[Operative treatment of acute mesenteric ischaemia]

The incidence of acute mesenteric ischemia (AMI) appears to be increasing due to aging in the population with increasing prevalence of comorbidities. Despite the wide-scale availability of diagnostic technologies, the timely detection and correct treatment are not ensured. This is due to the fact that the required CT angiography is not immediately performed and that vascular surgical reconstruction can be performed within the short ischemic tolerance window of the bowels amounting 4-6 hours.

In our case report, we retrospectively analysed the time of the operation after the onset of the complaint, the types of occlusions, the surgical interventions that could be performed and the progress of the disease.

Case 1: In the case of superior mesenteric artery (SMA) emboli, without bowel necrosis and ischemia, embolectomy is the treatment. Case 2: In the case of complete superior mesenteric artery occlusion, proper bowel circulation will not restore despite the delayed arterial reconstruction, as a result, the patient will not survive. Case 3: In the case of incomplete SMA occlusion, even if the diagnosis is confirmed several days after the onset of complaints and the patient has an acute abdomen, extensive bowel necrosis will not evolve in every case. Case 4: Acute complete occlusion on chronic mesenteric ischemia. The bowels were found macroscopically healthy during the operation. We performed vascular reconstruction.

Acute mesenteric ischemia is a rare disease, which is recognised and treated mostly late. A proportion of patients can be saved, if vascular reconstruction and bowel resection can be performed at the same time at the first operation.