Intestinal ischemia--surgeon's view

In mesenteric ischemia, we are still facing the problem of late diagnosis: Only early start of therapy within the first 12 hours of symptom onset can reduce mortality rates below 50 percent. Most effective diagnostic tests are catheter-angiography with the option of therapeutic intervention and multi-slice computed tomography. As for treatment strategy reasons, acute arterial thrombosis and embolic ischemia should be regared separately from venous, non-occlusive (NOMI) and chronic mesenteric ischemia. Acute arterial ischemia is treated by immediate open exploration, revascularization and bowel resection. Venous ischemia is treated best by catheter anticoagulation, while in NOMI restoration of altered hemodynamics and selective vasodilatation is the therapy of choice. Late complications in mesenteric ischemia are malabsorption, bypass graft thrombosis and the small-bowel-syndrom, that can be solved in selected cases by small bowel transplantation.