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Acute mesenteric ischemia (part I) - Incidence, etiologies, and how to improve early diagnosis
Jussi M Kärkkäinen1, Stefan Acosta2
1Heart Center, Kuopio University Hospital, P.O. Box 100, 70029 Kuopio, Finland.
Abstract:
Acute mesenteric ischemia (AMI) is generally thought to be a rare disease, but in fact, it is more common cause of acute abdomen than appendicitis or ruptured abdominal aortic aneurysm in patients over 75 years of age. In occlusive AMI, surgical treatment without revascularization is associated with as high as 80% overall mortality. It has been shown that early diagnosis with contrast-enhanced computed tomography and revascularization can reduce the overall mortality in AMI by up to 50%. However, only a minority of patients with AMI are being treated actively with revascularization in the United States, and the situation is very likely similar in Europe as well. What can we do to improve diagnostic performance, so that more patients get proper treatment? The diagnosis is a collaborative effort of emergency department surgeons, gastrointestinal and vascular surgeons, and radiologists. The etiological categorization of AMI should be practical and guide the therapy. Furthermore, the limitations of the diagnostic examinations need to be understood with special emphasis on computed tomography findings on patients with slowly progressing "acute-on-chronic" mesenteric ischemia.
Insights
Acute mesenteric ischemia (AMI), a common cause of acute abdomen in older adults, has high mortality without timely intervention. Early diagnosis via CT scans and revascularization can significantly reduce deaths, yet treatment remains underutilized.
Area of Science:
- Vascular Surgery
- Radiology
- Gastroenterology
Background:
- Acute mesenteric ischemia (AMI) is an underrecognized cause of acute abdomen in patients over 75.
- Occlusive AMI without revascularization carries an 80% mortality rate.
- Current treatment rates with revascularization are suboptimal in the US and Europe.
Purpose of the Study:
- To highlight the importance of early diagnosis and revascularization in improving outcomes for acute mesenteric ischemia.
- To discuss strategies for enhancing diagnostic performance in AMI.
- To emphasize the collaborative role of multiple surgical and radiological specialties in AMI management.
Main Methods:
- Review of existing literature on acute mesenteric ischemia diagnosis and treatment.
- Emphasis on contrast-enhanced computed tomography (CECT) for early diagnosis.
- Discussion of etiological categorization to guide therapy.
Main Results:
- Early diagnosis with CECT and prompt revascularization can decrease AMI mortality by up to 50%.
- A minority of AMI patients receive active revascularization, indicating a gap in care.
- Understanding diagnostic limitations, especially CECT in acute-on-chronic mesenteric ischemia, is crucial.
Conclusions:
- Improving diagnostic accuracy is essential to increase the rate of life-saving revascularization for AMI.
- A multidisciplinary approach involving emergency, gastrointestinal, vascular surgeons, and radiologists is key.
- Further research and clinical practice improvements are needed to optimize AMI management and reduce mortality.