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[Acute mesenteric ischemia--frequently overlooked and often fatal]
12. Medizinische Abteilung, Abertinenkrankenhaus, Hamburg. guntram.lock@albertinen.de
Background:
Acute mesenteric ischemia still carries an appallingly high mortality rate. Subsets of acute mesenteric ischemia comprise mesenteric artery embolism and thrombosis, mesenterial vein thrombosis and non occlusive mesenteric ischemia.
Diagnosis:
Clinical presentation initially is often dominated by a discrepancy between severe subjective pain and relatively unspectacular findings on physical examination. The key to better survival rates (and the main problem in clinical practice) are early and, if indicated, invasive and aggressive diagnosis and treatment. Unfortunately, there are no non invasive diagnostic tests of sufficient sensitivity and specificity so far, and mesenterial angiography (or abdominal CT, if mesenterial venous thrombosis is suspected) remains the gold standard of diagnosis.
Treatment:
In the obstructive forms of arterial mesenteric ischemia, the main therapeutic step after stabilization of the circulation remains an early laparotomy with embolectomy or revascularization and, if appropriate, resection of infarcted bowel. In patients with nonocclusive mesenteric ischemia, counteraction of mesenteric vasoconstriction is the main therapeutic principle.
Objectives:
This review describes the different forms of acute mesenteric ischemia and gives an overview of the currently established and recommended forms of diagnosis and treatment.
Insights
Acute mesenteric ischemia has a high mortality rate. Early diagnosis and treatment, including angiography or CT scans, are crucial for improving survival in patients with this condition.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Emergency Medicine
Background:
- Acute mesenteric ischemia (AMI) presents a significant clinical challenge with a high mortality rate.
- Subtypes of AMI include mesenteric artery embolism/thrombosis, mesenteric vein thrombosis, and non-occlusive mesenteric ischemia.
Purpose of the Study:
- To review the various forms of acute mesenteric ischemia.
- To provide an overview of current diagnostic and therapeutic strategies for AMI.
Main Methods:
- Clinical presentation often shows a disparity between severe pain and physical findings.
- Diagnosis relies on invasive methods like mesenteric angiography or abdominal CT scans due to lack of sensitive non-invasive tests.
Main Results:
- Early and aggressive diagnosis and treatment are key to improving survival rates in AMI.
- Treatment for obstructive arterial AMI involves laparotomy, embolectomy/revascularization, and bowel resection if necessary.
- For non-occlusive mesenteric ischemia, the primary treatment is to counteract mesenteric vasoconstriction.
Conclusions:
- Timely diagnosis and intervention are critical for managing acute mesenteric ischemia.
- Established diagnostic and treatment protocols exist for different forms of AMI, aiming to reduce mortality.