Mesenteric ischemia

Abstract

Acute mesenteric ischemia represents one to two percent of all gastrointestinal illnesses. There are three possible causes of acute arterial mesenteric ischemia: embolism, thrombosis, and nonocclusive mesenteric insufficiency. The key to early diagnosis is a high index of suspicion. The classic clinical picture of obvious cardiac disease, sudden onset of severe abdominal pain and gastrointestinal emptying, is not always present. Serum markers and plain films are often nondiagnostic but may suggest acute arterial mesenteric ischemia. Angiography establishes the diagnosis and allows for planning of aortomesenteric bypass, if indicated. Papaverine is immediately instilled to decrease splanchnic vasoconstriction. Embolic and thrombotic disease is treated by laparotomy with re-establishment of visceral perfusion. Only after blood flow is restored is nonviable bowel resected. Clinical methods of assessing intestinal viability include Doppler scanning, intravascular dyes, and tissue oximetry. The decision to perform a second-look laparotomy is made prior to closure of the abdomen. Pharmacologic treatment is the mainstay of nonocclusive ischemia. Surgery is reserved for clinical deterioration. Survival is dependent on the cause and extent of occlusion as well as the rapidity of diagnosis and therapy. Bowel necrosis results in mortality rates between 80 percent and 95 percent.

Mesenteric artery thrombosis: A case report of combined protein S and protein C deficiency

“…Acute mesenteric ischemia is typically the result of thrombosis, embolism, or nonocclusive ischemia [3]. Mesenteric artery thrombosis is an unusual presentation for a young female.…”

Intraoperative Laser Doppler Flowmetry: A Predictor of Ischemic Injury in Acute Mesenteric Infarction

“…The difficulty in establishing an early diagnosis in acute mesenteric ischemia is probably the most important cause of the high mortality, which varies from 60 to 80% [1, 2, 3, 4], and an additional delay in the decision for explorative laparotomy further increases the impairment of splanchnic perfusion. Unfortunately, most cases of acute intestinal ischemia are only diagnosed intraoperative, at a time when full mesenteric infarction has already been established.…”

“…The overall mortality is reported to be as high as 80% [1, 2, 3, 4], and one factor limiting the successful management of such patients is the difficulty in accurately predicting intestinal recovery from ischemic injury following surgical treatment of the underlying disease. Only immediate recognition and aggressive management can prevent the often fatal outcome.…”

Can heat shock protein 32 be used for the early diagnosis of acute mesenteric ischemia?

“…The disease is usually observed in the elderly and has mortality rates as high as 56-93% (1). The main reason for this high mortality is late diagnosis (2). Therefore, diagnosis of this condition at earlier stages is very important.…”