Acute mesenteric ischemia: diagnostic and therapeutic strategy

Abstract

Acute mesenteric ischemia is defined by the association of acute mesenteric vascular insufficiency and a bowel ischemia. Mesenteric insufficiency can be occlusive (arterial or venous obstruction) or non-occlusive (low flow, hypotension, hypoxemia). Bowel ischemia can be defined as early or late. The mortality associated with AMI is very high, ranging from 65% to 80%. The diagnostic strategy is based upon a high index of suspicion of the disease. The cornerstone of the diagnosis is urgent abdominal computed tomography with contrast enhancement injection. Abdominal CT identifies the mechanism of mesenteric insufficiency, and signs of bowel ischemia. The results of abdominal CT directly determines the therapeutic strategy. The treatment of AMI is based upon a triad: urgent revascularisation, resection of the necrotic bowel, and association of medical treatment aiming at stabilizing the patient and not impairing the remaining gut. Multidisciplinary care in high experience centers for early occlusive arterial AMI is necessary.