A surgical approach to acute mesenteric ischemia

Bowel ischemia may arise from a number of causes affecting the arterial and venous compartments of the mesenteric circulation. The rapid onset of acute mesenteric ischemia and the potential rapidity with which bowel infarction may occur explain the lethality of this disease. This review addresses the causes and consequences of arterial obstruction, focusing on the acute phenomenon of mesenteric ischemia. Therapeutic strategies are dependent on reversible or irreversible ischemic damage on bowel integrity. Surgery is far the most favorable treatment, as it includes the assessment of intestinal viability, determination or conformation of the underlying cause, revascularization, and resection of the nonviable intestine. A variety of operative procedures are described to restore blood flow and secure the viability of the remaining bowel. In this context, a number of new treatment modalities are reported, which have been introduced in the last decades of the previous century. These treatment modalities may benefit a certain population of patients with acute mesenteric artery occlusion and may improve outcome of this lethal disease.