Materiały źródłowe

• #1 Intestinal ischemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-ischemia/diagnosis-treatment/drc-20373950

  Treatment of intestinal ischemia involves restoring the blood supply to the digestive tract. Choices vary depending on the cause of the condition and how bad it is. […] For severe colon damage, you may need surgery to remove the dead tissue. You also may need surgery to bypass a blockage in one of your intestinal arteries. If you have angiography to diagnose the condition, it may be possible to widen a narrowed artery during the procedure. […] Angioplasty uses a balloon inflated at the end of a catheter to press in the fatty deposits. The balloon also stretches the artery, making a wider path for the blood to flow. […] Your healthcare professional may put a springlike metallic tube, called a stent, into your artery to help keep it open. Your health professional also can remove a blood clot or dissolve it with medicine.

• #2 Bowel Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554527/

  Regardless of the etiology of intestinal ischemia, in patients suspected of intestinal infarction or perforation based on clinical, radiographic, or laboratory tests, exploratory laparotomy should not be delayed. […] Resection of the infarcted intestine is strongly indicated. […] The treatment of NOMI or colonic ischemia focuses on removing insulting factors (vasoconstrictive medications), hemodynamic support and monitoring, treating the underlying cause (sepsis, heart failure), and the administration of intra-arterial vasodilation medications. […] Severe ischemia requires prompt surgical referral and intensive care unit monitoring.

• #3 Small Bowel Ischemia – American College of Gastroenterology

  https://gi.org/topics/small-bowel-ischemia/

  Small bowel ischemia requires prompt medical care to avoid damage to intestinal tissue that can lead to death. […] The goals of treatment are to restore blood supply to the intestines and maintain proper function in the digestive tract. Treatment options for intestinal ischemia vary depending on the cause of the condition and the severity of damage in the intestines. […] If you have small bowel ischemia but no damage to intestinal tissue, medications may be enough to manage the condition. Your doctor may recommend one or more medications, such as clot-busting medications to break up blood clots, blood thinners (anticoagulant medications) to prevent blood clots, and antibiotics to treat or prevent infections. […] Angioplasty is a minimally invasive catheter procedure that doctors use to open narrowed blood vessels. […] Depending on your specific case, surgery might be the best treatment option. Typical surgical procedures include laparoscopy and laparotomy.

• #4 Bowel Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554527/

  Bowel ischemia can classify as small intestine ischemia, which is commonly known as mesenteric ischemia and large intestine ischemia, which generally referred to as colonic ischemia. […] This activity describes the etiology, evaluation, and management of bowel ischemia and highlights the role of the interprofessional team in improving care for patients with this condition. […] Summarize the treatment options of bowel ischemia. […] Based on acute mesenteric ischemia (AMI) subtypes, different medication treatments have been suggested. Papaverine, through the angiographic catheter with the mechanism of relaxation of vessels vasospasm, can be used for all arterial forms of AMI and nonocclusive mesenteric ischemia. […] Initial treatments include maintenance of adequate oxygen saturation, hemodynamic stability, and correction of electrolyte abnormalities.

• #5 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Accordingly, the present paper aims to provide an update with recommendations based on the most currently accepted concepts in the management of AMI. […] When the diagnosis of AMI is made, fluid resuscitation should commence immediately to enhance visceral perfusion. Electrolyte abnormalities should be corrected, and nasogastric decompression initiated. […] Broad-spectrum antibiotics should be immediately administered. […] Prompt laparoscopy/laparotomy should be done for patients with an overt peritonitis. […] The goal of surgical intervention for AMI includes: 1) Re-establishment of the blood supply to the ischemic bowel. 2) Resection of all non-viable regions. 3) Preservation of all viable bowel. […] Revascularization when relevant has an essential role in the multidisciplinary approach to AMI.

• #6 Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0150-5

  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. […] Early diagnosis and timely surgical intervention are the cornerstones of modern treatment and are essential to reduce the high mortality associated with this entity. […] 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. […] When the diagnosis of AMI is made, fluid resuscitation should commence immediately to enhance visceral perfusion. Electrolyte abnormalities should be corrected, and nasogastric decompression initiated.

• #7 Acute Mesenteric Ischemia in the ED: Diagnosis and Treatment

  https://www.ebmedicine.net/topics/abdominal/emergency-medicine-mesenteric-ischemia

  Acute mesenteric ischemia (AMI) is a potentially catastrophic cause of abdominal pain that is likely underdiagnosed in ED patients due to its sometimes vague and variable symptoms. […] In most cases, urgent referral will be required, although managing only a patients cardiac comorbidities may mask their dangerous mesenteric ischemia. […] The value of laboratory testing for patients with suspected AMI. […] The imaging recommendations for prompt diagnosis. […] Treatment: Aggressive Fluid Administration, Address Metabolic Derangements, Antibiotics, Anticoagulation, Analgesia, Avoidance of Vasopressors, Alleviate Stomach, Avoid Supraphysiologic Oxygenation, Advance Directives, Abdominal Compartment Syndrome. […] You wonder whether this could represent acute mesenteric ischemia, and what treatment you should implement immediately. […] You wonder what additional resuscitative measures you could take in the ED, and whether any advanced therapies might benefit this patient.

• #8 Bowel Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554527/

  Regardless of the etiology of intestinal ischemia, in patients suspected of intestinal infarction or perforation based on clinical, radiographic, or laboratory tests, exploratory laparotomy should not be delayed. […] Resection of the infarcted intestine is strongly indicated. […] The treatment of NOMI or colonic ischemia focuses on removing insulting factors (vasoconstrictive medications), hemodynamic support and monitoring, treating the underlying cause (sepsis, heart failure), and the administration of intra-arterial vasodilation medications. […] Severe ischemia requires prompt surgical referral and intensive care unit monitoring.

• #9 Acute Mesenteric Ischemia Medication: Vasodilators, Thrombolytics, Anticoagulants, Antibiotics, Analgesics

  https://emedicine.medscape.com/article/189146-medication

  Drug types used in the treatment of acute mesenteric ischemia (AMI) include vasodilators, thrombolytics, anticoagulants, antibiotics, and analgesics. Therapeutic drugs (except for analgesics and prophylactic antibiotics) should be withheld until the type of AMI present has been determined by means of computed tomography (CT) or angiography. […] Vasodilators dilate the mesenteric arterial system, thereby reversing reactive arterial vasospasms in AMI. […] Thrombolytics are angiographically infused to lyse thrombi. They are used in selected patients with embolic AMI. […] Anticoagulants are indicated for preventing further extension of thrombus in mesenteric venous thrombosis (MVT) or, after revascularization, in arterial occlusive AMI. […] Antibiotics are administered to prevent or treat sepsis caused by breakdown of the mucosal barrier in bowel necrosis or perforation. […] Analgesics are used to relieve pain caused by bowel ischemia.

• #10 Intestinal ischemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-ischemia/diagnosis-treatment/drc-20373950

  You might need surgery to remove a blood clot, to bypass an artery blockage, or to repair or remove a damaged part of the intestine. Treatment also may include antibiotics and medicines to prevent clots, dissolve clots or widen blood vessels. […] Treatment aims to restore blood flow to your intestine. Your surgeon can bypass the blocked arteries or widen narrowed arteries with angioplasty or by placing a stent in the artery. […] If your intestine shows no damage, you won’t need repair. But you’ll likely need to take medicine that keeps your blood from clotting, called anticoagulant medicine, for about 3 to 6 months.

• #11 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  Aside from timely diagnosis and treatment of predisposing conditions, there are no known preventive measures for AMI. […] Guidelines for the management of AMI have been published by the World Society of Emergency Surgery. […] Intra-arterial infusion of papaverine through the angiography catheter at the affected vessel is useful for all arterial forms of AMI. […] Thrombolytic agents infused through the angiography catheter can be life-saving for selected patients with AMAE. […] Heparin anticoagulation is the main therapy for MVT. […] Surgical treatment of AMAT (ie, thrombotic AMI) involves exploratory laparotomy, followed by identification of the involved artery and bowel. […] For patients with severe MVT, exploratory laparotomy with assessment of bowel viability is indicated. […] Some experience with percutaneous endovascular interventions has been accumulated. […] A second-look laparotomy is the most reliable method of determining bowel viability.

• #12 Bowel Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554527/

  Broad-spectrum antibiotic therapy with coverage of colonic flora is the recommended intervention to prevent and treat sepsis. […] Based on intestinal ischemia subtypes, suggestions have included different treatment options. […] The data indicate that in patients with acute mesenteric arterial occlusion, an endovascular intervention can be as effective as traditional surgical. […] Catheter-directed thrombolysis is indicated in patients with distal mesenteric embolization or incomplete aspiration embolectomy. […] However, papaverine infusion should not be used simultaneously with heparin due to an increased risk of papaverine precipitation. […] In patients with embolic AMI, the pharmacomechanical thrombolysis is recommended within the 8 hours of symptoms initiation in selected patients.

• #13 Update in management of mesenteric ischemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4087969/

  Thrombolytic therapy in the management of intestinal ischemia was first reported in 1979 with the successful application of intraarterial streptokinase in the SMA. […] In the subset of patients who suffer from nonocclusive ischemia, intraarterial vasodilator therapy has been largely responsible for the decrease in mortality from 70% in the 1980s to 50%-55% during the last decade. […] Investigational therapy in the treatment of mesenteric ischemia has focused on pharmacologic strategies to treat mesenteric ischemia. […] The dual-hit hypothesis of ischemic injury is comprised of the initial hypoxic episode and then the subsequent reperfusion injury after reestablishment of forward flow. […] In conclusion, mesenteric ischemia, a spectrum of disorders with multiple etiologies still carries significant morbidity and mortality.

• #14 Bowel Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554527/

  Broad-spectrum antibiotic therapy with coverage of colonic flora is the recommended intervention to prevent and treat sepsis. […] Based on intestinal ischemia subtypes, suggestions have included different treatment options. […] The data indicate that in patients with acute mesenteric arterial occlusion, an endovascular intervention can be as effective as traditional surgical. […] Catheter-directed thrombolysis is indicated in patients with distal mesenteric embolization or incomplete aspiration embolectomy. […] However, papaverine infusion should not be used simultaneously with heparin due to an increased risk of papaverine precipitation. […] In patients with embolic AMI, the pharmacomechanical thrombolysis is recommended within the 8 hours of symptoms initiation in selected patients.

• #15 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  Aside from timely diagnosis and treatment of predisposing conditions, there are no known preventive measures for AMI. […] Guidelines for the management of AMI have been published by the World Society of Emergency Surgery. […] Intra-arterial infusion of papaverine through the angiography catheter at the affected vessel is useful for all arterial forms of AMI. […] Thrombolytic agents infused through the angiography catheter can be life-saving for selected patients with AMAE. […] Heparin anticoagulation is the main therapy for MVT. […] Surgical treatment of AMAT (ie, thrombotic AMI) involves exploratory laparotomy, followed by identification of the involved artery and bowel. […] For patients with severe MVT, exploratory laparotomy with assessment of bowel viability is indicated. […] Some experience with percutaneous endovascular interventions has been accumulated. […] A second-look laparotomy is the most reliable method of determining bowel viability.

• #16 Bowel Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554527/

  Broad-spectrum antibiotic therapy with coverage of colonic flora is the recommended intervention to prevent and treat sepsis. […] Based on intestinal ischemia subtypes, suggestions have included different treatment options. […] The data indicate that in patients with acute mesenteric arterial occlusion, an endovascular intervention can be as effective as traditional surgical. […] Catheter-directed thrombolysis is indicated in patients with distal mesenteric embolization or incomplete aspiration embolectomy. […] However, papaverine infusion should not be used simultaneously with heparin due to an increased risk of papaverine precipitation. […] In patients with embolic AMI, the pharmacomechanical thrombolysis is recommended within the 8 hours of symptoms initiation in selected patients.

• #17 Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0150-5

  Broad-spectrum antibiotics should be administered immediately. Unless contraindicated, patients should be anticoagulated with intravenous unfractionated heparin. […] Prompt laparotomy should be done for patients with overt peritonitis. […] Damage control surgery is an important adjunct for patients who require intestinal resection due to the necessity to reassess bowel viability and in patients with refractory sepsis. Planned re-laparotomy is an essential part of AMI management. […] Mesenteric venous thrombosis can often be successfully treated with a continuous infusion of unfractionated heparin. […] When NOMI is suspected, the treatment focus should be to correct the underlying cause and to restore mesenteric perfusion. Infarcted bowel should be resected promptly. […] The finding of massive gut necrosis requires careful assessment of the patients underlying co-morbidities and advanced directives in order to judge whether comfort carries the best treatment.

• #18 Acute Mesenteric Ischemia Medication: Vasodilators, Thrombolytics, Anticoagulants, Antibiotics, Analgesics

  https://emedicine.medscape.com/article/189146-medication

  Drug types used in the treatment of acute mesenteric ischemia (AMI) include vasodilators, thrombolytics, anticoagulants, antibiotics, and analgesics. Therapeutic drugs (except for analgesics and prophylactic antibiotics) should be withheld until the type of AMI present has been determined by means of computed tomography (CT) or angiography. […] Vasodilators dilate the mesenteric arterial system, thereby reversing reactive arterial vasospasms in AMI. […] Thrombolytics are angiographically infused to lyse thrombi. They are used in selected patients with embolic AMI. […] Anticoagulants are indicated for preventing further extension of thrombus in mesenteric venous thrombosis (MVT) or, after revascularization, in arterial occlusive AMI. […] Antibiotics are administered to prevent or treat sepsis caused by breakdown of the mucosal barrier in bowel necrosis or perforation. […] Analgesics are used to relieve pain caused by bowel ischemia.

• #19 Bowel Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554527/

  Broad-spectrum antibiotic therapy with coverage of colonic flora is the recommended intervention to prevent and treat sepsis. […] Based on intestinal ischemia subtypes, suggestions have included different treatment options. […] The data indicate that in patients with acute mesenteric arterial occlusion, an endovascular intervention can be as effective as traditional surgical. […] Catheter-directed thrombolysis is indicated in patients with distal mesenteric embolization or incomplete aspiration embolectomy. […] However, papaverine infusion should not be used simultaneously with heparin due to an increased risk of papaverine precipitation. […] In patients with embolic AMI, the pharmacomechanical thrombolysis is recommended within the 8 hours of symptoms initiation in selected patients.

• #20 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. […] Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. […] Traditionally, AMI has been treated with open surgery. Over the past two decades, the rapid development of endovascular techniques has made this approach an important alternative for patients with occlusion of the superior mesenteric artery (SMA). Some studies have shown that endovascular therapy is associated with lower rates of mortality and bowel resection than the traditional, open approach. […] The assessment and therapy carried out by an interdisciplinary team should keep the time-to-reperfusion interval as short as possible.

• #21 Diagnosis and Management of Acute Mesenteric Ischemia – Endovascular Today

  https://evtoday.com/articles/2021-jan/diagnosis-and-management-of-acute-mesenteric-ischemia

  Although relatively uncommon, mesenteric ischemia is responsible for significant morbidity and mortality in affected individuals. […] The rapid mobilization of a multidisciplinary team consisting of vascular surgeons, general surgeons, intensivists, and radiologists is crucial to address the needs of this critically ill patient population. […] The administration of crystalloid fluid initially, followed by blood as necessary, should start in the emergency department. Broad-spectrum antibiotics directed against normal gut flora should also be given prior to proceeding to the operating room. […] Over the last 20 years, as endovascular techniques have become increasingly sophisticated and practitioners more adept at employing them, minimally invasive approaches to mesenteric ischemia have gained popularity.

• #22 Intestinal ischemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-ischemia/diagnosis-treatment/drc-20373950

  Treatment of intestinal ischemia involves restoring the blood supply to the digestive tract. Choices vary depending on the cause of the condition and how bad it is. […] For severe colon damage, you may need surgery to remove the dead tissue. You also may need surgery to bypass a blockage in one of your intestinal arteries. If you have angiography to diagnose the condition, it may be possible to widen a narrowed artery during the procedure. […] Angioplasty uses a balloon inflated at the end of a catheter to press in the fatty deposits. The balloon also stretches the artery, making a wider path for the blood to flow. […] Your healthcare professional may put a springlike metallic tube, called a stent, into your artery to help keep it open. Your health professional also can remove a blood clot or dissolve it with medicine.

• #23 Mesenteric ischemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/mesenteric-ischemia/diagnosis-treatment/drc-20450391

  If a blood clot causes a sudden loss of blood flow to the small intestine, you might require immediate surgery to treat your mesenteric ischemia. […] Mesenteric ischemia that develops over time might be treated with angioplasty. Angioplasty is a procedure that uses a balloon to open the narrowed area. A mesh tube called a stent might be placed in the narrowed area. […] Mesenteric ischemia also can be treated via open surgery through an incision.

• #24 Intestinal ischemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-ischemia/diagnosis-treatment/drc-20373950

  Treatment of intestinal ischemia involves restoring the blood supply to the digestive tract. Choices vary depending on the cause of the condition and how bad it is. […] For severe colon damage, you may need surgery to remove the dead tissue. You also may need surgery to bypass a blockage in one of your intestinal arteries. If you have angiography to diagnose the condition, it may be possible to widen a narrowed artery during the procedure. […] Angioplasty uses a balloon inflated at the end of a catheter to press in the fatty deposits. The balloon also stretches the artery, making a wider path for the blood to flow. […] Your healthcare professional may put a springlike metallic tube, called a stent, into your artery to help keep it open. Your health professional also can remove a blood clot or dissolve it with medicine.

• #25 Chronic Mesenteric Ischemia Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/chronic-mesenteric-ischemia

  The goal of chronic mesenteric ischemia treatment is to restore blood flow to your intestines before damage occurs. […] If diet changes do not help and symptoms cause weight loss, long-term abdominal pain, and even food fear your doctor at the UPMC Heart and Vascular Institute may recommend minimally invasive or open surgical treatments to increase blood flow to your intestines. […] Your doctor will insert a balloon-tipped catheter inside the blocked artery at the point of the blockage. […] To make sure the artery stays open, your doctor may place a stent. A stent is a metal-mesh tube that acts as a scaffold by pressing against the artery walls, keeping the artery open. […] An option when angioplasty is ineffective or when more than one blood vessel is blocked. […] Increases blood flow from the aorta to the blood vessels, supplying the bowel beyond the areas of narrowing.

• #26 Bowel Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554527/

  Broad-spectrum antibiotic therapy with coverage of colonic flora is the recommended intervention to prevent and treat sepsis. […] Based on intestinal ischemia subtypes, suggestions have included different treatment options. […] The data indicate that in patients with acute mesenteric arterial occlusion, an endovascular intervention can be as effective as traditional surgical. […] Catheter-directed thrombolysis is indicated in patients with distal mesenteric embolization or incomplete aspiration embolectomy. […] However, papaverine infusion should not be used simultaneously with heparin due to an increased risk of papaverine precipitation. […] In patients with embolic AMI, the pharmacomechanical thrombolysis is recommended within the 8 hours of symptoms initiation in selected patients.

• #27 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  Aside from timely diagnosis and treatment of predisposing conditions, there are no known preventive measures for AMI. […] Guidelines for the management of AMI have been published by the World Society of Emergency Surgery. […] Intra-arterial infusion of papaverine through the angiography catheter at the affected vessel is useful for all arterial forms of AMI. […] Thrombolytic agents infused through the angiography catheter can be life-saving for selected patients with AMAE. […] Heparin anticoagulation is the main therapy for MVT. […] Surgical treatment of AMAT (ie, thrombotic AMI) involves exploratory laparotomy, followed by identification of the involved artery and bowel. […] For patients with severe MVT, exploratory laparotomy with assessment of bowel viability is indicated. […] Some experience with percutaneous endovascular interventions has been accumulated. […] A second-look laparotomy is the most reliable method of determining bowel viability.

• #28 Everything to Know About Intestinal Ischemia

  https://resources.healthgrades.com/right-care/digestive-health/ischemic-bowel

  Doctors may perform examinations to check your intestines, such as a colonoscopy or an abdominal surgery called laparotomy. […] Your medical team may also recommend surgery or other procedures to help restore blood flow or remove any damaged tissues: Thrombectomy: A thrombectomy involves using a catheter and thin removal device to suck out blood clots; Balloon angioplasty: A surgeon will make a small incision and insert a catheter and small balloon, guiding it up to the blocked artery. They will then inflate the balloon to help restore blood flow, sometimes placing a stent to keep your artery widened; Bypass surgery: With bypass surgery, surgeons take a healthy blood vessel from another part of your body and reattach it to make a new route for blood to flow through; Resection: An intestine resection involves removing damaged parts of your intestines. […] Treatment options for ischemic bowel include medication, bowel rest, and sometimes surgery.

• #29 Bowel Ischemia – MD Searchlight

  https://mdsearchlight.com/health/bowel-ischemia/

  Depending on the type of intestinal ischemia, different treatments might be needed. There is evidence that both endovascular intervention (a minimally invasive procedure inside blood vessels) and traditional surgery can be successful in cases of acute mesenteric arterial occlusion (blockage). […] Endovascular intervention includes either drug treatment or mechanical removal of the blockage, such as pulling it out via a large tube (catheter) with a stiff wire. In special cases, drugs that dissolve blood clots are used. Current evidence suggests that certain medications have a lower risk of non-brain bleeding, and so tend to be favored. An initial heparin injection, a blood thinner, helps prevent further clotting. This is followed by warfarin, another blood thinner, administered orally for at least six months.

• #30 Bowel Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554527/

  Broad-spectrum antibiotic therapy with coverage of colonic flora is the recommended intervention to prevent and treat sepsis. […] Based on intestinal ischemia subtypes, suggestions have included different treatment options. […] The data indicate that in patients with acute mesenteric arterial occlusion, an endovascular intervention can be as effective as traditional surgical. […] Catheter-directed thrombolysis is indicated in patients with distal mesenteric embolization or incomplete aspiration embolectomy. […] However, papaverine infusion should not be used simultaneously with heparin due to an increased risk of papaverine precipitation. […] In patients with embolic AMI, the pharmacomechanical thrombolysis is recommended within the 8 hours of symptoms initiation in selected patients.

• #31 Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review

  https://www.mdpi.com/2077-0383/13/5/1217

  The mainstay of management of the thromboembolic subtypes of acute mesenteric ischemia involves revascularization of viable bowel tissue, typically achieved through surgery or endovascular approaches, with open surgery being the gold standard of definitive management. […] Endovascular interventions have gained popularity in the management of acute mesenteric ischemia due to the reports of lower laparotomy requirements, reduced bowel resection, and lower mortality rates. […] The Society for Vascular Surgery recommends revascularization for symptomatic patients with chronic mesenteric ischemia, aiming to reverse the presenting symptoms and improve overall quality of life. […] Endovascular revascularization is strongly recommended as the initial treatment in patients with amenable lesions, with open surgical revascularization reserved for patients with lesions not amenable to an endovascular intervention approach.

• #32 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  Recognition of acute mesenteric ischemia (AMI) before permanent tissue damage occurs is the best way of improving patient survival, and only angiography or exploratory surgery makes early diagnosis possible. […] Treatment options depend on the etiology of intestinal ischemia, as well as on the hemodynamic stability of the patient and the experience/expertise of the treating staff. Generally speaking, nonocclusive AMI is treated medically, whereas occlusive AMI is correctable with surgery. Definitive treatment options include the following: […] All cases of mesenteric ischemia with signs of peritonitis or possible bowel infarction, regardless of etiology, generally warrant immediate surgical intervention for the resection of ischemic or necrotic intestines. […] Surgical treatment may be contraindicated if the risks from comorbid conditions preclude survival after general anesthesia. If the ischemia is thought to be caused by vasospasm, surgery is not indicated. Medical management with anticoagulants and intra-arterial vasodilators is appropriate.

• #33 Intestinal ischemia – Wikipedia

  https://en.wikipedia.org/wiki/Intestinal_ischemia

  Treatment of acute ischemia may include stenting or medications to break down the clot provided at the site of obstruction by interventional radiology. Open surgery may also be used to remove or bypass the obstruction and may be required to remove any intestines that may have died. If not rapidly treated outcomes are often poor. Among those affected even with treatment the risk of death is 70% to 90%. […] In those with chronic disease bypass surgery is the treatment of choice. Those who have thrombosis of the vein may be treated with anticoagulation such as heparin and warfarin, with surgery used if they do not improve. […] The treatment of intestinal ischemia depends on the cause and can be medical or surgical. However, if bowel has become necrotic, the only treatment is surgical removal of the dead segments of bowel.

• #34 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  Aside from timely diagnosis and treatment of predisposing conditions, there are no known preventive measures for AMI. […] Guidelines for the management of AMI have been published by the World Society of Emergency Surgery. […] Intra-arterial infusion of papaverine through the angiography catheter at the affected vessel is useful for all arterial forms of AMI. […] Thrombolytic agents infused through the angiography catheter can be life-saving for selected patients with AMAE. […] Heparin anticoagulation is the main therapy for MVT. […] Surgical treatment of AMAT (ie, thrombotic AMI) involves exploratory laparotomy, followed by identification of the involved artery and bowel. […] For patients with severe MVT, exploratory laparotomy with assessment of bowel viability is indicated. […] Some experience with percutaneous endovascular interventions has been accumulated. […] A second-look laparotomy is the most reliable method of determining bowel viability.

• #35

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-gastrointestinal/mesenteric-ischemia

  By the end of this module, the student will be able to: […] Discuss treatment options for mesenteric ischemia. […] The main goal is to identify mesenteric ischemia early in undifferentiated abdominal pain patients so that rapid revascularization to the mesentery can be achieved preventing bowel infarction and its subsequent complications. […] The first and most important initial action is to consider mesenteric ischemia in the differential diagnosis of all elderly patients with abdominal pain. […] Early surgical consultation is highly recommended so that the surgeons can closely follow the patient, do serial abdominal examinations, review the CT imaging with radiology, and take the patient to the OR rapidly thus saving as much bowel as possible. […] The treatment of choice for mesenteric artery embolus is embolectomy and bowel visualization to assess for signs of necrosis.

• #36 Update in management of mesenteric ischemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4087969/

  Surgical revascularization for visceral ischemia due to an occluded SMA was first described by Shaw et al in 1958, in which they reported two successful cases of mesenteric thromboendarterectomy. […] For chronic occlusive disease, when revascularization is considered, single-vessel bypass to the superior mesenteric artery has been very successful, even in patients with multiple-vessel occlusions. […] Antegrade aortoceliac bypass and transaortic endarterectomy have been successful for poor-risk patients, and are usually adequate for multiple outflows. […] Since the first reports of percutaneous transluminal angioplasty of the visceral vessels in 1980, endovascular therapy for atherosclerotic disease has rapidly expanded in both scope and indication in the last ten years. […] In both the acute and chronic presentation of intestinal ischemia, endoluminal therapy has emerged as a main, if not first-line therapy.

• #37 Surgery for Mesenteric Ischemia | NYU Langone Health

  https://nyulangone.org/conditions/mesenteric-ischemia/treatments/surgery-for-mesenteric-ischemia

  NYU Langone specialists may recommend surgery to decrease the risk of life-threatening complications for people who have acute mesenteric ischemia. They may suggest surgery if you need more than medication to remove a blockage. […] Surgery can also help increase blood and oxygen flow to the intestines and prevent tissue death from a lack of oxygen, known as gangrene. […] Vascular surgeons at NYU Langone are experts in performing surgery to manage this rare and dangerous condition. The goal is to restore blood flow to the intestines. […] For people with chronic mesenteric ischemia, a doctor may perform a transaortic endarterectomy, in which he or she removes plaque blocking the mesenteric artery. […] Your doctors may recommend arterial bypass surgery if you have a severe blockage in one or more arteries that cannot be treated effectively with a minimally invasive procedure, such as balloon angioplasty.

• #38 Update in management of mesenteric ischemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4087969/

  Surgical revascularization for visceral ischemia due to an occluded SMA was first described by Shaw et al in 1958, in which they reported two successful cases of mesenteric thromboendarterectomy. […] For chronic occlusive disease, when revascularization is considered, single-vessel bypass to the superior mesenteric artery has been very successful, even in patients with multiple-vessel occlusions. […] Antegrade aortoceliac bypass and transaortic endarterectomy have been successful for poor-risk patients, and are usually adequate for multiple outflows. […] Since the first reports of percutaneous transluminal angioplasty of the visceral vessels in 1980, endovascular therapy for atherosclerotic disease has rapidly expanded in both scope and indication in the last ten years. […] In both the acute and chronic presentation of intestinal ischemia, endoluminal therapy has emerged as a main, if not first-line therapy.

• #39 Chronic Mesenteric Ischemia Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/chronic-mesenteric-ischemia

  Your vascular surgeon uses a blood vessel from another location to create a detour around the blockage by attaching one end to the blocked artery above the blockage and the other end below the blockage. […] Symptoms typically improve immediately and you will receive close follow-up care through regular ultrasounds. […] Decreasing the risk of atherosclerosis the condition that causes chronic mesenteric ischemia. […] Quitting smoking. […] Controlling blood sugars in people with diabetes. […] Lowering cholesterol levels. […] Lowering high blood pressure. […] Taking anti-platelet medications, such as aspirin and clopidogrel (Plavix).

• #40 Intestinal ischemia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-ischemia/diagnosis-treatment/drc-20373950

  Treatment of intestinal ischemia involves restoring the blood supply to the digestive tract. Choices vary depending on the cause of the condition and how bad it is. […] For severe colon damage, you may need surgery to remove the dead tissue. You also may need surgery to bypass a blockage in one of your intestinal arteries. If you have angiography to diagnose the condition, it may be possible to widen a narrowed artery during the procedure. […] Angioplasty uses a balloon inflated at the end of a catheter to press in the fatty deposits. The balloon also stretches the artery, making a wider path for the blood to flow. […] Your healthcare professional may put a springlike metallic tube, called a stent, into your artery to help keep it open. Your health professional also can remove a blood clot or dissolve it with medicine.

• #41 Intestinal ischemia – Wikipedia

  https://en.wikipedia.org/wiki/Intestinal_ischemia

  Surgical revascularisation remains the treatment of choice for intestinal ischaemia related to an occlusion of the vessels supplying the bowel, but thrombolytic medical treatment and vascular interventional radiological techniques have a growing role. […] If the ischemia has progressed to the point that the affected intestinal segments are gangrenous, a bowel resection of those segments is called for. Often, obviously dead segments are removed at the first operation, and a second-look operation is planned to assess segments that are borderline that may be savable after revascularization.

• #42 Bowel Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554527/

  Regardless of the etiology of intestinal ischemia, in patients suspected of intestinal infarction or perforation based on clinical, radiographic, or laboratory tests, exploratory laparotomy should not be delayed. […] Resection of the infarcted intestine is strongly indicated. […] The treatment of NOMI or colonic ischemia focuses on removing insulting factors (vasoconstrictive medications), hemodynamic support and monitoring, treating the underlying cause (sepsis, heart failure), and the administration of intra-arterial vasodilation medications. […] Severe ischemia requires prompt surgical referral and intensive care unit monitoring.

• #43 Surgery for Mesenteric Ischemia | NYU Langone Health

  https://nyulangone.org/conditions/mesenteric-ischemia/treatments/surgery-for-mesenteric-ischemia

  In order to watch for further tissue damage, the divided ends of the intestines are not reconnected right away. […] If you have acute mesenteric ischemia, an emergency open surgery called a laparotomy may be necessary to diagnose and manage the condition. […] The surgery typically may require a 7- to 14-days hospital stay, plus 6 to 8 weeks of recovery at home. […] People with acute mesenteric ischemia typically require longer recovery time than people with the chronic type of this condition and longer monitoring in the hospital.

• #44 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  Aside from timely diagnosis and treatment of predisposing conditions, there are no known preventive measures for AMI. […] Guidelines for the management of AMI have been published by the World Society of Emergency Surgery. […] Intra-arterial infusion of papaverine through the angiography catheter at the affected vessel is useful for all arterial forms of AMI. […] Thrombolytic agents infused through the angiography catheter can be life-saving for selected patients with AMAE. […] Heparin anticoagulation is the main therapy for MVT. […] Surgical treatment of AMAT (ie, thrombotic AMI) involves exploratory laparotomy, followed by identification of the involved artery and bowel. […] For patients with severe MVT, exploratory laparotomy with assessment of bowel viability is indicated. […] Some experience with percutaneous endovascular interventions has been accumulated. […] A second-look laparotomy is the most reliable method of determining bowel viability.

• #45 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Accordingly, the present paper aims to provide an update with recommendations based on the most currently accepted concepts in the management of AMI. […] When the diagnosis of AMI is made, fluid resuscitation should commence immediately to enhance visceral perfusion. Electrolyte abnormalities should be corrected, and nasogastric decompression initiated. […] Broad-spectrum antibiotics should be immediately administered. […] Prompt laparoscopy/laparotomy should be done for patients with an overt peritonitis. […] The goal of surgical intervention for AMI includes: 1) Re-establishment of the blood supply to the ischemic bowel. 2) Resection of all non-viable regions. 3) Preservation of all viable bowel. […] Revascularization when relevant has an essential role in the multidisciplinary approach to AMI.

• #46 Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0150-5

  Broad-spectrum antibiotics should be administered immediately. Unless contraindicated, patients should be anticoagulated with intravenous unfractionated heparin. […] Prompt laparotomy should be done for patients with overt peritonitis. […] Damage control surgery is an important adjunct for patients who require intestinal resection due to the necessity to reassess bowel viability and in patients with refractory sepsis. Planned re-laparotomy is an essential part of AMI management. […] Mesenteric venous thrombosis can often be successfully treated with a continuous infusion of unfractionated heparin. […] When NOMI is suspected, the treatment focus should be to correct the underlying cause and to restore mesenteric perfusion. Infarcted bowel should be resected promptly. […] The finding of massive gut necrosis requires careful assessment of the patients underlying co-morbidities and advanced directives in order to judge whether comfort carries the best treatment.

• #47 Acute Mesenteric Ischemia – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/acute-mesenteric-ischemia

  Acute mesenteric ischemia is interruption of intestinal blood flow by embolism, thrombosis, or a low-flow state. […] Treatment is by embolectomy, revascularization of viable segments, or resection; sometimes vasodilator therapy is successful. […] Patients should be resuscitated with intravenous fluids to improve visceral perfusion. Broad-spectrum antibiotics should be initiated. […] If diagnosis is made during exploratory laparotomy, options are surgical embolectomy, revascularization, and resection. […] If diagnosis is made by angiography, infusion of the vasodilator papaverine through the angiography catheter may improve survival in nonocclusive ischemia. […] For arterial occlusion, thrombolysis or surgical embolectomy may be done. […] Patients with arterial embolism or venous thrombosis should be considered for long-term anticoagulation and dual antiplatelet therapy and surveillance for graft or stent patency. […] Treatment options include embolectomy, revascularization, and resection.

• #48 Acute Mesenteric Ischemia – Digestive Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/digestive-disorders/gastrointestinal-emergencies/acute-mesenteric-ischemia

  Immediate treatment is needed using angioplasty or surgery. […] People who have acute mesenteric ischemia are given fluids and antibiotics by vein. […] If mesenteric ischemia is diagnosed during surgery, the blood vessel blockage can sometimes be removed or bypassed, but other times the affected intestine must be removed. […] If mesenteric ischemia is diagnosed during CT angiography or mesenteric angiography, doctors may try to relieve the blockage in the blood vessels using angioplasty and placement of a stent. […] After recovery, many people need to take a medication to help prevent blood clotting.

• #49 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  Aside from timely diagnosis and treatment of predisposing conditions, there are no known preventive measures for AMI. […] Guidelines for the management of AMI have been published by the World Society of Emergency Surgery. […] Intra-arterial infusion of papaverine through the angiography catheter at the affected vessel is useful for all arterial forms of AMI. […] Thrombolytic agents infused through the angiography catheter can be life-saving for selected patients with AMAE. […] Heparin anticoagulation is the main therapy for MVT. […] Surgical treatment of AMAT (ie, thrombotic AMI) involves exploratory laparotomy, followed by identification of the involved artery and bowel. […] For patients with severe MVT, exploratory laparotomy with assessment of bowel viability is indicated. […] Some experience with percutaneous endovascular interventions has been accumulated. […] A second-look laparotomy is the most reliable method of determining bowel viability.

• #50

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-gastrointestinal/mesenteric-ischemia

  By the end of this module, the student will be able to: […] Discuss treatment options for mesenteric ischemia. […] The main goal is to identify mesenteric ischemia early in undifferentiated abdominal pain patients so that rapid revascularization to the mesentery can be achieved preventing bowel infarction and its subsequent complications. […] The first and most important initial action is to consider mesenteric ischemia in the differential diagnosis of all elderly patients with abdominal pain. […] Early surgical consultation is highly recommended so that the surgeons can closely follow the patient, do serial abdominal examinations, review the CT imaging with radiology, and take the patient to the OR rapidly thus saving as much bowel as possible. […] The treatment of choice for mesenteric artery embolus is embolectomy and bowel visualization to assess for signs of necrosis.

• #51 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  Aside from timely diagnosis and treatment of predisposing conditions, there are no known preventive measures for AMI. […] Guidelines for the management of AMI have been published by the World Society of Emergency Surgery. […] Intra-arterial infusion of papaverine through the angiography catheter at the affected vessel is useful for all arterial forms of AMI. […] Thrombolytic agents infused through the angiography catheter can be life-saving for selected patients with AMAE. […] Heparin anticoagulation is the main therapy for MVT. […] Surgical treatment of AMAT (ie, thrombotic AMI) involves exploratory laparotomy, followed by identification of the involved artery and bowel. […] For patients with severe MVT, exploratory laparotomy with assessment of bowel viability is indicated. […] Some experience with percutaneous endovascular interventions has been accumulated. […] A second-look laparotomy is the most reliable method of determining bowel viability.

• #52 Intestinal Ischemia – Internal Medicine Residency Handbook

  https://vim-book.org/gastroenterology/gastroenterology-intestinal-ischemia/

  Sudden onset or absence of blood flow to the small intestines. […] General: IVFs, NPO, hemodynamic monitoring and support (try to avoid vasoconstricting agents), anticoagulation, broad-spectrum antibiotics, pain control. […] If develops peritonitis or evidence of perforation on CT EGS consult for surgery. […] Mesenteric arterial embolism: Embolectomy vs. local infusion of thrombolytic agent. […] Mesenteric arterial thrombosis: Surgical revascularization vs. thrombolysis with endovascular angioplasty and stenting. […] Venous thrombosis: Anticoagulation; possible thrombolysis if persistent symptoms. […] Nonocclusive occlusion: Treat underlying cause, stop vasoconstriction meds, consider intra-arterial vasodilator infusion. […] Revascularization (open vs. endovascular) is indicated if symptoms are present. […] Mesenteric angioplasty and stenting is first-line therapy. […] Goal is to prevent future bowel infarction.

• #53 Intestinal ischemia – Wikipedia

  https://en.wikipedia.org/wiki/Intestinal_ischemia

  Surgical revascularisation remains the treatment of choice for intestinal ischaemia related to an occlusion of the vessels supplying the bowel, but thrombolytic medical treatment and vascular interventional radiological techniques have a growing role. […] If the ischemia has progressed to the point that the affected intestinal segments are gangrenous, a bowel resection of those segments is called for. Often, obviously dead segments are removed at the first operation, and a second-look operation is planned to assess segments that are borderline that may be savable after revascularization.

• #54 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Endovascular revascularization procedures are the primary option in cases of arterial occlusion when sufficient expertise is available. […] Damage control surgery (DCS) with temporary abdominal closure is an important adjunct for patients who require intestinal resection allowing reassessment of bowel viability and in situations of severe abdominal sepsis. […] Mesenteric venous thrombosis can often be successfully treated with a continuous infusion of unfractionated heparin. […] When NOMI is suspected, the focus is to correct the underlying cause and improve mesenteric perfusion. Infarcted bowel should be resected promptly. […] Postoperative intensive care of AMI patients is directed toward the improved intestinal perfusion and the prevention of a multiple organ failure. […] Treatment of AMI is optimal in a dedicated center using a focused care bundle and a multidisciplinary team. […] Patients undergoing revascularization should have surveillance imaging and long-term anticoagulation.

• #55 Intestinal ischemia – Wikipedia

  https://en.wikipedia.org/wiki/Intestinal_ischemia

  Treatment of acute ischemia may include stenting or medications to break down the clot provided at the site of obstruction by interventional radiology. Open surgery may also be used to remove or bypass the obstruction and may be required to remove any intestines that may have died. If not rapidly treated outcomes are often poor. Among those affected even with treatment the risk of death is 70% to 90%. […] In those with chronic disease bypass surgery is the treatment of choice. Those who have thrombosis of the vein may be treated with anticoagulation such as heparin and warfarin, with surgery used if they do not improve. […] The treatment of intestinal ischemia depends on the cause and can be medical or surgical. However, if bowel has become necrotic, the only treatment is surgical removal of the dead segments of bowel.

• #56 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Mesenteric Arterial Ischemia: Initial management: Aggressive IV fluids and electrolyte monitoring, AVOID vasopressors. IV broad-spectrum antibiotics. IV unfractionated heparin: decision should be made with surgical consult. NPO in acute mesenteric ischemia. Enteral nutrition or parenteral nutrition in chronic mesenteric ischemia. […] Unstable: laparotomy with thromboembolectomy, mesenteric bypass and/or retrograde mesenteric stent, and bowel resection, if necessary. […] Mesenteric Venous Thrombosis: Stepwise approach: If symptoms are mild and no CT evidence of compromised bowel perfusion, LMWH and transition to oral anticoagulation. If symptoms are severe and CT shows edematous bowel, continuous IV UFH. If medical treatment fails, options include percutaneous mechanical thrombectomy and/or catheter-directed thrombolysis via transhepatic access.

• #57 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  Aside from timely diagnosis and treatment of predisposing conditions, there are no known preventive measures for AMI. […] Guidelines for the management of AMI have been published by the World Society of Emergency Surgery. […] Intra-arterial infusion of papaverine through the angiography catheter at the affected vessel is useful for all arterial forms of AMI. […] Thrombolytic agents infused through the angiography catheter can be life-saving for selected patients with AMAE. […] Heparin anticoagulation is the main therapy for MVT. […] Surgical treatment of AMAT (ie, thrombotic AMI) involves exploratory laparotomy, followed by identification of the involved artery and bowel. […] For patients with severe MVT, exploratory laparotomy with assessment of bowel viability is indicated. […] Some experience with percutaneous endovascular interventions has been accumulated. […] A second-look laparotomy is the most reliable method of determining bowel viability.

• #58 Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0150-5

  Broad-spectrum antibiotics should be administered immediately. Unless contraindicated, patients should be anticoagulated with intravenous unfractionated heparin. […] Prompt laparotomy should be done for patients with overt peritonitis. […] Damage control surgery is an important adjunct for patients who require intestinal resection due to the necessity to reassess bowel viability and in patients with refractory sepsis. Planned re-laparotomy is an essential part of AMI management. […] Mesenteric venous thrombosis can often be successfully treated with a continuous infusion of unfractionated heparin. […] When NOMI is suspected, the treatment focus should be to correct the underlying cause and to restore mesenteric perfusion. Infarcted bowel should be resected promptly. […] The finding of massive gut necrosis requires careful assessment of the patients underlying co-morbidities and advanced directives in order to judge whether comfort carries the best treatment.

• #59 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Mesenteric Arterial Ischemia: Initial management: Aggressive IV fluids and electrolyte monitoring, AVOID vasopressors. IV broad-spectrum antibiotics. IV unfractionated heparin: decision should be made with surgical consult. NPO in acute mesenteric ischemia. Enteral nutrition or parenteral nutrition in chronic mesenteric ischemia. […] Unstable: laparotomy with thromboembolectomy, mesenteric bypass and/or retrograde mesenteric stent, and bowel resection, if necessary. […] Mesenteric Venous Thrombosis: Stepwise approach: If symptoms are mild and no CT evidence of compromised bowel perfusion, LMWH and transition to oral anticoagulation. If symptoms are severe and CT shows edematous bowel, continuous IV UFH. If medical treatment fails, options include percutaneous mechanical thrombectomy and/or catheter-directed thrombolysis via transhepatic access.

• #60 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Mesenteric Arterial Ischemia: Initial management: Aggressive IV fluids and electrolyte monitoring, AVOID vasopressors. IV broad-spectrum antibiotics. IV unfractionated heparin: decision should be made with surgical consult. NPO in acute mesenteric ischemia. Enteral nutrition or parenteral nutrition in chronic mesenteric ischemia. […] Unstable: laparotomy with thromboembolectomy, mesenteric bypass and/or retrograde mesenteric stent, and bowel resection, if necessary. […] Mesenteric Venous Thrombosis: Stepwise approach: If symptoms are mild and no CT evidence of compromised bowel perfusion, LMWH and transition to oral anticoagulation. If symptoms are severe and CT shows edematous bowel, continuous IV UFH. If medical treatment fails, options include percutaneous mechanical thrombectomy and/or catheter-directed thrombolysis via transhepatic access.

• #61 Acute Mesenteric Ischemia Treatment & Management: Approach Considerations, Initial Resuscitation and Stabilization, Pharmacologic Therapy

  https://emedicine.medscape.com/article/189146-treatment

  Aside from timely diagnosis and treatment of predisposing conditions, there are no known preventive measures for AMI. […] Guidelines for the management of AMI have been published by the World Society of Emergency Surgery. […] Intra-arterial infusion of papaverine through the angiography catheter at the affected vessel is useful for all arterial forms of AMI. […] Thrombolytic agents infused through the angiography catheter can be life-saving for selected patients with AMAE. […] Heparin anticoagulation is the main therapy for MVT. […] Surgical treatment of AMAT (ie, thrombotic AMI) involves exploratory laparotomy, followed by identification of the involved artery and bowel. […] For patients with severe MVT, exploratory laparotomy with assessment of bowel viability is indicated. […] Some experience with percutaneous endovascular interventions has been accumulated. […] A second-look laparotomy is the most reliable method of determining bowel viability.

• #62 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Mesenteric Arterial Ischemia: Initial management: Aggressive IV fluids and electrolyte monitoring, AVOID vasopressors. IV broad-spectrum antibiotics. IV unfractionated heparin: decision should be made with surgical consult. NPO in acute mesenteric ischemia. Enteral nutrition or parenteral nutrition in chronic mesenteric ischemia. […] Unstable: laparotomy with thromboembolectomy, mesenteric bypass and/or retrograde mesenteric stent, and bowel resection, if necessary. […] Mesenteric Venous Thrombosis: Stepwise approach: If symptoms are mild and no CT evidence of compromised bowel perfusion, LMWH and transition to oral anticoagulation. If symptoms are severe and CT shows edematous bowel, continuous IV UFH. If medical treatment fails, options include percutaneous mechanical thrombectomy and/or catheter-directed thrombolysis via transhepatic access.

• #63 Bowel Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554527/

  Regardless of the etiology of intestinal ischemia, in patients suspected of intestinal infarction or perforation based on clinical, radiographic, or laboratory tests, exploratory laparotomy should not be delayed. […] Resection of the infarcted intestine is strongly indicated. […] The treatment of NOMI or colonic ischemia focuses on removing insulting factors (vasoconstrictive medications), hemodynamic support and monitoring, treating the underlying cause (sepsis, heart failure), and the administration of intra-arterial vasodilation medications. […] Severe ischemia requires prompt surgical referral and intensive care unit monitoring.

• #64 Mesenteric Ischemia: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23246-mesenteric-ischemia

  While this is a subtype of mesenteric ischemia, surgery isnt always necessary to correct this problem (and it usually isnt helpful early on). […] The key with NOMI is to treat whatevers causing those vessels to constrict and prevent it from happening again. […] Surgery for this issue is common, especially when it involves a slow-growing clot or blood vessels that have become too narrow. […] Balloon angioplasty and other catheter-based procedures are often considered with this condition. […] Clot-busting medications are also common when clots dont move and grow into blockages.

• #65 Bowel Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK554527/

  Regardless of the etiology of intestinal ischemia, in patients suspected of intestinal infarction or perforation based on clinical, radiographic, or laboratory tests, exploratory laparotomy should not be delayed. […] Resection of the infarcted intestine is strongly indicated. […] The treatment of NOMI or colonic ischemia focuses on removing insulting factors (vasoconstrictive medications), hemodynamic support and monitoring, treating the underlying cause (sepsis, heart failure), and the administration of intra-arterial vasodilation medications. […] Severe ischemia requires prompt surgical referral and intensive care unit monitoring.

• #66 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Nonocclusive Mesenteric Ischemia: Ensure hemodynamic stability: fluid resuscitation and electrolytes, blood transfusion. Manage underlying cause (HF or sepsis). IV infusion of vasodilatory and antispasmodic agents can be used: Papaverine 60 mg bolus followed by infusion (30-60 mg/hr) with repeated angiograms obtained every 24 hours. Laparotomy when bowel necrosis is suspected. […] Long-term management: Aspirin lifelong in all patients who undergo endovascular or open repair. Clopidogrel for 1-3 months after endovascular repair. DOAC indicated in patients with atrial fibrillation, MVT. Lifestyle management: smoking cessation, exercise, manage dyslipidemia and hypertension.

• #67 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Nonocclusive Mesenteric Ischemia: Ensure hemodynamic stability: fluid resuscitation and electrolytes, blood transfusion. Manage underlying cause (HF or sepsis). IV infusion of vasodilatory and antispasmodic agents can be used: Papaverine 60 mg bolus followed by infusion (30-60 mg/hr) with repeated angiograms obtained every 24 hours. Laparotomy when bowel necrosis is suspected. […] Long-term management: Aspirin lifelong in all patients who undergo endovascular or open repair. Clopidogrel for 1-3 months after endovascular repair. DOAC indicated in patients with atrial fibrillation, MVT. Lifestyle management: smoking cessation, exercise, manage dyslipidemia and hypertension.

• #68 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Nonocclusive Mesenteric Ischemia: Ensure hemodynamic stability: fluid resuscitation and electrolytes, blood transfusion. Manage underlying cause (HF or sepsis). IV infusion of vasodilatory and antispasmodic agents can be used: Papaverine 60 mg bolus followed by infusion (30-60 mg/hr) with repeated angiograms obtained every 24 hours. Laparotomy when bowel necrosis is suspected. […] Long-term management: Aspirin lifelong in all patients who undergo endovascular or open repair. Clopidogrel for 1-3 months after endovascular repair. DOAC indicated in patients with atrial fibrillation, MVT. Lifestyle management: smoking cessation, exercise, manage dyslipidemia and hypertension.

• #69 Update in management of mesenteric ischemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4087969/

  Thrombolytic therapy in the management of intestinal ischemia was first reported in 1979 with the successful application of intraarterial streptokinase in the SMA. […] In the subset of patients who suffer from nonocclusive ischemia, intraarterial vasodilator therapy has been largely responsible for the decrease in mortality from 70% in the 1980s to 50%-55% during the last decade. […] Investigational therapy in the treatment of mesenteric ischemia has focused on pharmacologic strategies to treat mesenteric ischemia. […] The dual-hit hypothesis of ischemic injury is comprised of the initial hypoxic episode and then the subsequent reperfusion injury after reestablishment of forward flow. […] In conclusion, mesenteric ischemia, a spectrum of disorders with multiple etiologies still carries significant morbidity and mortality.

• #70 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Nonocclusive Mesenteric Ischemia: Ensure hemodynamic stability: fluid resuscitation and electrolytes, blood transfusion. Manage underlying cause (HF or sepsis). IV infusion of vasodilatory and antispasmodic agents can be used: Papaverine 60 mg bolus followed by infusion (30-60 mg/hr) with repeated angiograms obtained every 24 hours. Laparotomy when bowel necrosis is suspected. […] Long-term management: Aspirin lifelong in all patients who undergo endovascular or open repair. Clopidogrel for 1-3 months after endovascular repair. DOAC indicated in patients with atrial fibrillation, MVT. Lifestyle management: smoking cessation, exercise, manage dyslipidemia and hypertension.

• #71 Update in management of mesenteric ischemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4087969/

  Thrombolytic therapy in the management of intestinal ischemia was first reported in 1979 with the successful application of intraarterial streptokinase in the SMA. […] In the subset of patients who suffer from nonocclusive ischemia, intraarterial vasodilator therapy has been largely responsible for the decrease in mortality from 70% in the 1980s to 50%-55% during the last decade. […] Investigational therapy in the treatment of mesenteric ischemia has focused on pharmacologic strategies to treat mesenteric ischemia. […] The dual-hit hypothesis of ischemic injury is comprised of the initial hypoxic episode and then the subsequent reperfusion injury after reestablishment of forward flow. […] In conclusion, mesenteric ischemia, a spectrum of disorders with multiple etiologies still carries significant morbidity and mortality.

• #72 Ischemic Colitis: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24513-ischemic-colitis

  How do you fix ischemic colitis? The treatment will depend on how severe it is and if you have any complications, such as infection in your abdominal cavity. Severe or complicated cases will require emergency surgery. Most cases can be managed medically. You’ll receive IV fluids and broad-spectrum antibiotics to treat or prevent infection. You may receive oxygen therapy to help increase your cardiac output and blood flow. Your healthcare provider will discontinue any medications that contribute to ischemic colitis. They’ll prescribe bowel rest, which means not using your digestive system for a while to let it heal. You’ll have a liquid diet or IV nutrition. […] Other possible treatments may include: Stomach decompression by nasogastric tube. If ischemic colitis has paralyzed part of your colon, a healthcare provider may need to draw air, fluid or food from your stomach. Blood vessel treatments. Your provider may need to surgically remove a blockage from one of your arteries. They might dissolve a blood clot or place a stent in a narrowed blood vessel. Colectomy. If there’s any tissue death or rupture in your colon wall, that part may need to be removed (resected). Bowel resection may also involve a temporary or permanent colostomy.

• #73 Ischemic Colitis – Gastrointestinal Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/ischemic-colitis

  Treatment of ischemic colitis is supportive with IV fluids, bowel rest, and antibiotics. […] Surgery is rarely required, unless ischemic colitis is a complication of a vascular procedure or there is full-thickness necrosis. Approximately 5% of patients have a recurrence. […] Occasionally, strictures develop at the site of the ischemia several weeks later, necessitating surgical resection.

• #74 Ischemic Colitis: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24513-ischemic-colitis

  How do you fix ischemic colitis? The treatment will depend on how severe it is and if you have any complications, such as infection in your abdominal cavity. Severe or complicated cases will require emergency surgery. Most cases can be managed medically. You’ll receive IV fluids and broad-spectrum antibiotics to treat or prevent infection. You may receive oxygen therapy to help increase your cardiac output and blood flow. Your healthcare provider will discontinue any medications that contribute to ischemic colitis. They’ll prescribe bowel rest, which means not using your digestive system for a while to let it heal. You’ll have a liquid diet or IV nutrition. […] Other possible treatments may include: Stomach decompression by nasogastric tube. If ischemic colitis has paralyzed part of your colon, a healthcare provider may need to draw air, fluid or food from your stomach. Blood vessel treatments. Your provider may need to surgically remove a blockage from one of your arteries. They might dissolve a blood clot or place a stent in a narrowed blood vessel. Colectomy. If there’s any tissue death or rupture in your colon wall, that part may need to be removed (resected). Bowel resection may also involve a temporary or permanent colostomy.

• #75 Ischemic Colitis: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/ibd-crohns-disease/ulcerative-colitis/facts-about-ischemic-colitis

  Ischemic colitis is the most common type of intestinal ischemia, or gut-based blood blockages. […] Most people with ischemic colitis have mild cases and recover well with treatment. […] If you have a mild case (and most cases are mild), the inner lining of your colon is inflamed, sore, and bleeding. It usually heals on its own within 1-2 weeks. […] People with ischemic colitis typically spend a few days in the hospital in the intensive care unit, where doctors can monitor your blood flow. It also helps your colon heal. While in the hospital, you may receive IV antibiotics to prevent infection. […] To give your colon a rest while it heals, you wont be able to drink or eat anything for a few days. Youll get IV fluids and electrolytes to keep you hydrated. Supplemental oxygen can also help your bowel to heal.

• #76 Bowel Ischaemia | Doctor

  https://patient.info/doctor/bowel-ischaemia

  The ischaemia may be transient and resolve once the cause of the hypoperfusion has been alleviated. […] Bowel rest and supportive care are often helpful. […] Broad-spectrum antibiotics are recommended. […] […] […] Surgical care […] If symptoms do not improve in 24-48 hours, repeat colonoscopy or imaging of the mesenteric vasculature with CT angiography is necessary to re-evaluate the severity and degree of the disease. […] Increasing abdominal tenderness with guarding and rebound tenderness, fever, uncontrollable bleeding, and paralytic ileus indicate possible infarction of the colon (severe disease) and require urgent laparotomy and removal of the necrotic part of the colon.

• #77 Ischemic Colitis: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24513-ischemic-colitis

  How do you fix ischemic colitis? The treatment will depend on how severe it is and if you have any complications, such as infection in your abdominal cavity. Severe or complicated cases will require emergency surgery. Most cases can be managed medically. You’ll receive IV fluids and broad-spectrum antibiotics to treat or prevent infection. You may receive oxygen therapy to help increase your cardiac output and blood flow. Your healthcare provider will discontinue any medications that contribute to ischemic colitis. They’ll prescribe bowel rest, which means not using your digestive system for a while to let it heal. You’ll have a liquid diet or IV nutrition. […] Other possible treatments may include: Stomach decompression by nasogastric tube. If ischemic colitis has paralyzed part of your colon, a healthcare provider may need to draw air, fluid or food from your stomach. Blood vessel treatments. Your provider may need to surgically remove a blockage from one of your arteries. They might dissolve a blood clot or place a stent in a narrowed blood vessel. Colectomy. If there’s any tissue death or rupture in your colon wall, that part may need to be removed (resected). Bowel resection may also involve a temporary or permanent colostomy.

• #78 Ischemic Colitis + 5 Natural Treatments to Help Find Relief – Dr. Axe

  https://draxe.com/health/ischemic-colitis/

  Ischemic colitis is the most common type of intestinal vasculopathy and form of ischemia affecting the bowels. […] Treatment for ischemic colitis will depend on how severe someone’s symptoms are and the suspected underlying causes. Some conventional treatments that are used to manage ischemic colitis include: treating any underlying health issues that are contributing to the problem, such as heart disease, a blood clot or blood pressure problems. This is usually done using a combination of medications and lifestyle changes. […] In some cases, when ischemic colitis is severe, surgery might be needed. Only approximately 20 percent of patients require surgery due to intestinal damage. […] Treatments for ischemic colitis include: treating any underlying health issues that are contributing to the problem; changing medications; treating dehydration and electrolyte imbalances; resolving any intestinal infections; reducing inflammation in the GI tract; and in about 20 percent of cases, surgery.

• #79 Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review

  https://www.mdpi.com/2077-0383/13/5/1217

  The mainstay of management of the thromboembolic subtypes of acute mesenteric ischemia involves revascularization of viable bowel tissue, typically achieved through surgery or endovascular approaches, with open surgery being the gold standard of definitive management. […] Endovascular interventions have gained popularity in the management of acute mesenteric ischemia due to the reports of lower laparotomy requirements, reduced bowel resection, and lower mortality rates. […] The Society for Vascular Surgery recommends revascularization for symptomatic patients with chronic mesenteric ischemia, aiming to reverse the presenting symptoms and improve overall quality of life. […] Endovascular revascularization is strongly recommended as the initial treatment in patients with amenable lesions, with open surgical revascularization reserved for patients with lesions not amenable to an endovascular intervention approach.

• #80 Role of Endovascular Therapies in Chronic Mesenteric Ischemia: Current Status and Technical Considerations

  https://www.acc.org/latest-in-cardiology/articles/2016/12/20/07/12/role-of-endovascular-therapies-in-chronic-mesenteric-ischemia

  Chronic mesenteric ischemia (CMI), commonly referred to as „intestinal angina” is an uncommon vascular condition with an insidious onset that often leads to severe debilitating abdominal symptoms. […] Since its introduction by Shaw et al. in 1958, open surgical repair (OSR) has been the standard of treatment for CMI. […] In years since, multiple studies have reported that percutaneous endovascular treatment (PVET) of CMI is possible with a high technical success rate and with minimal complications in properly selected patients. […] As a result, PEVT has supplanted OSR as the default treatment for CMI in many centers across the United States, especially in patients with severe cardiovascular co-morbidities. […] As of 2005, PEVT has acquired a Class IB recommendation by the ACC/AHA for the treatment of CMI due to mesenteric stenosis, which is the same level of recommendation as for surgical endarterectomy or bypass grafting.

• #81 Intestinal Ischemia Surgery & Treatment

  https://lacolon.com/article/intestinal-ischemia-surgery

  At a basic level, the goal of treatment for intestinal ischemia is to restore blood flow to the area of the intestine that has been affected. […] The treatment for mild, non-gangrenous colonic ischemia is supportive and includes things like bowel rest and IV fluids. The treatment for severe gangrenous ischemia is broad-spectrum antibiotics and surgery where the surgeon will remove the affected part of your gut. […] The treatment for acute mesenteric ischemia begins with supportive care, which includes IV fluids, nasogastric tube placement, and food restriction. Initial treatment also includes broad-spectrum antibiotics and heparin, which is a drug that helps prevent any more clots from forming. […] The treatment for chronic mesenteric ischemia involves eating frequent but smaller meals and choosing low-fat foods. Patients are also advised to reduce their risk of developing severe gut ischemia by maintaining a healthy lifestyle and quitting smoking.

• #82 Ischemic Colitis: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24513-ischemic-colitis

  If you’re recovering from an acute episode of ischemic colitis, your healthcare provider will recommend no food at first. After that, you may transition to a liquid diet and eventually a soft diet. Avoid foods high in fiber for now. The idea is to make your intestines work as little as possible while they’re healing. Digestion requires more blood flow and oxygen to the area, while bowel rest gives your body the chance to restore that blood supply. If you have long-term (chronic) ischemic colitis or another chronic condition that predisposes you to ischemic colitis, your healthcare provider may give you specific long-term guidelines.

• #83 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Nonocclusive Mesenteric Ischemia: Ensure hemodynamic stability: fluid resuscitation and electrolytes, blood transfusion. Manage underlying cause (HF or sepsis). IV infusion of vasodilatory and antispasmodic agents can be used: Papaverine 60 mg bolus followed by infusion (30-60 mg/hr) with repeated angiograms obtained every 24 hours. Laparotomy when bowel necrosis is suspected. […] Long-term management: Aspirin lifelong in all patients who undergo endovascular or open repair. Clopidogrel for 1-3 months after endovascular repair. DOAC indicated in patients with atrial fibrillation, MVT. Lifestyle management: smoking cessation, exercise, manage dyslipidemia and hypertension.

• #84 Bowel Ischaemia | Doctor

  https://patient.info/doctor/bowel-ischaemia

  These patients have a five-year mortality of 40%, with the majority of deaths attributed to myocardial infarction or cardiovascular death. […] Symptomatic chronic mesenteric ischaemia (CMI) is an indication for either open or endovascular revascularisation, as patients with untreated symptomatic CMI carry a five-year mortality rate that approaches 100%. […] Nutrition is important in pre-operative assessment, as patients are often malnourished at the time of diagnosis; total parenteral nutrition may be necessary both pre- and postoperatively. […] The optimal revascularisation approach depends heavily on the anatomy and pre-operative condition of the patient. […] Renal failure is a common postoperative complication. […] […] […] Ischaemic colitis treatment10 […] Medical care

• #85 Chronic Mesenteric Ischemia Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/chronic-mesenteric-ischemia

  Your vascular surgeon uses a blood vessel from another location to create a detour around the blockage by attaching one end to the blocked artery above the blockage and the other end below the blockage. […] Symptoms typically improve immediately and you will receive close follow-up care through regular ultrasounds. […] Decreasing the risk of atherosclerosis the condition that causes chronic mesenteric ischemia. […] Quitting smoking. […] Controlling blood sugars in people with diabetes. […] Lowering cholesterol levels. […] Lowering high blood pressure. […] Taking anti-platelet medications, such as aspirin and clopidogrel (Plavix).

• #86 Mesenteric Artery Ischemia: Causes, Symptoms, and Treatment

  https://www.healthline.com/health/mesenteric-artery-ischemia

  Surgery can treat chronic mesenteric artery ischemia if needed. Surgery isnt always necessary if intestinal ischemia progresses slowly. Lifestyle adjustments may help reverse atherosclerosis naturally. […] Lifestyle changes to treat chronic mesenteric artery ischemia can include: eating a low-fat and low-sodium diet to reduce blood pressure and cholesterol levels, exercising daily to lower cholesterol, regulate blood pressure, and increase heart health, quitting smoking, if you smoke. […] These medications also play a role in treating mesenteric artery ischemia: antibiotics, if an infection caused a blockage in the intestinal arteries, blood thinners to prevent future blood clots, such as heparin or warfarin, vasodilator drugs, such as hydralazine or nitroglycerin, to prevent spasm of your blood vessels. […] Most people with chronic mesenteric artery ischemia recover well with treatment and lifestyle changes. […] Acute intestinal ischemia is more life threatening, as treatment can occur too late after intestinal tissue is already dead. Prompt treatment is crucial for a good outlook.

• #87 Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review

  https://www.mdpi.com/2077-0383/13/5/1217

  The mainstay of management of the thromboembolic subtypes of acute mesenteric ischemia involves revascularization of viable bowel tissue, typically achieved through surgery or endovascular approaches, with open surgery being the gold standard of definitive management. […] Endovascular interventions have gained popularity in the management of acute mesenteric ischemia due to the reports of lower laparotomy requirements, reduced bowel resection, and lower mortality rates. […] The Society for Vascular Surgery recommends revascularization for symptomatic patients with chronic mesenteric ischemia, aiming to reverse the presenting symptoms and improve overall quality of life. […] Endovascular revascularization is strongly recommended as the initial treatment in patients with amenable lesions, with open surgical revascularization reserved for patients with lesions not amenable to an endovascular intervention approach.

• #88 Role of Endovascular Therapies in Chronic Mesenteric Ischemia: Current Status and Technical Considerations

  https://www.acc.org/latest-in-cardiology/articles/2016/12/20/07/12/role-of-endovascular-therapies-in-chronic-mesenteric-ischemia

  Chronic mesenteric ischemia (CMI), commonly referred to as „intestinal angina” is an uncommon vascular condition with an insidious onset that often leads to severe debilitating abdominal symptoms. […] Since its introduction by Shaw et al. in 1958, open surgical repair (OSR) has been the standard of treatment for CMI. […] In years since, multiple studies have reported that percutaneous endovascular treatment (PVET) of CMI is possible with a high technical success rate and with minimal complications in properly selected patients. […] As a result, PEVT has supplanted OSR as the default treatment for CMI in many centers across the United States, especially in patients with severe cardiovascular co-morbidities. […] As of 2005, PEVT has acquired a Class IB recommendation by the ACC/AHA for the treatment of CMI due to mesenteric stenosis, which is the same level of recommendation as for surgical endarterectomy or bypass grafting.

• #89 Update in management of mesenteric ischemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4087969/

  Surgical revascularization for visceral ischemia due to an occluded SMA was first described by Shaw et al in 1958, in which they reported two successful cases of mesenteric thromboendarterectomy. […] For chronic occlusive disease, when revascularization is considered, single-vessel bypass to the superior mesenteric artery has been very successful, even in patients with multiple-vessel occlusions. […] Antegrade aortoceliac bypass and transaortic endarterectomy have been successful for poor-risk patients, and are usually adequate for multiple outflows. […] Since the first reports of percutaneous transluminal angioplasty of the visceral vessels in 1980, endovascular therapy for atherosclerotic disease has rapidly expanded in both scope and indication in the last ten years. […] In both the acute and chronic presentation of intestinal ischemia, endoluminal therapy has emerged as a main, if not first-line therapy.

• #90 Role of Endovascular Therapies in Chronic Mesenteric Ischemia: Current Status and Technical Considerations

  https://www.acc.org/latest-in-cardiology/articles/2016/12/20/07/12/role-of-endovascular-therapies-in-chronic-mesenteric-ischemia

  Initial therapy of CMI should be directed towards controlling underlying risk factors such as diabetes, hypertension, and hypercholesterolemia. […] Ultimately, most patients with CMI require revascularization, and medical management alone is usually reserved for patients who are too high risk for any revascularization options (surgical or percutaneous), or who have refractory symptoms despite failed previous revascularization attempts. […] As mentioned above, PEVT currently has a Class IB ACC/AHA recommendation for the treatment of CMI. […] Once a decision towards revascularization is made, careful consideration must be made towards selecting which vessel(s) to revascularize in situations where more than one vessel is significantly stenosed. […] Studies have shown that recanalization of the SMA has the highest likelihood of providing lasting benefit.

• #91 Chronic Mesenteric Ischemia Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/chronic-mesenteric-ischemia

  The goal of chronic mesenteric ischemia treatment is to restore blood flow to your intestines before damage occurs. […] If diet changes do not help and symptoms cause weight loss, long-term abdominal pain, and even food fear your doctor at the UPMC Heart and Vascular Institute may recommend minimally invasive or open surgical treatments to increase blood flow to your intestines. […] Your doctor will insert a balloon-tipped catheter inside the blocked artery at the point of the blockage. […] To make sure the artery stays open, your doctor may place a stent. A stent is a metal-mesh tube that acts as a scaffold by pressing against the artery walls, keeping the artery open. […] An option when angioplasty is ineffective or when more than one blood vessel is blocked. […] Increases blood flow from the aorta to the blood vessels, supplying the bowel beyond the areas of narrowing.

• #92 Role of Endovascular Therapies in Chronic Mesenteric Ischemia: Current Status and Technical Considerations

  https://www.acc.org/latest-in-cardiology/articles/2016/12/20/07/12/role-of-endovascular-therapies-in-chronic-mesenteric-ischemia

  However, if the SMA cannot be treated by endovascular means (e.g., due to calcification or presence of an ostial or long occlusion), an attempt at celiac angioplasty can be beneficial. […] Once a vessel is identified for revascularization, the decision to conduct plain balloon angioplasty versus primary stenting must be made. […] The overall complication rate of PEVT is low (0-10%), and is mostly attributed to access site complications, including access site hematoma, AV fistula, pseudoaneurysm, etc. […] Acute intestinal ischemia secondary to embolization, thrombosis, or dissection is the most feared complication of mesenteric endovascular intervention. […] In a nationwide United States inpatient sample of 5583 medicare beneficiaries (1988-2006) undergoing revascularization for CMI, PEVT was performed in 62% patients. […] Once diagnosed, treatment options include PEVT and OSR. […] However, for many high surgical risk patients, PEVT is becoming the preferred treatment in atherosclerotic CMI due to reduced peri-operative morbidity and mortality compared to OSR.

• #93 Advancements in Treatment Strategies for Chronic Mesenteric Ischemia: A Comprehensive Review

  https://www.mdpi.com/2077-0383/12/22/7112

  Chronic mesenteric ischemia (CMI) arises from the inability to achieve adequate intestinal blood flow after meals, leading to an imbalance between oxygen and metabolite supply and demand. […] The inaugural performance of endovascular revascularization (ER) for visceral vessels took place in 1980. […] Despite the limited quality of available evidence, the consensus among experts is strongly in favor of PMAS over PTA alone for the treatment of atherosclerotic mesenteric artery stenosis. […] There are several key areas of focus for chronic mesenteric ischemia (CMI) treatment. […] Well-designed randomized controlled trials comparing different stent types, such as covered stents versus bare metal stents, are needed to evaluate efficacy, patency rates, and long-term outcomes in CMI patients.

• #94 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Nonocclusive Mesenteric Ischemia: Ensure hemodynamic stability: fluid resuscitation and electrolytes, blood transfusion. Manage underlying cause (HF or sepsis). IV infusion of vasodilatory and antispasmodic agents can be used: Papaverine 60 mg bolus followed by infusion (30-60 mg/hr) with repeated angiograms obtained every 24 hours. Laparotomy when bowel necrosis is suspected. […] Long-term management: Aspirin lifelong in all patients who undergo endovascular or open repair. Clopidogrel for 1-3 months after endovascular repair. DOAC indicated in patients with atrial fibrillation, MVT. Lifestyle management: smoking cessation, exercise, manage dyslipidemia and hypertension.

• #95 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Endovascular revascularization procedures are the primary option in cases of arterial occlusion when sufficient expertise is available. […] Damage control surgery (DCS) with temporary abdominal closure is an important adjunct for patients who require intestinal resection allowing reassessment of bowel viability and in situations of severe abdominal sepsis. […] Mesenteric venous thrombosis can often be successfully treated with a continuous infusion of unfractionated heparin. […] When NOMI is suspected, the focus is to correct the underlying cause and improve mesenteric perfusion. Infarcted bowel should be resected promptly. […] Postoperative intensive care of AMI patients is directed toward the improved intestinal perfusion and the prevention of a multiple organ failure. […] Treatment of AMI is optimal in a dedicated center using a focused care bundle and a multidisciplinary team. […] Patients undergoing revascularization should have surveillance imaging and long-term anticoagulation.

• #96 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Endovascular revascularization procedures are the primary option in cases of arterial occlusion when sufficient expertise is available. […] Damage control surgery (DCS) with temporary abdominal closure is an important adjunct for patients who require intestinal resection allowing reassessment of bowel viability and in situations of severe abdominal sepsis. […] Mesenteric venous thrombosis can often be successfully treated with a continuous infusion of unfractionated heparin. […] When NOMI is suspected, the focus is to correct the underlying cause and improve mesenteric perfusion. Infarcted bowel should be resected promptly. […] Postoperative intensive care of AMI patients is directed toward the improved intestinal perfusion and the prevention of a multiple organ failure. […] Treatment of AMI is optimal in a dedicated center using a focused care bundle and a multidisciplinary team. […] Patients undergoing revascularization should have surveillance imaging and long-term anticoagulation.

• #97 Acute Mesenteric Ischemia – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/acute-mesenteric-ischemia

  Acute mesenteric ischemia is interruption of intestinal blood flow by embolism, thrombosis, or a low-flow state. […] Treatment is by embolectomy, revascularization of viable segments, or resection; sometimes vasodilator therapy is successful. […] Patients should be resuscitated with intravenous fluids to improve visceral perfusion. Broad-spectrum antibiotics should be initiated. […] If diagnosis is made during exploratory laparotomy, options are surgical embolectomy, revascularization, and resection. […] If diagnosis is made by angiography, infusion of the vasodilator papaverine through the angiography catheter may improve survival in nonocclusive ischemia. […] For arterial occlusion, thrombolysis or surgical embolectomy may be done. […] Patients with arterial embolism or venous thrombosis should be considered for long-term anticoagulation and dual antiplatelet therapy and surveillance for graft or stent patency. […] Treatment options include embolectomy, revascularization, and resection.

• #98 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Endovascular revascularization procedures are the primary option in cases of arterial occlusion when sufficient expertise is available. […] Damage control surgery (DCS) with temporary abdominal closure is an important adjunct for patients who require intestinal resection allowing reassessment of bowel viability and in situations of severe abdominal sepsis. […] Mesenteric venous thrombosis can often be successfully treated with a continuous infusion of unfractionated heparin. […] When NOMI is suspected, the focus is to correct the underlying cause and improve mesenteric perfusion. Infarcted bowel should be resected promptly. […] Postoperative intensive care of AMI patients is directed toward the improved intestinal perfusion and the prevention of a multiple organ failure. […] Treatment of AMI is optimal in a dedicated center using a focused care bundle and a multidisciplinary team. […] Patients undergoing revascularization should have surveillance imaging and long-term anticoagulation.

• #99 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Nonocclusive Mesenteric Ischemia: Ensure hemodynamic stability: fluid resuscitation and electrolytes, blood transfusion. Manage underlying cause (HF or sepsis). IV infusion of vasodilatory and antispasmodic agents can be used: Papaverine 60 mg bolus followed by infusion (30-60 mg/hr) with repeated angiograms obtained every 24 hours. Laparotomy when bowel necrosis is suspected. […] Long-term management: Aspirin lifelong in all patients who undergo endovascular or open repair. Clopidogrel for 1-3 months after endovascular repair. DOAC indicated in patients with atrial fibrillation, MVT. Lifestyle management: smoking cessation, exercise, manage dyslipidemia and hypertension.

• #100 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Endovascular revascularization procedures are the primary option in cases of arterial occlusion when sufficient expertise is available. […] Damage control surgery (DCS) with temporary abdominal closure is an important adjunct for patients who require intestinal resection allowing reassessment of bowel viability and in situations of severe abdominal sepsis. […] Mesenteric venous thrombosis can often be successfully treated with a continuous infusion of unfractionated heparin. […] When NOMI is suspected, the focus is to correct the underlying cause and improve mesenteric perfusion. Infarcted bowel should be resected promptly. […] Postoperative intensive care of AMI patients is directed toward the improved intestinal perfusion and the prevention of a multiple organ failure. […] Treatment of AMI is optimal in a dedicated center using a focused care bundle and a multidisciplinary team. […] Patients undergoing revascularization should have surveillance imaging and long-term anticoagulation.

• #101 Acute Mesenteric Ischemia – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/acute-mesenteric-ischemia

  Acute mesenteric ischemia is interruption of intestinal blood flow by embolism, thrombosis, or a low-flow state. […] Treatment is by embolectomy, revascularization of viable segments, or resection; sometimes vasodilator therapy is successful. […] Patients should be resuscitated with intravenous fluids to improve visceral perfusion. Broad-spectrum antibiotics should be initiated. […] If diagnosis is made during exploratory laparotomy, options are surgical embolectomy, revascularization, and resection. […] If diagnosis is made by angiography, infusion of the vasodilator papaverine through the angiography catheter may improve survival in nonocclusive ischemia. […] For arterial occlusion, thrombolysis or surgical embolectomy may be done. […] Patients with arterial embolism or venous thrombosis should be considered for long-term anticoagulation and dual antiplatelet therapy and surveillance for graft or stent patency. […] Treatment options include embolectomy, revascularization, and resection.

• #102 Ischemic Colitis: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24513-ischemic-colitis

  If you’re recovering from an acute episode of ischemic colitis, your healthcare provider will recommend no food at first. After that, you may transition to a liquid diet and eventually a soft diet. Avoid foods high in fiber for now. The idea is to make your intestines work as little as possible while they’re healing. Digestion requires more blood flow and oxygen to the area, while bowel rest gives your body the chance to restore that blood supply. If you have long-term (chronic) ischemic colitis or another chronic condition that predisposes you to ischemic colitis, your healthcare provider may give you specific long-term guidelines.

• #103 Ischemic Colitis: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/ibd-crohns-disease/ulcerative-colitis/facts-about-ischemic-colitis

  Ischemic colitis is the most common type of intestinal ischemia, or gut-based blood blockages. […] Most people with ischemic colitis have mild cases and recover well with treatment. […] If you have a mild case (and most cases are mild), the inner lining of your colon is inflamed, sore, and bleeding. It usually heals on its own within 1-2 weeks. […] People with ischemic colitis typically spend a few days in the hospital in the intensive care unit, where doctors can monitor your blood flow. It also helps your colon heal. While in the hospital, you may receive IV antibiotics to prevent infection. […] To give your colon a rest while it heals, you wont be able to drink or eat anything for a few days. Youll get IV fluids and electrolytes to keep you hydrated. Supplemental oxygen can also help your bowel to heal.

• #104 Ischemic Colitis: Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24513-ischemic-colitis

  If you’re recovering from an acute episode of ischemic colitis, your healthcare provider will recommend no food at first. After that, you may transition to a liquid diet and eventually a soft diet. Avoid foods high in fiber for now. The idea is to make your intestines work as little as possible while they’re healing. Digestion requires more blood flow and oxygen to the area, while bowel rest gives your body the chance to restore that blood supply. If you have long-term (chronic) ischemic colitis or another chronic condition that predisposes you to ischemic colitis, your healthcare provider may give you specific long-term guidelines.

• #105 Bowel Ischaemia | Doctor

  https://patient.info/doctor/bowel-ischaemia

  These patients have a five-year mortality of 40%, with the majority of deaths attributed to myocardial infarction or cardiovascular death. […] Symptomatic chronic mesenteric ischaemia (CMI) is an indication for either open or endovascular revascularisation, as patients with untreated symptomatic CMI carry a five-year mortality rate that approaches 100%. […] Nutrition is important in pre-operative assessment, as patients are often malnourished at the time of diagnosis; total parenteral nutrition may be necessary both pre- and postoperatively. […] The optimal revascularisation approach depends heavily on the anatomy and pre-operative condition of the patient. […] Renal failure is a common postoperative complication. […] […] […] Ischaemic colitis treatment10 […] Medical care

• #106 Bowel Ischaemia | Doctor

  https://patient.info/doctor/bowel-ischaemia

  These patients have a five-year mortality of 40%, with the majority of deaths attributed to myocardial infarction or cardiovascular death. […] Symptomatic chronic mesenteric ischaemia (CMI) is an indication for either open or endovascular revascularisation, as patients with untreated symptomatic CMI carry a five-year mortality rate that approaches 100%. […] Nutrition is important in pre-operative assessment, as patients are often malnourished at the time of diagnosis; total parenteral nutrition may be necessary both pre- and postoperatively. […] The optimal revascularisation approach depends heavily on the anatomy and pre-operative condition of the patient. […] Renal failure is a common postoperative complication. […] […] […] Ischaemic colitis treatment10 […] Medical care

• #107 Update in management of mesenteric ischemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4087969/

  Thrombolytic therapy in the management of intestinal ischemia was first reported in 1979 with the successful application of intraarterial streptokinase in the SMA. […] In the subset of patients who suffer from nonocclusive ischemia, intraarterial vasodilator therapy has been largely responsible for the decrease in mortality from 70% in the 1980s to 50%-55% during the last decade. […] Investigational therapy in the treatment of mesenteric ischemia has focused on pharmacologic strategies to treat mesenteric ischemia. […] The dual-hit hypothesis of ischemic injury is comprised of the initial hypoxic episode and then the subsequent reperfusion injury after reestablishment of forward flow. […] In conclusion, mesenteric ischemia, a spectrum of disorders with multiple etiologies still carries significant morbidity and mortality.

• #108

  https://link.springer.com/article/10.1007/s00384-020-03739-z

  Ischemic colitis (IC) is the most prevalent ischemic injury of the gastrointestinal tract. […] To comprehensively detail the current state of diagnostic methods and available drug therapies for detecting and treating IC, this review aims to provide a concise and practical summary of the corresponding literature. […] Most patients respond well to the conservative treatment, and surgical consultation is needed when conservative treatment is ineffective. […] Studies of potential drug therapy have been developed, including phosphodiesterase type 5 inhibitors, pentoxifylline, rebamipide, prostaglandin E1, and polydeoxyribonucleotide. […] Accurate diagnoses and effective treatments have helped reduce the mortality rate and improve prognoses for patients afflicted with IC, and corresponding drug therapies have been constantly updated as new research has emerged.

• #109

  https://link.springer.com/article/10.1007/s00384-020-03739-z

  Ischemic colitis (IC) is the most prevalent ischemic injury of the gastrointestinal tract. […] To comprehensively detail the current state of diagnostic methods and available drug therapies for detecting and treating IC, this review aims to provide a concise and practical summary of the corresponding literature. […] Most patients respond well to the conservative treatment, and surgical consultation is needed when conservative treatment is ineffective. […] Studies of potential drug therapy have been developed, including phosphodiesterase type 5 inhibitors, pentoxifylline, rebamipide, prostaglandin E1, and polydeoxyribonucleotide. […] Accurate diagnoses and effective treatments have helped reduce the mortality rate and improve prognoses for patients afflicted with IC, and corresponding drug therapies have been constantly updated as new research has emerged.

• #110

  https://link.springer.com/article/10.1007/s00384-020-03739-z

  Ischemic colitis (IC) is the most prevalent ischemic injury of the gastrointestinal tract. […] To comprehensively detail the current state of diagnostic methods and available drug therapies for detecting and treating IC, this review aims to provide a concise and practical summary of the corresponding literature. […] Most patients respond well to the conservative treatment, and surgical consultation is needed when conservative treatment is ineffective. […] Studies of potential drug therapy have been developed, including phosphodiesterase type 5 inhibitors, pentoxifylline, rebamipide, prostaglandin E1, and polydeoxyribonucleotide. […] Accurate diagnoses and effective treatments have helped reduce the mortality rate and improve prognoses for patients afflicted with IC, and corresponding drug therapies have been constantly updated as new research has emerged.

• #111

  https://link.springer.com/article/10.1007/s00384-020-03739-z

  Ischemic colitis (IC) is the most prevalent ischemic injury of the gastrointestinal tract. […] To comprehensively detail the current state of diagnostic methods and available drug therapies for detecting and treating IC, this review aims to provide a concise and practical summary of the corresponding literature. […] Most patients respond well to the conservative treatment, and surgical consultation is needed when conservative treatment is ineffective. […] Studies of potential drug therapy have been developed, including phosphodiesterase type 5 inhibitors, pentoxifylline, rebamipide, prostaglandin E1, and polydeoxyribonucleotide. […] Accurate diagnoses and effective treatments have helped reduce the mortality rate and improve prognoses for patients afflicted with IC, and corresponding drug therapies have been constantly updated as new research has emerged.

• #112

  https://link.springer.com/article/10.1007/s00384-020-03739-z

  Ischemic colitis (IC) is the most prevalent ischemic injury of the gastrointestinal tract. […] To comprehensively detail the current state of diagnostic methods and available drug therapies for detecting and treating IC, this review aims to provide a concise and practical summary of the corresponding literature. […] Most patients respond well to the conservative treatment, and surgical consultation is needed when conservative treatment is ineffective. […] Studies of potential drug therapy have been developed, including phosphodiesterase type 5 inhibitors, pentoxifylline, rebamipide, prostaglandin E1, and polydeoxyribonucleotide. […] Accurate diagnoses and effective treatments have helped reduce the mortality rate and improve prognoses for patients afflicted with IC, and corresponding drug therapies have been constantly updated as new research has emerged.

• #113

  https://link.springer.com/article/10.1007/s00384-020-03739-z

  Ischemic colitis (IC) is the most prevalent ischemic injury of the gastrointestinal tract. […] To comprehensively detail the current state of diagnostic methods and available drug therapies for detecting and treating IC, this review aims to provide a concise and practical summary of the corresponding literature. […] Most patients respond well to the conservative treatment, and surgical consultation is needed when conservative treatment is ineffective. […] Studies of potential drug therapy have been developed, including phosphodiesterase type 5 inhibitors, pentoxifylline, rebamipide, prostaglandin E1, and polydeoxyribonucleotide. […] Accurate diagnoses and effective treatments have helped reduce the mortality rate and improve prognoses for patients afflicted with IC, and corresponding drug therapies have been constantly updated as new research has emerged.

• #114

  https://journals.lww.com/shockjournal/fulltext/2024/05000/effects_of_hyperbaric_oxygen_therapy_on_intestinal.2.aspx

  Ischemia can cause reversible or irreversible cell or tissue damage, and reperfusion after ischemia not only has no therapeutic effect but also aggravates cell damage. […] Therefore, it is necessary to identify better therapeutic methods for relieving intestinal ischemia and hypoxia. Hyperbaric oxygenation refers to the intermittent inhalation of 100% oxygen in an environment greater than 1 atm pressure, which can better increase the oxygen level in the tissue and change the inflammatory pathway. […] Hyperbaric oxygen therapy (HBOT) is the application of hyperbaric oxygen and a hyperbaric environment to treat related diseases. […] HBOT has the therapeutic properties of reducing tissue hypoxia and pathological inflammation, and increasing new blood vessels, and it has great application prospects, by reducing ischemic damage, controlling inflammation, reducing oxidative stress, improving the process of cleaning damaged cells, and recruiting cells involved in repair.

• #115

  https://journals.lww.com/shockjournal/fulltext/2024/05000/effects_of_hyperbaric_oxygen_therapy_on_intestinal.2.aspx

  Current treatments for intestinal IR injury use antioxidants and antibiotics to repair the damage. […] Antioxidative free radicals are an important means of treating IR injury in the intestinal mucosal epithelial cells. […] Hyperbaric oxygen treatment reduced Gpx4 expression, suggesting a beneficial effect on oxidative stress due to a reduced demand for antioxidant responses due to the reduction of hyperbaric oxygen-induced reactive oxygen species (ROS). […] An increasing number of experts have confirmed that anticytokine and leukocyte therapies can bring considerable benefits to intestinal IR injury, and these findings also provide new insights into the management of intestinal IR injury. […] The application of hyperbaric oxygen to IR injury has broad prospects. Numerous studies have demonstrated that hyperbaric oxygen has powerful therapeutic effects against anti-inflammatory, tissue repair, angiogenesis, and anti-oxidative stress.

• #116 Update in management of mesenteric ischemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4087969/

  Thrombolytic therapy in the management of intestinal ischemia was first reported in 1979 with the successful application of intraarterial streptokinase in the SMA. […] In the subset of patients who suffer from nonocclusive ischemia, intraarterial vasodilator therapy has been largely responsible for the decrease in mortality from 70% in the 1980s to 50%-55% during the last decade. […] Investigational therapy in the treatment of mesenteric ischemia has focused on pharmacologic strategies to treat mesenteric ischemia. […] The dual-hit hypothesis of ischemic injury is comprised of the initial hypoxic episode and then the subsequent reperfusion injury after reestablishment of forward flow. […] In conclusion, mesenteric ischemia, a spectrum of disorders with multiple etiologies still carries significant morbidity and mortality.

• #117

  https://journals.lww.com/shockjournal/fulltext/2024/05000/effects_of_hyperbaric_oxygen_therapy_on_intestinal.2.aspx

  Current treatments for intestinal IR injury use antioxidants and antibiotics to repair the damage. […] Antioxidative free radicals are an important means of treating IR injury in the intestinal mucosal epithelial cells. […] Hyperbaric oxygen treatment reduced Gpx4 expression, suggesting a beneficial effect on oxidative stress due to a reduced demand for antioxidant responses due to the reduction of hyperbaric oxygen-induced reactive oxygen species (ROS). […] An increasing number of experts have confirmed that anticytokine and leukocyte therapies can bring considerable benefits to intestinal IR injury, and these findings also provide new insights into the management of intestinal IR injury. […] The application of hyperbaric oxygen to IR injury has broad prospects. Numerous studies have demonstrated that hyperbaric oxygen has powerful therapeutic effects against anti-inflammatory, tissue repair, angiogenesis, and anti-oxidative stress.

• #118 Update in management of mesenteric ischemia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4087969/

  Thrombolytic therapy in the management of intestinal ischemia was first reported in 1979 with the successful application of intraarterial streptokinase in the SMA. […] In the subset of patients who suffer from nonocclusive ischemia, intraarterial vasodilator therapy has been largely responsible for the decrease in mortality from 70% in the 1980s to 50%-55% during the last decade. […] Investigational therapy in the treatment of mesenteric ischemia has focused on pharmacologic strategies to treat mesenteric ischemia. […] The dual-hit hypothesis of ischemic injury is comprised of the initial hypoxic episode and then the subsequent reperfusion injury after reestablishment of forward flow. […] In conclusion, mesenteric ischemia, a spectrum of disorders with multiple etiologies still carries significant morbidity and mortality.

• #119

  https://link.springer.com/article/10.1007/s00423-010-0726-y

  Patients with acute mesenteric ischemia are still at highest risk for a fatal course of disease. New diagnostic and therapeutic developments have not been tested in larger studies yet, neither has any of these methods led to an increased survival in studies published so far. Taken together, mesenteric ischemia requires high awareness, earliest possible diagnosis, and treatment by an experienced interdisciplinary team of gastroenterologists, radiologists, and surgeons.

• #120 Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-022-00443-x

  Endovascular revascularization procedures are the primary option in cases of arterial occlusion when sufficient expertise is available. […] Damage control surgery (DCS) with temporary abdominal closure is an important adjunct for patients who require intestinal resection allowing reassessment of bowel viability and in situations of severe abdominal sepsis. […] Mesenteric venous thrombosis can often be successfully treated with a continuous infusion of unfractionated heparin. […] When NOMI is suspected, the focus is to correct the underlying cause and improve mesenteric perfusion. Infarcted bowel should be resected promptly. […] Postoperative intensive care of AMI patients is directed toward the improved intestinal perfusion and the prevention of a multiple organ failure. […] Treatment of AMI is optimal in a dedicated center using a focused care bundle and a multidisciplinary team. […] Patients undergoing revascularization should have surveillance imaging and long-term anticoagulation.

• #121

  https://link.springer.com/article/10.1007/s00423-010-0726-y

  Mesenteric ischemia is a condition well-known among physicians treating patients with abdominal symptoms. Even so, mortality rates have not decreased significantly over the last decades. The purpose of this article is to review current treatment concepts of acute and chronic mesenteric ischemia. […] Early diagnosis is one of the most important features that determine a patients prognosis. Conventional angiography and multidetector computed tomography are therefore appropriate to quickly diagnose mesenteric ischemia, the latter being commonly more available. Once a patient presents with signs of peritonitis, instant laparotomy is indicated, and infarcted bowel segments need to be resected, followed by a second-look operation if necessary. If bowel necrosis is clinically not suspected, different approaches should be applied according to source and nature of mesenteric ischemia. Besides established surgical treatment concepts, more and more interventional procedures are developed and evaluated. However, superiority of these new techniques could only be shown for selected patient groups so far. In chronic mesenteric ischemia, interventional approaches seem to be an attractive alternative in patients who are in a condition too bad to undergo surgery. Patients with colonic ischemia are treated best in a conservative manner and by resolving the underlying cause, if identified.

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