Acute mesenteric ischemia--frequently overlooked and often fatal

Background: Acute mesenteric ischemia still carries an appallingly high mortality rate. Subsets of acute mesenteric ischemia comprise mesenteric artery embolism and thrombosis, mesenterial vein thrombosis and non occlusive mesenteric ischemia. Methods: Clinical presentation initially is often dominated by a discrepancy between severe subjective pain and relatively unspectacular findings on physical examination. The key to better survival rates (and the main problem in clinical practice) are early and, if indicated, invasive and aggressive diagnosis and treatment. Unfortunately, there are no non invasive diagnostic tests of sufficient sensitivity and specificity so far, and mesenterial angiography (or abdominal CT, if mesenterial venous thrombosis is suspected) remains the gold standard of diagnosis. Methods: In the obstructive forms of arterial mesenteric ischemia, the main therapeutic step after stabilization of the circulation remains an early laparotomy with embolectomy or revascularization and, if appropriate, resection of infarcted bowel. In patients with nonocclusive mesenteric ischemia, counteraction of mesenteric vasoconstriction is the main therapeutic principle.

Objective: This review describes the different forms of acute mesenteric ischemia and gives an overview of the currently established and recommended forms of diagnosis and treatment.