Acute Mesenteric Ischemia

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Acute Mesenteric Ischemia


Introduction

Acute mesenteric ischemia (AMI) refers to the sudden reduction of intestinal perfusion, which can be due to occlusive or nonocclusive obstruction of arterial or venous blood fl ow. AMI is a potentially fatal vascular emergency with overall mortality of 60% to 80%, and its reported incidence is increasing [ 1–5 ]. Of those surviving, 20% to 60% develop short gut syndrome. The common end point in AMI is a pathophysiologic process that results in bowel ischemia and/ or necrosis. Despite advances in diagnosis and treatment, the survival rate has not improved substantially during the past 70 years due to continued diffi culty in recognizing the condition before bowel infarction occurs. The clinical presentation is nonspecifi c in most cases. Classically, AMI is characterized by severe pain out of proportion to physical examination fi ndings. Physical examination does not reliably differentiate between ischemic and infarcted bowel. Patients frequently present with symptoms compatible with other diagnoses, such as ileus, peritonitis, pancreatitis, or diverticulitis. The risk factors for AMI and the clinical course differ depending on the underlying etiology . As bowel ischemia progresses, severe metabolic derangements ensue. If they are not addressed early in the clinical course, they lead to a series of events culminating in multiple organ dysfunction and death. The timely use of diagnostic and therapeutic methods to quickly restore blood fl ow is paramount in reducing the high mortality rate associated with AMI.

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