Routine colonoscopy in patients with high risk of non-occlusive mesenteric ischemia

Abstract

We thank Acosta et al. [1] for their critical comment on our retrospective study [2] and important clarifications regarding the nomenclature of acute mesenteric ischemia (AMI). Most importantly, the authors point out the difference between intensive care unit (ICU) patients and non-ICU inpatients or outpatients with AMI. In our cohort, over 80% of the patients have been treated in the ICU when AMI was suspected, and more than 50% were supported with vasopressors [2, 3]. Clinical signs and symptoms for AMI such as abdominal pain are unspecific and occur late in many patients [4]. Critically ill patients in the ICU frequently receive analgesics, or they are even comatose, seriously complicating clinical assessment. Due to hemodynamic instability or even cardiocirculatory arrest resulting in intestinal hypoperfusion, these patients are particularly susceptible to non-occlusive mesenteric ischemia (NOMI). Diagnostic difficulties mean that NOMI is often overlooked and only diagnosed post-mortem by autopsy [5].The small intestine is mainly affected in patients with acute occlusion of the superior mesenteric artery (SMA). In these cases, AMI can be reliably diagnosed by clinical assessment and computed tomography angiography (CTA) in many cases. In contrast, NOMI often affects the right hemicolon [5]. Therefore, we recommend developing screening protocols for colonoscopy in critically ill patients in the ICU with a high risk of NOMI for timely detection of colon ischemia. We argue that patients