Acute mesenteric ischemia: diagnostic and therapeutic challenges

Excerpt

Acute mesenteric ischemia is diagnostically and therapeutically the most challenging abdominal surgical emergency. It may occur as a result of acute thrombosis or embolism of either the superior mesenteric artery or vein or from nonocclusive ischemia, usually secondary to severe hypotension and high doses of vasopressors. The clinical presentation during the early stages of the disease is usually nonspecific, the appropriate radiological investigation is often delayed because of low index of suspicion and the early CT scan findings are often not diagnostic, especially in no occlusive mesenteric ischemia, which is the most common type of ischemia encountered in critically ill patients in the intensive care unit. CT angiography is reliable in the diagnosis of acute mesenteric ischemia due to occlusion of the superior mesenteric vessels. However, its role in nonocclusive mesenteric ischemia is usually limited, especially during the early stage of the disease, where CT angiography usually shows little or nondiagnostic findings of mesenteric ischemia. …