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Updated: Jul 4, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Mesenteric ischemia--outcome after surgical therapy in 83 patients
M H Dahlke1, L Asshoff, F C Popp
1Department of Surgery, University of Regensburg, Regensburg, Germany. marc.dahlke@klinik.uni-regensburg.de
Background:
Intestinal ischemia is the prime vascular emergency for the visceral surgeon. However, the diagnosis of mesenteric ischemia is difficult, the surgical options are often limited and the overall outcome is generally poor.
Methods:
We report on a single center series of 83 patients undergoing surgery for mesenteric ischemia during a 3-year period. Risk factors, clinical presentation, type and timing of imaging studies and their implications for surgical therapy and outcome are analyzed.
Results:
Hypertension and diabetes were the most common risk factors (68/64% of all patients). Abdominal pain was the most general symptom upon presentation to the surgical unit (73%). Two-phase, contrast-enhanced computed tomography was applied as the standard preoperative imaging modality (correct diagnosis in 69%). Bowel resections were necessary in most patients; approaches to restore blood flow by vascular surgery interventions were applied in 17 patients (20%). The overall morbidity and mortality rate in our study cohort was expectedly high (59% 1 month mortality).
Conclusion:
The diagnosis and surgical treatment of mesenteric ischemia remains a major difficulty. We recommend preoperative CT analysis followed by an aggressive indication for early surgical exploration and bowel resection. An attempt of revascularization is justified for selected patients with limited macrovascular disease.
Insights
Mesenteric ischemia diagnosis and treatment remain challenging for surgeons. Early surgical exploration and bowel resection, guided by preoperative CT scans, are recommended, with revascularization for select patients.
Area of Science:
- Vascular Surgery
- Abdominal Surgery
- Gastroenterology
Background:
- Mesenteric ischemia presents a significant vascular emergency in visceral surgery.
- Diagnosis is often difficult, surgical options are limited, and patient outcomes are generally poor.
Purpose of the Study:
- To analyze risk factors, clinical presentation, and imaging modalities in patients undergoing surgery for mesenteric ischemia.
- To evaluate the impact of diagnostic and therapeutic strategies on surgical outcomes.
Main Methods:
- A single-center series of 83 patients undergoing surgery for mesenteric ischemia over a 3-year period.
- Analysis of risk factors, clinical symptoms, imaging studies (primarily contrast-enhanced CT), surgical interventions, and patient outcomes.
Main Results:
- Hypertension and diabetes were the most prevalent risk factors.
- Abdominal pain was the most common presenting symptom.
- Contrast-enhanced CT correctly diagnosed mesenteric ischemia in 69% of cases, with bowel resection required in most patients; 20% underwent vascular surgery interventions.
Conclusions:
- Diagnosing and surgically treating mesenteric ischemia remain challenging.
- Preoperative CT analysis and early surgical exploration with bowel resection are recommended.
- Revascularization is advised for carefully selected patients with limited macrovascular disease.
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