Mesenteric ischaemia

Abstract The mortality of acute mesenteric ischaemia has remained high for decades despite improvements in diagnostic, interventional, and surgical techniques. The time to diagnosis of acute mesenteric ischaemia is the most important modifiable predictor of the outcome of the patient. Hence, focus on the specific history and recognition of predisposing factors set the course for time-saving and efficient diagnosis. The initial clinical stage of acute mesenteric ischaemia is characterized by the sudden onset of severe abdominal pain followed by a painless interval. The symptoms of non-occlusive mesenteric ischaemia and intestinal venous thrombosis are different and less specific than those of acute arterial occlusive ischaemia. Biphasic contrast-enhanced computed tomography is the diagnostic tool of choice for diagnosis of arterial and venous occlusion. A central occlusion of the superior mesenteric artery or signs of peritonitis require immediate surgery. However, endovascular techniques for arterial occlusion have taken on a greater importance today. In case of a peripheral embolism in patients with no signs of peritonitis, interventional pharmacotherapy with local fibrinolytic agents should be conducted. The accompanying intensive care management includes volume replacement, systemic anticoagulation, and antibiotic therapy, as well as close patient monitoring to exclude secondary organ failure.