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Cited by 35Abdominal vascular conditions and treatmentsAppendicitis Diagnosis and ManagementIntestinal and Peritoneal Adhesions

Management of acute mesenteric ischaemia: Results of a worldwide survey

Open access
Hess, Benjamin, Cahenzli, Martin, Forbes, Alastair, Burgos, Rosa, Coccolini, Federico, Corcos, Olivier, Holst, Mette, Irtun, Øivind +97 more·2023·Clinical Nutrition ESPEN
DOI 10.1016/j.clnesp.2022.12.022
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Abstract

BACKGROUND: Acute mesenteric ischaemia (AMI) is a condition with high mortality. This survey assesses current attitudes and practices to manage AMI worldwide. METHODS: A questionnaire survey about the practices of diagnosing and managing AMI, endorsed by several specialist societies, was sent to different medical specialists and hospitals worldwide. Data from individual health care professionals and from medical teams were collected. RESULTS: We collected 493 individual forms from 71 countries and 94 team forms from 34 countries. Almost half of respondents were surgeons, and most of the responding teams (70%) were led by surgeons. Most of the respondents indicated that diagnosis of AMI is often delayed but rarely missed. Emergency revascularisation is often considered for patients with AMI but rarely in cases of transmural ischaemia (intestinal infarction). Responses from team hospitals with a dedicated special unit (14 team forms) indicated more aggressive revascularisation. Abdominopelvic CT-scan with intravenous contrast was suggested as the most useful diagnostic test, indicated by approximately 90% of respondents. Medical history and risk factors were thought to be more important in diagnosis of AMI without transmural ischaemia, whereas for intestinal infarction, plasma lactate concentrations and surgical exploration were considered more useful. In elderly patients, a palliative approach is often chosen over extensive bowel resection. There was a large variability in anticoagulant treatment, as well as in timing of surgery to restore bowel continuity. CONCLUSIONS: Delayed diagnosis of AMI is common despite wide availability of an adequate imaging modality, i.e. CT-scan. Large variability in treatment approaches exists, indicating the need for updated guidelines. Increased awareness and knowledge of AMI may improve current practice until more robust evidence becomes available. Adherence to the existing guidelines may help in improving differences in treatment and outcomes.

AI snapshot

Written from the paper’s full text.

TL;DR

This worldwide survey of clinicians and hospital teams found that acute mesenteric ischaemia (AMI) diagnosis is often delayed despite wide availability of contrast-enhanced CT, and that management varies widely. Dedicated special units reported more aggressive revascularisation, while age strongly influenced decisions between curative resection and palliative care.

Key findings

  • The survey collected 493 individual forms from 71 countries and 94 team forms from 34 countries; most respondents were surgeons (individuals 47%, team responders 45%), and 70% of teams were led by surgeons.
  • Abdominopelvic CT with intravenous contrast was considered the most useful diagnostic test by approximately 90% of respondents; for ischaemia it was cited by 85% of individuals vs 96% of teams, and for infarction by 92% vs 93%.
  • Emergency revascularisation was often considered for AMI without infarction (46% of teams vs 31% of individuals) but rarely for transmural ischaemia/infarction (37% of individuals and 42% of teams indicated patients with mesenteric infarction rarely undergo emergency revascularisation).
  • In a hypothetical 80-year-old with extensive bowel infarction, palliative management was chosen by 44% of individuals and 70% of teams; in a 45-year-old, bowel resection with planned second-look surgery was chosen by 49% of individuals and 77% of teams.

Methods

  • A questionnaire survey on diagnosis and management of AMI was distributed worldwide through endorsing societies, with separate Individual and Team forms; individual responses were collected 1 April–30 June 2021 and team responses 1 October–31 December 2021.
  • The team survey was sent to 287 hospitals in 61 countries; 95 replies were received (response rate 33%), and after clearing 9 duplicates, 493 individual responses from 71 countries were analysed.
  • Data were analysed descriptively using SPSS Version 25; no patient data were involved and formal ethical approval was waived.

Limitations

  • Stated in the paper: most individual and completed team surveys came from European centres, so representative intercontinental comparison was not feasible and overall results may not apply to other countries or continents.
  • Stated in the paper: a high percentage of respondents were surgeons and surgeon-led teams, preventing meaningful comparative analysis of treatment considerations by different specialties; respondents likely had a special interest in AMI and may be overrepresented.
  • Evident from the text: the survey captures reported attitudes and practices rather than actual clinical outcomes, and the team response rate was 33%, so selection and response bias are possible.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.clnesp.2022.12.022

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 31 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    According to individual replies patients with AMI were most commonly managed in the ICU, HDU and surgical wards, followed by combined medical/surgical wards and medical wards.

    “According to individual replies patients with AMI were most commonly managed in the ICU (intensive care unit), HDU (high dependency unit) and surgical wards, followed by combined medical/surgical wards and medical wards”
    Quote in the paperNot a substantial claim
  • Findingown data

    The main reason to start antibiotics was diagnosis of mesenteric ischaemia (37%).

    “The main reason to start antibiotics was diagnosis of mesenteric ischaemia (37%), while unstable haemodynamics or elevated inflammation markers were not a part of this decision-making process.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In 70% of the teams the general surgeon had the lead.

    “in 70% of the teams the general surgeon had the lead.”
    Quote in the paperNot a substantial claim
  • Findingown data

    There was large variability in anticoagulant treatment.

    “There was a large variability in anticoagulant treatment, as well as in timing of surgery to restore bowel continuity.”
    Quote in the paperSubstantial claim
  • Findingown data

    Large variability in treatment approaches exists.

    “Large variability in treatment approaches exists, indicating the need for updated guidelines.”
    Quote in the paperSubstantial claim
  • May combine two claims. 40
  • Classified as probably not a substantial claim. 21

  • May combine two claims.

    Findingown data

    If angioplasty and/or bypass surgery is not performed at the respondent's hospital, 44% of the individual respondents but only 11% of the teams would refer patients to another hospital.

    “If angioplasty and/or bypass surgery is not performed at the respondent's hospital, 44% of the individual respondents but only 11% of the teams would refer patients to another hospital.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In 18% of cases teams were created solely to complete this survey.

    “In 18% of cases teams were created solely to complete this survey.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Around one third of respondents felt that the diagnosis of AMI was often missed.

    “However, around one third of respondents still felt that the diagnosis was often missed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most participants were employed at a university or teaching hospital (60% of individuals, 73% of teams).

    “most were employed at a university or teaching hospital (60% of individuals, 73% of teams)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Medical history and risk factors were thought to be more important in diagnosis of AMI without transmural ischaemia, whereas for intestinal infarction, plasma lactate concentrations and surgical exploration were considered more useful.

    “Medical history and risk factors were thought to be more important in diagnosis of AMI without transmural ischaemia, whereas for intestinal infarction, plasma lactate concentrations and surgical exploration were considered more useful.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    46% of the teams (but only 31% of individual respondents) indicated that an emergency revascularisation procedure is often performed in their hospital in patients with mesenteric ischaemia which has not yet progressed to infarction.

    “At the same time, 46% of the teams (but only 31% of individual respondents) indicated that an emergency revascularisation procedure is often performed in their hospital in patients with mesenteric ischaemia which has not yet progressed to infarction”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most respondents indicated that diagnosis of AMI is often delayed but rarely missed.

    “Most of the respondents indicated that diagnosis of AMI is often delayed but rarely missed.”
    • Also stated in: § 3.3. Emergency services management · plain
      “Most of respondents answered that the diagnosis of AMI is often delayed but rarely missed, as shown in Fig. 1.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In patients with mesenteric ischaemia not yet progressed to infarction, 46% of teams and 31% of individual respondents indicated that emergency revascularisation is often performed.

    “At the same time, 46% of the teams (but only 31% of individual respondents) indicated that an emergency revascularisation procedure is often performed in their hospital in patients with mesenteric ischaemia which has not yet progressed to infarction”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Contrast-enhanced ultrasound, the use of ICG, and of CT scan without contrast media are rarely considered.

    “A contrast-enhanced ultrasound, the use of ICG, and of CT scan without contrast media are rarely considered.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Emergency revascularisation is often considered for patients with AMI but rarely in cases of transmural ischaemia (intestinal infarction).

    “Emergency revascularisation is often considered for patients with AMI but rarely in cases of transmural ischaemia (intestinal infarction).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Almost half of respondents were surgeons.

    “Almost half of respondents were surgeons, and most of the responding teams (70%) were led by surgeons.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    21% of the teams meet daily, 21% once per week and the rest less frequently.

    “21% of the teams meet daily, 21% once per week and the rest less frequently.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Antibiotic therapy is considered by 60% of team respondents and by 57% of special units.

    “Antibiotic therapy is considered by 60% of team respondents and by 57% of special units.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most participants were surgeons (individuals: 47%; team responders: 45%).

    “Most of the participants were surgeons (individuals: 47%; team responders: 45%)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The team survey received 95 replies from 287 invited sites, a response rate of 33%.

    “For the team survey, from 287 invited sites we received 95 replies (response rate 33%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Therapeutic anticoagulation was a treatment option described by 68% of team respondents and 64% of special units.

    “Therapeutic anticoagulation was a treatment option described by 68% of team respondents and 64% of special units”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    There was a high percentage of European and especially Italian teams (32%) participating.

    “Overall, there was a high percentage of European and especially Italian teams (32%) participating.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Almost all respondents (individual 97%; team responders 99%) were personally involved in the management of AMI patients.

    “Almost all respondents (individual 97%; team responders 99%) were personally involved in the management of AMI patients”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    A history of postprandial abdominal pain, unintentional weight loss and the presence of cardiovascular risk factors are perceived to be most helpful in diagnosis of ischaemia.

    “A history of postprandial abdominal pain, unintentional weight loss and the presence of cardiovascular risk factors are perceived to be most helpful in diagnosis of ischaemia”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Platelet aggregation inhibitors were described by 70% of team respondents and 86% of special units.

    “whereas the respective numbers for platelet aggregation inhibitors were 70% and 86%.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The survey collected 493 individual responses from 71 countries.

    “We collected 493 individual forms from 71 countries and 94 team forms from 34 countries.”
    • Also stated in: § 3.1. General · plain
      “After clearing 9 duplicates, 493 responses from 71 countries were analysed (Supplement Fig. 1).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    AMI patients are managed in different hospital units, although admission to surgical wards and ICU or high-care units is often preferred.

    “AMI patients are managed in different hospital units, although admission to surgical wards and ICU or high-care units is often preferred.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    69% of all teams (86% of special units) considered anti-aggregation therapy in ischaemia and 49% of all teams (57% of special units) in infarction.

    “69% of all teams (86% of the special units) considered anti-aggregation therapy in ischaemia and 49% of all teams (57% of the special units) in infarction.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Based on the survey results, computed tomography with intravenous contrast is recognized to be the most useful element in diagnosing AMI and is widely available.

    “Based on our results, computed tomography with intravenous contrast is recognized to be the most useful element in diagnosing AMI and is widely available.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    After bowel resection, 29% of individual respondents and 26% of teams would not reconsider arterial revascularisation if it had not been performed before.

    “After bowel resection, 40% of the individuals and 56% of the teams would reconsider arterial revascularisation, if not performed before, whereas 29% of the individuals and 26% of the teams would not.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    A high percentage of respondents were surgeons and surgeon-led teams.

    “A high percentage of respondents were surgeons and surgeon-led teams.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Extended intestinal resection is favored by most participants when signs of extensive necrosis are present, but primary diagnostic laparoscopy is also frequently considered.

    “Extended intestinal resection is favored by most participants when signs of extensive necrosis are present, but primary diagnostic laparoscopy is also frequently considered.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Enteroclysis in the case of a distal mucus fistula is considered by 20% of individual respondents and 25% of team respondents.

    “Enteroclysis in the case of a distal mucus fistula is considered by 20% of the individual and 25% of the team respondents.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For an 80-year-old patient with extensive small and large bowel infarction and no other comorbidities affecting life expectancy, 44% of individual respondents and 70% of teams considered starting a palliative process.

    “In the 80-year-old patient, individuals considered starting a palliative process in 44% as did 70% of teams.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The decision to perform enteroclysis in the case of a distal mucus fistula seems to be dependent on the length of residual downstream bowel (32% individuals / 45% teams) and the absence of distal strictures (30% individuals / 40% teams), while the arterial blood supply is less often evaluated.

    “This decision seems to be dependent on the length of residual downstream bowel (32%/ 45%) and the absence of distal strictures (30%/40%), while the arterial blood supply is less often evaluated.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    After bowel resection, 40% of individual respondents and 56% of teams would reconsider arterial revascularisation if it had not been performed before.

    “After bowel resection, 40% of the individuals and 56% of the teams would reconsider arterial revascularisation, if not performed before, whereas 29% of the individuals and 26% of the teams would not.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For diagnosis of NOMI, 97% of the teams but only 61% of individual respondents consider a CT-scan with contrast media to be useful.

    “For diagnosis of NOMI, 97% of the teams but only 61% of individual respondents consider a CT-scan with contrast media to be useful”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    68% of all teams (64% of special units) considered anticoagulation therapy in ischaemia and 61% (57% of special units) in infarction.

    “68% of all teams (64% of the special units) considered anticoagulation therapy in ischaemia and 61% (57% of the special units) in infarction.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Platelet aggregation inhibitors are considered more often in arterial thrombosis (50%) than in arterial embolism (35%), with less frequent use in other forms of AMI.

    “Platelet aggregation inhibitors are considered more often in arterial thrombosis (50%) than in arterial embolism (35%), with less frequent use in other forms of AMI.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Both therapeutic anticoagulation and platelet aggregation inhibitors are rarely considered in NOMI.

    “Both are rarely considered in NOMI.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Diagnostic laparoscopy and surgical revascularisation are more often considered in patients with intestinal infarction than medical or endovascular therapy.

    “Further, diagnostic laparoscopy and surgical revascularisation are more often considered in patients with intestinal infarction than medical or endovascular therapy.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Platelet aggregation inhibitors are generally recommended lifelong.

    “whereas platelet aggregation inhibitors (Fig. 5) are generally recommended lifelong.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Contrast-enhanced ultrasound (CEUS) and indocyanine green (ICG) are rarely used (3% and 7%, respectively).

    “contrast-enhanced ultrasound (CEUS) and indocyanine green (ICG) are rarely used (3% and 7%, respectively).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    AMI is a multidisciplinary emergency, requiring involvement of several different medical specialties.

    “Acute mesenteric ischaemia (AMI) is a multidisciplinary emergency, requiring involvement of several different medical specialties [1,2].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [1] Zientara, 2021, Interdisciplinary approach in emergency revascularization and treatment for acute mesenteric ischemia, BMC Surg source

      Not checked in the free run.

    • cites [2] Roussel, 2015, Revascularization of acute mesenteric ischemia after creation of a dedicated multidisciplinary center, J Vasc Surg source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The incidence of AMI increases exponentially with age and comorbidities.

    “The incidence of AMI increases exponentially with age and comorbidities [9e11] making it more common in the elderly.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9e11]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There are few recommendations and no general consensus regarding the use and timing of antibiotics, therapeutic anticoagulation, anti-aggregation, most appropriate nutrition and best revascularisation strategies.

    “There are few recommendations and no general consensus regarding the use and timing of antibiotics, therapeutic anticoagulation, anti-aggregation, most appropriate nutrition and best revascularisation strategies [3,4].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [3] Bala, 2017, Acute mesenteric ischemia: guidelines of the world society of emergency surgery, World J Emerg Surg source

      Not checked in the free run.

    • cites [4] Björck, 2017, Editor’s choice – management of the diseases of mesenteric arteries and veins: clinical practice guidelines of the European society of vascular surgery (ESVS), Eur J Vasc Endovasc Surg source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The 2017 WSES and ESVS guidelines disagree regarding the definition of AMI and on whether to include or exclude large bowel ischaemia.

    “These guidelines disagree regarding the definition of AMI and on whether to include or exclude large bowel ischaemia but agree that early diagnosis and prompt revascularisation is essential to reduce mortality and bowel resection rates.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [3] Bala, 2017, Acute mesenteric ischemia: guidelines of the world society of emergency surgery, World J Emerg Surg source

      Not checked in the free run.

    • cites [4] Björck, 2017, Editor’s choice – management of the diseases of mesenteric arteries and veins: clinical practice guidelines of the European society of vascular surgery (ESVS), Eur J Vasc Endovasc Surg source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The World Society of Emergency Surgery and the European Society for Vascular Surgery each released their first guidelines for the management of AMI in 2017.

    “Attempting to improve patient care, the World Society of Emergency Surgery and the European Society for Vascular Surgery each released their first guidelines for the management of AMI in 2017 [3,4].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [3] Bala, 2017, Acute mesenteric ischemia: guidelines of the world society of emergency surgery, World J Emerg Surg source

      Not checked in the free run.

    • cites [4] Björck, 2017, Editor’s choice – management of the diseases of mesenteric arteries and veins: clinical practice guidelines of the European society of vascular surgery (ESVS), Eur J Vasc Endovasc Surg source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The completion rate of the individual questionnaire was 82% and of the team questionnaire 86%.

    “The completion rate of the individual questionnaire was 82% and of the team questionnaire 86%.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Some preliminary evidence suggests that a multidisciplinary approach implemented in a special unit can achieve high survival rates and lower morbidity.

    “Still, some preliminary evidence suggests that a multidisciplinary approach implemented in a special unit can achieve high survival rates and lower morbidity [2,14,15].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [2] Roussel, 2015, Revascularization of acute mesenteric ischemia after creation of a dedicated multidisciplinary center, J Vasc Surg source

      Not checked in the free run.

    • cites [14] Corcos, 2013, Effects of a multimodal management strategy for acute mesenteric ischemia on survival and intestinal failure, Clin Gastroenterol Hepatol source

      Not checked in the free run.

    • cites [15] Najdawi, 2022, Endovascular revascularization of acute arterial mesenteric ischemia: report of a 3-year experience from an intestinal stroke center unit, Eur Radiol

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The 2017 WSES and ESVS guidelines agree that early diagnosis and prompt revascularisation is essential to reduce mortality and bowel resection rates.

    “These guidelines disagree regarding the definition of AMI and on whether to include or exclude large bowel ischaemia but agree that early diagnosis and prompt revascularisation is essential to reduce mortality and bowel resection rates.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [3] Bala, 2017, Acute mesenteric ischemia: guidelines of the world society of emergency surgery, World J Emerg Surg source

      Not checked in the free run.

    • cites [4] Björck, 2017, Editor’s choice – management of the diseases of mesenteric arteries and veins: clinical practice guidelines of the European society of vascular surgery (ESVS), Eur J Vasc Endovasc Surg source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In suspected AMI, the common concern about renal function with application of contrast media is clearly outbalanced by the immediate risk of death through AMI.

    “Another important point is that if there is a suspicion of AMI, the common concern about the renal function with application of contrast media is clearly outbalanced by the immediate risk of death through AMI [5,19].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [5] Ginsburg, 2018, ACR appropriateness Criteria® imaging of mesenteric ischemia, J Am Coll Radiol source

      Not checked in the free run.

    • cites [19] Tolonen, 2021, The implementation of a pathway and care bundle for the management of acute occlusive arterial mesenteric ischemia reduced mortality, J Trauma Acute Care Surg source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Hospitals with a specialized AMI unit might be overrepresented in this study due to their interest in AMI.

    “Several hospitals report having a specialized AMI unit, although they might be overrepresented in this study due to their interest in AMI.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    The diagnosis of AMI might be delayed or missed in younger patients because of the lower prevalence at younger ages.

    “In contrast, the diagnosis of AMI might be delayed or missed in younger patients because of the lower prevalence at younger ages.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The large variability in treatment strategies could be explained by low awareness of this rare disease, at least partially explained by the absence of clear evidence-based guidance in many aspects of AMI.

    “This could be explained by the low awareness regarding this rare disease, at least partially explained by the absence of clear evidence-based guidance in many aspects of AMI.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The ESVS Clinical Practice Guidelines give a strong (1 B) recommendation for standardized use of antibiotics in AMI.

    “Although a strong (1 B) recommendation for standardized use of antibiotics in AMI is given in the Clinical Practice Guidelines of the European Society for Vascular Surgery [4], only 68% of respondents considered routine antibiotic treatment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Björck, 2017, Editor’s choice – management of the diseases of mesenteric arteries and veins: clinical practice guidelines of the European society of vascular surgery (ESVS), Eur J Vasc Endovasc Surg source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    AMI is a time-sensitive diagnosis where nonspecific symptoms and the absence of specific diagnostic biomarkers combined with low awareness due to the low incidence of AMI are probably the main factors responsible for the delay in diagnosis, and consequently also in management.

    “AMI is a time-sensitive diagnosis where nonspecific symptoms and the absence of specific diagnostic biomarkers combined with low awareness due to the low incidence of AMI are probably the main factors responsible for the delay in diagnosis, and consequently also in management.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: AMI is a time-sensitive diagnosis.

  • May combine two claims.

    Interpretationown data

    A representative analysis of intercontinental differences in diagnostic and therapeutic management of AMI is not feasible, and the overall results may not apply to other countries and continents.

    “Therefore, a representative analysis of intercontinental differences in diagnostic and therapeutic management of AMI is not feasible and our overall results may not apply to other countries and continents.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Recommendations on the management of AMI are based on scarce evidence in the literature and the two sets of international guidelines from 2017.

    “Recommendations on the management of AMI are based on scarce evidence in the literature and the two sets of international guidelines on this topic from 2017 [3,4], while recent updated guidelines by WSES [17] were published after our survey.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [3] Bala, 2017, Acute mesenteric ischemia: guidelines of the world society of emergency surgery, World J Emerg Surg source

      Not checked in the free run.

    • cites [4] Björck, 2017, Editor’s choice – management of the diseases of mesenteric arteries and veins: clinical practice guidelines of the European society of vascular surgery (ESVS), Eur J Vasc Endovasc Surg source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    With an increasing incidence of AMI due to increased life expectancy and reductions in AMI-related mortality, more patients with short bowel syndrome may increase the need for specialized intestinal stroke or intestinal failure units.

    “With an increasing incidence of AMI due to increased life expectancy as well as reductions in AMIrelated mortality, more patients with short bowel syndrome may B. Hess, M. Cahenzli, A. Forbes et al.Clinical Nutrition ESPEN 54 (2023) 194e205”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Specialized acute coronary care and stroke units are common in modern large hospitals, whereas an intestinal stroke or intestinal failure unit is rare.
    • Rests on an assumption: The incidence of AMI is increasing due to increased life expectancy and reductions in AMI-related mortality.
55 of 55

  • The paper relies on this without support.

    No studies are available that describe differences in clinical practice and treatment of AMI.

    “No studies are available that describe these differences in clinical practice and treatment of AMI, and the current survey is a first step attempting to fill this gap.”

  • The paper relies on this without support.

    Most available studies on AMI are retrospective and single-centre.

    “Most available studies are retrospective and single-centre.”

  • The paper relies on this without support.

    A uniform algorithm for diagnosis and management of AMI is currently not available.

    “However, a uniform algorithm for diagnosis and management of AMI is currently not available”

  • The paper relies on this without support.

    Different underlying pathophysiological mechanisms and the lack of sensitive and specific clinical and laboratory parameters to predict the presence of AMI result in delayed diagnosis and hamper improvement in clinical care.

    “Different underlying pathophysiological mechanisms leading to AMI and the lack of sensitive and specific clinical and laboratory parameters to predict the presence of AMI result in delayed diagnosis and hamper improvement in clinical care”

  • The paper relies on this without support.

    A widespread historical belief that AMI is deadly, together with difficulties in prospectively studying this multifaceted and uncommon disease, has inhibited research and progress in this field.

    “A widespread historical belief that acute mesenteric ischemia is a deadly condition, together with difficulties in prospectively studying this multifaceted and uncommon disease, has further inhibited research and progress in this field.”

  • The paper relies on this without support.

    Specialized acute coronary care and stroke units are common in modern large hospitals, whereas an intestinal stroke or intestinal failure unit is rare.

    “While specialized acute coronary care and stroke units are common in modern large hospitals, an intestinal stroke or intestinal failure unit is rare.”

  • The paper relies on this without support.

    A lack of specific biomarkers and specific phenotypes makes the clinical picture of AMI less clear than that of acute coronary syndrome or cerebrovascular ischaemia.

    “A lack of specific biomarkers and specific phenotypes result in a clinical picture of AMI that is less clear than the clinical features of acute coronary syndrome or cerebrovascular ischaemia.”

  • The paper relies on this without support.

    Greater awareness of clinicians of acute coronary syndrome and cerebrovascular ischaemia increases clinical suspicion and consequently improves diagnostic accuracy.

    “Moreover, the greater awareness of clinicians of these two conditions increases clinical suspicion and consequently usefully influences diagnostic accuracy.”

  • The paper relies on this without support.

    The key to early diagnosis of AMI is a high level of clinical suspicion.

    “The key to early diagnosis is a high level of clinical suspicion.”

  • The paper relies on this without support.

    Available evidence on AMI consists largely of retrospective single-centre studies carried out over many years or even decades.

    “Available evidence consists largely of retrospective singlecentre studies carried out over many years or even decades, but a prospective multicentre study has now been initiated and will allow for a better description of epidemiology as well as a structured analysis of current practice [21].”

  • The paper relies on this without support.

    There are clear guidelines on indication, timing, duration of anticoagulation and anti-aggregation therapy in acute coronary syndrome, but no such consensus exists for AMI.

    “While there are clear guidelines on indication, timing, duration of anticoagulation and anti-aggregation therapy in acute coronary syndrome, no such consensus exists for AMI.”

  • The paper relies on this without support.

    The incidence of AMI is increasing due to increased life expectancy and reductions in AMI-related mortality.

    “With an increasing incidence of AMI due to increased life expectancy as well as reductions in AMIrelated mortality, more patients with short bowel syndrome may B. Hess, M. Cahenzli, A. Forbes et al.Clinical Nutrition ESPEN 54 (2023) 194e205”

  • The paper relies on this without support.

    AMI is a time-sensitive diagnosis.

    “AMI is a time-sensitive diagnosis where nonspecific symptoms and the absence of specific diagnostic biomarkers combined with low awareness due to the low incidence of AMI are probably the main factors responsible for the delay in diagnosis, and consequently also in management.”
13 of 13

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A recent survey identified delay in diagnosis of AMI and heterogeneity in management approaches as contributing to poor outcomes.

    “A recent survey has identified delay in diagnosis of AMI and heterogeneity in management approaches as contributing to poor outcomes [8].”

    From Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study) (2024) · cites this paper as [8]

    The Introduction states that delayed diagnosis is associated with mortality and severe morbidity. The Discussion and Conclusion report substantial variation in AMI management, but the survey does not establish that this variation contributes to poor outcomes. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • A worldwide survey among specialists involved in the care for patients with AMI indicated that roughly half of the respondents rarely or never performed emergency revascularisation for AMI.

    “A worldwide survey among specialists involved in the care for patients with AMI indicated that roughly half of the respondents rarely or never performed emergency revascularisation for AMI. 121”

    From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [121]

    Section 3.4 reports that 37% of individual respondents and 42% of team respondents said patients with mesenteric infarction rarely undergo emergency revascularisation. The claim is close on the proportion, but it extends this finding from patients with infarction to AMI patients generally. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Indocyanine green fluorescent imaging (ICGFI) is used in only 7% of centres for intra-operative quality control in visceral surgery to evaluate bowel viability.

    “Indocyanine green fluorescent imaging (ICGFI) is used in only 7% of centres for intra-operative quality control in visceral surgery to evaluate bowel viability. 121”

    From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [121]

    Section 3.5 reports that indocyanine green was rarely used (7%) for diagnosing non-occlusive mesenteric ischaemia. It does not identify that figure as the proportion of centres using fluorescent imaging for intra-operative quality control or bowel-viability assessment in visceral surgery. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • In an international survey, haemodynamic stability was considered a prerequisite for starting PN for 42% of respondents, who would start PN between immediately and within 72 hours.

    “In an international survey, haemodynamic stability was considered a prerequisite for starting PN for 42% of respondents, who would start PN between immediately and within 72 hours. 121”

    From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [121]

    Section 3.7 reports that achieving haemodynamic stability was an important criterion before starting parenteral nutrition for 42% of individual respondents. It lists “within 72 h” and “immediately” as subsequent response choices, not as the starting times selected by that same 42%. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Enteral feeding would be resumed by 44% after evidence of bowel activity.

    “Enteral feeding would be resumed by 44% after evidence of bowel activity.”

    From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [121]

    Section 3.7 reports that evidence of bowel activity guided commencement of oral or enteral nutrition for 44% of individual respondents, versus 42% of teams. The paper does not give a separate 44% figure for enteral feeding alone. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Prospective multicentre study cites the elderly-incidence paper

    Minor

    The Discussion cites reference 21 for the newly initiated prospective multicentre study. Reference 21 is instead a paper about AMI in the elderly; the prospective AMESI study is listed as reference 22.

  • Updated WSES guidelines cite a different reference

    Minor

    The Discussion attributes the updated WSES guidelines to reference 17. In the provided reference list, reference 17 is a 2013 article on gastrointestinal vascular emergencies; the updated WSES guidelines are listed as reference 18.

  • Personal data were collected despite a claim that none were processed

    Minor

    The ethics section says no responders' personal data were processed, but the Methods describe collecting optional personal email addresses and using respondents' IP addresses to identify duplicates.

3 of 3

The citation lists haven’t been fetched yet

References 23 · Cited by 35

Research works printed but not linked: 1

  1. Kärkkäinen, 2015, Acute mesenteric ischemia is a more common cause than expected of acute abdomen in the elderly, J Gastrointest Surg, 19, 1407, 10.1007/s11605-015-2830-3 · DOI · Paper page

Authors
Hess, B., Cahenzli, M., Forbes, A., Burgos, R., Coccolini, F., Corcos, O., Holst, M., Irtun, Ø., Klek, S., Pironi, L., Rasmussen, H. H., Serlie, M. J., Thibault, R., Gabe, S., Reintam Blaser, A., Akin, E., Ali, S. M., Argenio, G., Atici, S. D., Augustin, G., Baili, E., Bains, L., Bala, M., Baldini, E., Baraket, O., Barone, M., Biloslavo, A., Bini, R., Bombardini, C., Brisinda, G., Buonomo, L., Catena, F., Ceresoli, M., Chiarello, M. M., Chouliaras, C., D'Acapito, F., Damaskos, D., De Simone, B., Delogu, D., Demetrashvili, Z., Di Carlo, I., D'Oria, M., Durán-Muñoz-Cruzado, V. M., Forget, P., Fortuna, L., Fransvea, P., Frey, C., Gapejeva, O., Garcon, P., Gass, J.-M., Teixeira Gonsaga, R. A., Griffiths, E., Gundogan, K., Gurjar, M., Hamid, H. K. S., Silesky Jiménez, J. I., Kase, K., Hussain Kazmi, S. S., Kechagias, A., Khokha, V., Kobe, Y., Korkolis, D. P., Litvin, A., Lostoridis, E., Mahendran, H. A., Marino, F., Martinuzzi, A., Mesina, C., Neri, V., Panisic, M., Paolillo, C., Pararas, N., Perrone, G., Pesce, A., Picardi, B., Pither, C., Podda, M., Poskus, T., Poullenot, F., Przemyslaw, M., Sartelli, M., Sasia, D., Scheiterle, M., Seretis, F., Søreide, K., Sydorchuk, R., Szczepanek, K., Bodnar, Z., Tamion, F., Tarasconi, A., Teraa, M., Tolonen, M., Vanuytsel, T., Veroux, M., Vinter-Jensen, L., Visconti, D., Widmer, L., Zakaria, A. D., Zubareva, N., Societies, E. I., ESICM (European Society of Intensive Care Medicine), WSES (World Society of Emergency Surgery), WSACS (The Abdominal Compartment Society), support, I.-P., & WFICC (World Federation of Intensive and Critical Care)
Affiliations
  • Luzerner Kantonsspital (CH)
  • University of Tartu (EE)
  • Vall d'Hebron Hospital Universitari (ES)
  • University of Pisa (IT)
  • Hôpital Beaujon (FR)
  • Aalborg University Hospital (DK)
  • University Hospital of North Norway (NO)
  • IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
  • Amsterdam University Medical Centers (NL)
  • Inserm (FR)
  • St Mark's Hospital (GB)
  • Hamad General Hospital (QA)
  • University of Salerno (IT)
  • University Hospital Centre Zagreb (HR)
  • National and Kapodistrian University of Athens (GR)
  • Maulana Azad Medical College (IN)
  • Hadassah Medical Center (IL)
  • University of Chieti-Pescara (IT)
  • Ospedale di Cattinara (IT)
  • Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
  • University of Ferrara (IT)
  • Agostino Gemelli University Polyclinic (IT)
  • Universidad de Buenos Aires (AR)
  • Ospedale “M. Bufalini” di Cesena (IT)
  • Azienda Ospedaliera San Gerardo (IT)
  • Edinburgh Royal Infirmary (GB)
  • Azienda Ospedaliero Universitaria di Sassari (IT)
  • University of Aberdeen (GB)
  • Azienda Ospedaliero-Universitaria Careggi (IT)
  • Hirslanden Klinik Aarau (CH)
  • North Estonia Medical Centre (EE)
  • Queen Elizabeth Hospital Birmingham (GB)
  • Sanjay Gandhi Post Graduate Institute of Medical Sciences (IN)
  • Tartu University Hospital (EE)
  • Kanta-Hämeen Keskussairaala (FI)
  • Chiba University Hospital (JP)
  • St Savas Hospital (GR)
  • Immanuel Kant Baltic Federal University (RU)
  • Sultanah Aminah Hospital (MY)
  • Gastroenterology Hospital "Saverio de Bellis" (IT)
  • University of Foggia (IT)
  • University of Verona (IT)
  • Alfaisal University (SA)
  • Ospedale di Parma (IT)
  • Azienda Unità Sanitaria Locale di Ferrara (IT)
  • ASL Roma (IT)
  • Norfolk and Norwich University Hospital (GB)
  • Azienda Ospedaliero-Universitaria Cagliari (IT)
  • Centre Hospitalier Universitaire de Bordeaux (FR)
  • Ospedale di Macerata (IT)
  • Azienda Sanitaria Ospedaliera S.Croce e Carle Cuneo (IT)
  • University of Patras (GR)
  • Stavanger University Hospital (NO)
  • Bukovinian State Medical University (UA)
  • Szpital Wielospecjalistyczny im. Stanley Dudricka w Skawinie (PL)
  • University Medical Center Utrecht (NL)
  • University of Helsinki (FI)
  • Universitair Ziekenhuis Leuven (BE)
  • Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco" (IT)
  • Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT)
  • University Hospital of Bern (CH)
  • Universiti Sains Malaysia (MY)
  • Perm State Medical Academy (RU)
Corresponding author
Hess, Benjamin
ORCID
Venue
Clinical Nutrition ESPEN
Publisher
Elsevier BV
Published
2023-04
Volume
54
Pages
194-205
ISSN
2405-4577 (ISSN-L)
DOI
10.1016/j.clnesp.2022.12.022
OpenAlex
W4313596564
Semantic Scholar
73a2b32fb129e4b978eecd3cf4cc0e508be0b129
Cited by
35
References
23
Citations by year
2026: 7 · 2025: 12 · 2024: 12 · 2023: 4
FWCI
9.38
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Nutrition ESPEN (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • VBN Forskningsportal (Aalborg Universitet) (acceptedVersion, cc-by-nc-nd)
  • HAL (submittedVersion, cc-by-nc-nd)
  • Pure Amsterdam UMC (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion, cc-by-nc-nd)
  • ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion, cc-by-nc-nd)
  • Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
  • BOA (University of Milano-Bicocca) (submittedVersion)
  • BORIS (University Library Bern) (submittedVersion, cc-by-nc-nd)
  • Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • Työväentutkimus Vuosikirja (submittedVersion)
  • UNICA IRIS Institutional Research Information System (University of Cagliari) (submittedVersion, other-oa)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
  • Tampere University Institutional Repository (Tampere University) (submittedVersion, cc-by-nc-nd)
  • Open Access CRIS of the University of Bern
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, intestinal infarction, delayed diagnosis, abdominal CT, plasma lactate, surgical exploration, anticoagulation, bowel resection, treatment variation
MeSH terms
Aged, Humans, Infarction, Intestines, Ischemia, Risk Factors, Mesenteric Ischemia

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-07.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.

Statistics and arithmetic are recomputed, not judged.

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