Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery

Abstract

Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process may progress to life-threatening intestinal necrosis. The incidence is low, estimated at 0.09–0.2% of all acute surgical admissions, but increases with age. Although the entity is an uncommon cause of abdominal pain, diligence is required because if untreated, mortality remains in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques is evolving and provides new treatment options. Lastly, a focused multidisciplinary approach based on early diagnosis and individualized treatment is essential. Thus, we believe that updated guidelines from World Society of Emergency Surgery are warranted, in order to provide the most recent and practical recommendations for diagnosis and treatment of AMI.

Superior mesenteric artery embolism after radiofrequency ablation in regularly anticoagulated patients with paroxysmal atrial fibrillation: a case report

“…Intestinal necrosis is often suggested if paracentesis draws nonclotting fluid. If diagnosis is difficult, early exploratory laparotomy or laparoscopy is not only a reliable diagnostic method but also a treatment method [ 14 ].…”

“…Blind observation or conservative treatment will cause the best time for treatment to be missed. Treatments for SMAE include general treatment, surgery or endovascular therapy [ 14 ]. In terms of drug therapy, anticoagulants, fluid replenishment increasing visceral perfusion, drugs relieving mesenteric vasospasm and broad-spectrum antibiotics should be immediately administered if drug contraindications are excluded [ 14 ].…”

“…Treatments for SMAE include general treatment, surgery or endovascular therapy [ 14 ]. In terms of drug therapy, anticoagulants, fluid replenishment increasing visceral perfusion, drugs relieving mesenteric vasospasm and broad-spectrum antibiotics should be immediately administered if drug contraindications are excluded [ 14 ]. Because of the extremely high mortality rate, drug therapy alone is not recommended, and early surgery or endovascular therapy is recommended [ 15 ].…”

A Gut-Wrenching Feeling: Overcoming Cognitive Biases in an Atypical Presentation of Chronic Mesenteric Ischemia

“…However, once the pathology results came back negative, we were left with no other known modalities of endoscopic evaluation of diarrheal diseases [ 6 , 11 ]. We then opted to repeat a CT scan with intravenous contrast revealing atherosclerotic disease burden [ 12 , 13 ] and this allowed us to discover that the patient was suffering from CMI.…”

Utility of Serum L-lactate in Identifying Ischemia in Acute Intestinal Obstruction: A Prospective Observational Study

“…During conditions of ischemic hypoxia, such as bowel ischemia, oxygen-deprived cells will adopt anaerobic glycolysis, and the level of serum lactate will rise [ 8 , 11 ]. Studies have suggested its potential as a biomarker of intestinal ischemia [ 12 , 13 ], and the World Society of Emergency Surgery (WSES) guidelines for the management of acute mesenteric ischemia state that while no laboratory parameters are sufficiently accurate to conclusively identify ischemic bowel, elevated L-lactate may assist [ 14 ]. This study aimed to evaluate the utility of serum L-lactate as a predictor of bowel ischemia in patients with intestinal obstruction.…”