Die akute mesenteriale Ischämie: Resektion oder Rekonstruktion?
Abstract
Acute mesenteric ischemia represents an intensive medical emergency which, when untreated, leads to sepsis and multiorgan failure. Predictive factors for survival are the time duration between onset of symptoms and therapy, etiology,patient age, and immediate therapy with anticoagulants in case of acute mesenteric thrombosis. Pathologically raised laboratory parameters (lactate, acidosis, leukocytosis) are signs of advanced mesenteric ischemia. Therapy aims at reinstating arterial perfusion of ischemic and potentially life-threatening intestinal regions and at avoiding further ischemias or infarctions. Immediate vessel reconstruction (embolectomy, thrombectomy,TEA,bypass) can prevent mesenteric infarction and is therefore preferable to intestinal resection alone, as long as irreversible ischemia or sepsis are not present. If the degree of reperfusion is in question, the indication for "second-look laparotomy" is to be used generously.
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In older published studies, thromboembolic occlusions were the most common etiology with 35-45%.
“In older published studies, thromboembolic occlusions were the most common etiology with 35–45% [15, 16].”
From Results after intraoperative open and endovascular revascularization of acute mesenteric ischemia requiring a laparotomy (2023) · cites this paper as [15]
Eckstein et al. mentioned the increased use of anticoagulants, the decreasing incidence of rheumatic valvular diseases, and the higher incidence of degenerative vascular diseases in the rising average age of the population as reasons for the increase in arteriosclerotic occlusions.
“As reasons for this Eckstein et al. mentioned the increased use of anticoagulants and the decreasing incidence of rheumatic valvular diseases as well as the higher incidence of degenerative vascular diseases in the rising average age of the population [15].”
From Results after intraoperative open and endovascular revascularization of acute mesenteric ischemia requiring a laparotomy (2023) · cites this paper as [15]
The SMA was occluded in all patients.
“In accordance with the literature, the SMA was occluded in all patients [15, 17].”
From Results after intraoperative open and endovascular revascularization of acute mesenteric ischemia requiring a laparotomy (2023) · cites this paper as [15]
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Cited by 54
- Authors
- Eckstein, H.-H.
- Affiliations
- Klinikum Ludwigsburg (DE)
- Corresponding author
- Eckstein, H.-H.
- ORCID
- Eckstein, H.-H.
- Venue
- Der Chirurg
- Published
- 2003-05
- Volume
- 74
- Issue
- 5
- Pages
- 419-431
- ISSN
- 0009-4722 (ISSN-L)
- OpenAlex
- W123306349
- Cited by
- 54
- References
- 0
- Citations by year
- 2025: 1 · 2023: 4 · 2022: 1 · 2021: 3 · 2020: 1 · 2019: 3 · 2017: 2 · 2016: 3 · 2015: 1 · 2014: 4 · 2013: 3 · 2012: 2
- FWCI
- 3.20
- Type
- journal article
- Language
- de
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Der Chirurg (publishedVersion)
- PubMed (publishedVersion)
- mediaTUM (Technical University of Munich) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
- Keywords
- acute mesenteric ischemia, mesenteric thrombosis, mesenteric infarction, sepsis, multiple organ failure, prognostic factors, lactate, acidosis, leukocytosis, anticoagulation, embolectomy, thrombectomy, bypass, second-look laparotomy, reperfusion, bowel resection
- MeSH terms
- Abdomen, Acute, Emergencies, Humans, Infarction, Intestines, Ischemia, Mesenteric Vascular Occlusion, Prognosis, Embolectomy, Thrombectomy
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