Diagnosis and Management of Acute Mesenteric Ischemia Is Reviewed

Tolonen M, Vikatmaa P. Diagnosis and Management of Acute Mesenteric Ischemia: What You Need to Know. J Trauma Acute Care Surg. 2025; in press.

This article reviewed current approaches for the management of arterial-occlusive acute mesenteric ischemia (Ao-AMI). Features of non-occlusive mesenteric ischemia and venous-occlusive mesenteric ischemia were also reviewed.

Overall mortality for acute mesenteric ischemia remains high at 50% to 80%. Early diagnosis is critical to successful treatment; because of this fact, a high index of suspicion is necessary. Patients are usually elderly and present with abdominal pain, nausea, vomiting, and/or hematochezia. Abdominal pain with a soft abdomen on palpation (pain out of proportion to physical examination findings) is a frequent finding.

Embolic ischemia should be suspected in patients with cardiac arrythmia. Imaging with CT angiography is the preferred method for confirming the diagnosis.

If possible, patients should be managed in facilities with hybrid operating rooms and surgeons with expertise in endovascular and open vascular surgical techniques. Intestinal resection will be necessary for patients with bowel necrosis; intestinal transplantation may be indicated for selected patients.

The article supplied clear algorithms for management of the common forms of mesenteric ischemia. Surgeons are encouraged to review the full content of the article.