Review article: diagnosis and management of mesenteric ischaemia with an emphasis on pharmacotherapy

Area of Science:

• Gastroenterology
• Vascular Surgery
• Emergency Medicine

Background:

• Mesenteric ischaemia involves decreased blood flow to the bowel, leading to cellular injury due to oxygen and nutrient deprivation.
• Acute mesenteric ischaemia (AMI) is rare but has high morbidity and mortality; early detection and treatment are crucial for better outcomes.
• Risk factors vary, with superior mesenteric artery embolism being common in older adults with cardiovascular disease, while acute mesenteric venous thrombosis affects younger individuals with hypercoagulable states.

Purpose of the Study:

• To summarize the current understanding of acute mesenteric ischaemia (AMI), including its causes, diagnosis, and management.
• To highlight the importance of prompt recognition and aggressive treatment in improving outcomes for AMI patients.
• To differentiate between acute and chronic mesenteric ischaemia (CMI) and their respective treatment strategies.

Main Methods:

• Review of existing literature on mesenteric ischaemia, focusing on diagnostic modalities and treatment approaches.
• Identification of subgroups of AMI, common risk factors, and typical clinical presentations.
• Discussion of diagnostic tools such as conventional angiography and computed tomography angiography.
• Overview of standard treatments including correction of predisposing conditions, resuscitation, antibiotics, and surgery.
• Exploration of adjunctive therapies like intra-arterial vasodilators and thrombolytics, as well as management of reperfusion injury.
• Description of chronic mesenteric ischaemia (CMI) presentation and treatment options (surgical revascularization or angioplasty/stenting).

Main Results:

• AMI presents with sudden abdominal pain, potentially with a misleadingly benign abdominal exam initially.
• Computed tomography angiography is a key diagnostic tool, alongside conventional angiography.
• Standard treatments involve addressing underlying causes, fluid resuscitation, antibiotics, and surgery if peritoneal signs are present.
• Vasodilators and thrombolytics are used in specific occlusive and non-occlusive AMI scenarios.
• CMI is typically caused by atherosclerotic disease and presents with post-prandial pain and weight loss.

Conclusions:

• Prompt diagnosis and aggressive management, including timely surgical intervention when necessary, significantly improve outcomes in acute mesenteric ischaemia.
• Understanding the diverse etiologies and risk factors is essential for effective treatment of both acute and chronic mesenteric ischaemia.
• Advanced imaging and therapeutic strategies play vital roles in managing this critical condition.