo","year":"2017","journal-title":"Am J Gastroenterol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1007\/s00423-023-03109-7","article-title":"Application of fluorescence-guided surgery in the acute care setting: a systematic literature review","volume":"408","author":"Fransvea","year":"2023","journal-title":"Langenbecks Arch Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1969","DOI":"10.1007\/s13304-024-01853-z","article-title":"Knowledge, attitudes and practices of using Indocyanine Green (ICG) fluorescence in emergency surgery: an international web-based survey in the ARtificial Intelligence in Emergency and trauma Surgery (ARIES)-WSES project","volume":"76","author":"De Simone","year":"2024","journal-title":"Updates Surg"},{"key":"B28","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s13017-025-00575-w","article-title":"Indocyanine green fluorescence-guided surgery in the emergency setting: the WSES international consensus position paper","volume":"20","author":"De Simone","year":"2025","journal-title":"World J Emerg Surg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1016\/j.revmed.2017.01.018","article-title":"L\u2019isch\u00e9mie m\u00e9sent\u00e9rique \u00e0 l\u2019\u00e8re des structures d\u2019urgences vasculaires intestinales [Management of mesenteric ischemia in the era of intestinal stroke centers: the gut and lifesaving strategy]","volume":"38","author":"Nuzzo","year":"2017","journal-title":"Rev Med Interne"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1824037\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T05:46:31Z","timestamp":1782279991000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1824037\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":29,"alternative-id":["10.3389\/fsurg.2026.1824037"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1824037","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]},"article-number":"1824037"}}