Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery
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REVIEW
Open Access
Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery Miklosh Bala1*, Jeffry Kashuk2, Ernest E. Moore3, Yoram Kluger4, Walter Biffl5, Carlos Augusto Gomes6, Offir Ben-Ishay4, Chen Rubinstein7, Zsolt J. Balogh8, Ian Civil9, Federico Coccolini10, Ari Leppaniemi11, Andrew Peitzman12, Luca Ansaloni10, Michael Sugrue13, Massimo Sartelli14, Salomone Di Saverio15, Gustavo P. Fraga16 and Fausto Catena17
Abstract Acute mesenteric ischemia (AMI) is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process will eventuate in life threatening intestinal necrosis. The incidence is low, estimated at 0.09–0.2% of all acute surgical admissions. Therefore, although the entity is an uncommon cause of abdominal pain, diligence is always required because if untreated, mortality has consistently been reported in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment and are essential to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques may provide new options. Thus, we believe that a current position paper from World Society of Emergency Surgery (WSES) is warranted, in order to put forth the most recent and practical recommendations for diagnosis and treatment of AMI. This review will address the concepts of AMI with the aim of focusing on specific areas where early diagnosis and management hold the strongest potential for improving outcomes in this disease process. Some of the key points include the prompt use of CT angiography to establish the diagnosis, evaluation of the potential for revascularization to re-establish blood flow to ischemic bowel, resection of necrotic intestine, and use of damage control techniques when appropriate to allow for re-assessment of bowel viability prior to definitive anastomosis and abdominal closure. Keywords: Mesenteric ischemia, Mesenteric arterial occlusion, Mesenteric angiography, Mesenteric artery stenting, Small bowel ischemia, Guidelines, Recommendations
Background Acute mesenteric ischemia (AMI) may be defined as a sudden interruption of the blood supply to a segment of the small intestine, leading to ischemia, cellular damage, intestinal necrosis, and eventually patient death if untreated [1]. AMI may be non-occlusive (NOMI) or occlusive, with the primary etiology further defined as mesenteric arterial embolism (50%), mesenteric arterial thrombosis (15–25%), or mesenteric venous thrombosis (5–15%) [2, 3]. The overall incidence is low (0.09 to 0.2% of all acute admissions to emergency departments), * Correspondence: [email protected] 1 Acute Care Surgery and Trauma Unit, General Surgery Department, Hadassah - Hebrew University Medical Center, Kiriat Hadassah, POB 12000, 91120 Jerusalem, Israel Full list of author information is available at the
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