Clin Colon Rectal Surg 2024; 37(06): 417-423
DOI: 10.1055/s-0043-1777667
Review Artile

Mesenteric Ischemia

Christopher O. Audu
1   Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
,
David W. Schechtman
1   Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
,
Frank M. Davis
1   Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
› Author Affiliations
Funding None.

Abstract

Mesenteric ischemia occurs when perfusion of the visceral organs fails to meet normal metabolic requirements and subsequently results in abdominal symptoms such as diffuse postprandial pain, peritonitis, food fear, and weight loss. While generally divided into acute and chronic manifestations, mesenteric ischemia is commonly misdiagnosed at initial presentation due to the significant overlap with symptoms of other abdominal pathologies. Prompt recognition and diagnosis, mesenteric revascularization, and critical care management remain the mainstay of treatment in these patients for optimal outcomes. This review will highlight acute versus chronic mesenteric ischemia, their etiology, diagnostic criteria, treatment options, and will emphasize the joint role of the gastrointestinal and vascular surgeon in the timely management of this condition to prevent devastating outcomes.



Publication History

Article published online:
15 December 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Granger DN, Richardson PD, Kvietys PR, Mortillaro NA. Intestinal blood flow. Gastroenterology 1980; 78 (04) 837-863
  • 2 Rosenblum JD, Boyle CM, Schwartz LB. The mesenteric circulation. Anatomy and physiology. Surg Clin North Am 1997; 77 (02) 289-306
  • 3 Parks DA, Granger DN. Contributions of ischemia and reperfusion to mucosal lesion formation. Am J Physiol 1986; 250 (6, Pt 1): G749-G753
  • 4 Tilsed JV, Casamassima A, Kurihara H. et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg 2016; 42 (02) 253-270
  • 5 Granger DN, Höllwarth ME, Parks DA. Ischemia-reperfusion injury: role of oxygen-derived free radicals. Acta Physiol Scand Suppl 1986; 548: 47-63
  • 6 Adkison D, Höllwarth ME, Benoit JN, Parks DA, McCord JM, Granger DN. Role of free radicals in ischemia-reperfusion injury to the liver. Acta Physiol Scand Suppl 1986; 548: 101-107
  • 7 Grootjans J, Lenaerts K, Derikx JP. et al. Human intestinal ischemia-reperfusion-induced inflammation characterized: experiences from a new translational model. Am J Pathol 2010; 176 (05) 2283-2291
  • 8 Stoney RJ, Cunningham CG. Acute mesenteric ischemia. Surgery 1993; 114 (03) 489-490
  • 9 Zettervall SL, Lo RC, Soden PA. et al. Trends in treatment and mortality for mesenteric ischemia in the United States from 2000 to 2012. Ann Vasc Surg 2017; 42: 111-119
  • 10 Ryer EJ, Kalra M, Oderich GS. et al. Revascularization for acute mesenteric ischemia. J Vasc Surg 2012; 55 (06) 1682-1689
  • 11 Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Arch Intern Med 2004; 164 (10) 1054-1062
  • 12 Endean ED, Barnes SL, Kwolek CJ, Minion DJ, Schwarcz TH, Mentzer Jr RM. Surgical management of thrombotic acute intestinal ischemia. Ann Surg 2001; 233 (06) 801-808
  • 13 Acosta S. Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg 2010; 23 (01) 4-8
  • 14 Acosta S, Ogren M, Sternby NH, Bergqvist D, Björck M. Clinical implications for the management of acute thromboembolic occlusion of the superior mesenteric artery: autopsy findings in 213 patients. Ann Surg 2005; 241 (03) 516-522
  • 15 Boley SJ, Feinstein FR, Sammartano R, Brandt LJ, Sprayregen S. New concepts in the management of emboli of the superior mesenteric artery. Surg Gynecol Obstet 1981; 153 (04) 561-569
  • 16 Schoots IG, Koffeman GI, Legemate DA, Levi M, van Gulik TM. Systematic review of survival after acute mesenteric ischaemia according to disease aetiology. Br J Surg 2004; Jan; 91 (01) 17-27
  • 17 Howard TJ, Plaskon LA, Wiebke EA, Wilcox MG, Madura JA. Nonocclusive mesenteric ischemia remains a diagnostic dilemma. Am J Surg 1996; 171 (04) 405-408
  • 18 Wilcox MG, Howard TJ, Plaskon LA, Unthank JL, Madura JA. Current theories of pathogenesis and treatment of nonocclusive mesenteric ischemia. Dig Dis Sci 1995; 40 (04) 709-716
  • 19 McNeill JR, Stark RD, Greenway CV. Intestinal vasoconstriction after hemorrhage: roles of vasopressin and angiotensin. Am J Physiol 1970; 219 (05) 1342-1347
  • 20 Brunaud L, Antunes L, Collinet-Adler S. et al. Acute mesenteric venous thrombosis: case for nonoperative management. J Vasc Surg 2001; 34 (04) 673-679
  • 21 Morasch MD, Ebaugh JL, Chiou AC, Matsumura JS, Pearce WH, Yao JS. Mesenteric venous thrombosis: a changing clinical entity. J Vasc Surg 2001; 34 (04) 680-684
  • 22 Gorgun E, Sapci I, Onder A. et al. Factors associated with portomesenteric venous thrombosis after total colectomy with ileorectal anastomosis or end ileostomy. Am J Surg 2018; 215 (01) 62-65
  • 23 Acosta S, Nilsson TK, Björck M. D-dimer testing in patients with suspected acute thromboembolic occlusion of the superior mesenteric artery. Br J Surg 2004; 91 (08) 991-994
  • 24 Menke J. Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis. Radiology 2010; 256 (01) 93-101
  • 25 Milner R, Woo EY, Carpenter JP. Superior mesenteric artery angioplasty and stenting via a retrograde approach in a patient with bowel ischemia: a case report. Vasc Endovascular Surg 2004; 38 (01) 89-91
  • 26 Wyers MC, Powell RJ, Nolan BW, Cronenwett JL. Retrograde mesenteric stenting during laparotomy for acute occlusive mesenteric ischemia. J Vasc Surg 2007; 45 (02) 269-275
  • 27 Mitchell EL, Moneta GL. Mesenteric duplex scanning. Perspect Vasc Surg Endovasc Ther 2006; 18 (02) 175-183
  • 28 Kolkman JJ, Bargeman M, Huisman AB, Geelkerken RH. Diagnosis and management of splanchnic ischemia. World J Gastroenterol 2008; 14 (48) 7309-7320
  • 29 Gallavan Jr RH, Chou CC. Possible mechanisms for the initiation and maintenance of postprandial intestinal hyperemia. Am J Physiol 1985; 249 (3, Pt 1): G301-G308
  • 30 Thomas JH, Blake K, Pierce GE, Hermreck AS, Seigel E. The clinical course of asymptomatic mesenteric arterial stenosis. J Vasc Surg 1998; 27 (05) 840-844
  • 31 Moneta GL, Lee RW, Yeager RA, Taylor Jr LM, Porter JM. Mesenteric duplex scanning: a blinded prospective study. J Vasc Surg 1993; 17 (01) 79-84 , discussion 85–86
  • 32 Bowersox JC, Zwolak RM, Walsh DB. et al. Duplex ultrasonography in the diagnosis of celiac and mesenteric artery occlusive disease. J Vasc Surg 1991; 14 (06) 780-786 , discussion 786–788
  • 33 Zwolak RM, Fillinger MF, Walsh DB. et al. Mesenteric and celiac duplex scanning: a validation study. J Vasc Surg 1998; 27 (06) 1078-1087 , discussion 1088
  • 34 Oderich GS, Gloviczki P, Bower TC. Open surgical treatment for chronic mesenteric ischemia in the endovascular era: when it is necessary and what is the preferred technique?. Semin Vasc Surg 2010; 23 (01) 36-46
  • 35 Wildermuth S, Leschka S, Alkadhi H, Marincek B. Multislice CT in the pre- and postinterventional evaluation of mesenteric perfusion. Eur Radiol 2005; 15 (06) 1203-1210
  • 36 Baden JG, Racy DJ, Grist TM. Contrast-enhanced three-dimensional magnetic resonance angiography of the mesenteric vasculature. J Magn Reson Imaging 1999; 10 (03) 369-375
  • 37 Hagspiel KD, Leung DA, Angle JF. et al. MR angiography of the mesenteric vasculature. Radiol Clin North Am 2002; 40 (04) 867-886
  • 38 Li KC, Dalman RL, Wright GA. In vivo flow-independent T2 measurements of superior mesenteric vein blood in diagnosis of chronic mesenteric ischemia: a preliminary evaluation. Acad Radiol 1999; 6 (09) 530-534
  • 39 Rheudasil JM, Stewart MT, Schellack JV, Smith III RB, Salam AA, Perdue GD. Surgical treatment of chronic mesenteric arterial insufficiency. J Vasc Surg 1988; 8 (04) 495-500
  • 40 Mueller C, Borriello R, Perlov-Antzis L. Parenteral nutrition support of a patient with chronic mesenteric artery occlusive disease. Nutr Clin Pract 1993; 8 (02) 73-77
  • 41 Huber TS, Björck M, Chandra A. et al. Chronic mesenteric ischemia: Clinical practice guidelines from the Society for Vascular Surgery. J Vasc Surg 2021; 73 (1S): 87S-115S
  • 42 Schermerhorn ML, Giles KA, Hamdan AD, Wyers MC, Pomposelli FB. Mesenteric revascularization: management and outcomes in the United States, 1988-2006. J Vasc Surg 2009; 50 (02) 341-348.e1
  • 43 Oderich GS, Bower TC, Sullivan TM, Bjarnason H, Cha S, Gloviczki P. Open versus endovascular revascularization for chronic mesenteric ischemia: risk-stratified outcomes. J Vasc Surg 2009; 49 (06) 1472-9.e3
  • 44 Atkins MD, Kwolek CJ, LaMuraglia GM, Brewster DC, Chung TK, Cambria RP. Surgical revascularization versus endovascular therapy for chronic mesenteric ischemia: a comparative experience. J Vasc Surg 2007; 45 (06) 1162-1171
  • 45 van Petersen AS, Kolkman JJ, Beuk RJ, Huisman AB, Doelman CJ, Geelkerken RH. Multidisciplinary Study Group Of Splanchnic Ischemia. Open or percutaneous revascularization for chronic splanchnic syndrome. J Vasc Surg 2010; 51 (05) 1309-1316