Mesenteric ischaemia: A multidisciplinary approach

Abstract

Mesenteric ischaemia may result from a wide range of pathological processes, each possessing unique clinical features, diagnostic difficulties, management strategies and outcome. Regardless of aetiology, prognosis depends crucially on rapid diagnosis and institution of treatment to prevent, or at least to minimize, bowel infarction. Progress in understanding the pathophysiology of mesenteric ischaemia has led to novel methods of treatment, so that in some circumstances therapy may be purely medical. More often surgery is required and is frequently life saving. Percutaneous transcatheter techniques are increasingly employed in both diagnosis and treatment. Close cooperation between radiologists, physicians and surgeons is therefore necessary if clinical outcome is to be optimized. This paper reviews the modern interdisciplinary management of mesenteric ischaemia in the light of recent advances.

Diagnostic utility of the neutrophil-to-lymphocyte ratio in patients with acute mesenteric ischemia: A retrospective cohort study

“…[14,15] Any diagnosis that begins with a suspicion raised by clinical findings should be confirmed by laboratory and imaging methods. Clinical presentation of AMI is highly varied.…”

Spontaneous Intramural Intestinal Hemorrhage versus Acute Mesenteric Ischemia by CT Evaluation

“…Unfortunately, abdominal CT occasionally does not help EPs differentiate SIIH from AMI due to similar CT findings (4)(5)(6). It is critical for EPs to make the right decision because the optimal treatments are quite different, conservative medical treatment for SIIH (1,7,8) and emergent surgical intervention for AMI (9)(10)(11). In our study, 20% (6/30) of the SIIH patients were transferred to our hospital under the impression of AMI and for emergent surgical intervention.…”

“…However, abdominal CT occasionally is not useful to help EPs differentiate SIIH from acute mesenteric ischemia (AMI) due to similar findings, such as homogenous bowel wall thickening or the presence of a target sign on intravenous contrast-enhanced studies (4)(5)(6). Ap- (1,3,7,8) and emergent surgical intervention for AMI (9)(10)(11). The purpose of our study was to discern the differences in abdominal CT findings and help EPs to differentiate SIIH from AMI.…”

Mesenteric Vascular Disease

“…Symptomatic patients are frequently found to have extensive atherosclerosis, with involvement of all three visceral arteries. However, NOMI can also occur in patients without mesenteric arterial occlusive disease (6,7,8). Visceral ischemia can occur due to low-flow states, especially in conjunction with intestinal atherosclerotic disease.…”