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<p>Acute mesenteric ischemia (AMI) is a&#xa0;time-critical vascular emergency associated with persistently high morbidity and mortality. Although the clinical presentation is often unspecific, the disease can lead to transmural bowel necrosis, sepsis, multiorgan failure and death within a very short time. The particular diagnostic challenge lies in the fact that early clinical and laboratory findings can be misleading: severe abdominal pain can occur without peritoneal signs and serum lactate is not a&#xa0;reliable early diagnostic marker. Likewise, computed tomography (CT) signs such as pneumatosis intestinalis, portomesenteric gas, free fluid or absent bowel wall contrast enhancement are often indicative of an already advanced ischemia.</p><p>Modern management of AMI is increasingly based on computed tomography angiography, endovascular recanalization, open revascularization and hybrid techniques, such as retrograde open mesenteric stenting (ROMS). Thus, treatment has shifted from laparotomy alone toward a&#xa0;reperfusion-based concept. Visceral surgical expertise remains essential for assessment of bowel viability, resection of irreversibly damaged intestinal sections, second-look procedures and management of abdominal complications; however, the initial therapeutic strategy should address the vascular cause: localization and morphology of the occlusion, recanalization potential, access route, endovascular or hybrid treatment options and bail-out strategies.</p><p>The AMI should therefore be understood primarily as a&#xa0;vascular salvage situation. An optimal care is interdisciplinary but must be carried out in structures that enable immediate vascular and endovascular surgical assessment and treatment. After vascular reconstruction visceral surgical aspects are mostly predominant.</p>

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Akute mesenteriale Ischämie: Warum vaskuläre Expertise entscheidend ist

  • 期刊论文

  • 发表日期：

    2026年6月23日

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  • Axel Larena-Avellaneda

摘要

Acute mesenteric ischemia (AMI) is a time-critical vascular emergency associated with persistently high morbidity and mortality. Although the clinical presentation is often unspecific, the disease can lead to transmural bowel necrosis, sepsis, multiorgan failure and death within a very short time. The particular diagnostic challenge lies in the fact that early clinical and laboratory findings can be misleading: severe abdominal pain can occur without peritoneal signs and serum lactate is not a reliable early diagnostic marker. Likewise, computed tomography (CT) signs such as pneumatosis intestinalis, portomesenteric gas, free fluid or absent bowel wall contrast enhancement are often indicative of an already advanced ischemia.

Modern management of AMI is increasingly based on computed tomography angiography, endovascular recanalization, open revascularization and hybrid techniques, such as retrograde open mesenteric stenting (ROMS). Thus, treatment has shifted from laparotomy alone toward a reperfusion-based concept. Visceral surgical expertise remains essential for assessment of bowel viability, resection of irreversibly damaged intestinal sections, second-look procedures and management of abdominal complications; however, the initial therapeutic strategy should address the vascular cause: localization and morphology of the occlusion, recanalization potential, access route, endovascular or hybrid treatment options and bail-out strategies.

The AMI should therefore be understood primarily as a vascular salvage situation. An optimal care is interdisciplinary but must be carried out in structures that enable immediate vascular and endovascular surgical assessment and treatment. After vascular reconstruction visceral surgical aspects are mostly predominant.