A clinical approach to acute mesenteric ischemia
Abstract
PURPOSE OF REVIEW: To summarize current evidence on acute mesenteric ischemia (AMI) in critically ill patients, addressing pathophysiology, definition, diagnosis and management. RECENT FINDINGS: A few recent studies showed that a multidiscipliary approach in specialized centers can improve the outcome of AMI. Such approach incorporates current knowledge in pathophysiology, early diagnosis with triphasic computed tomography (CT)-angiography, immediate endovascular or surgical restoration of mesenteric perfusion, and damage control surgery if transmural bowel infarction is present. No specific biomarkers are available to detect early mucosal injury in clinical setting. Nonocclusive mesenteric ischemia presents particular challenges, as the diagnosis based on CT-findings as well as vascular management is more difficult; some recent evidence suggests a possible role of potentially treatable stenosis of superior mesenteric artery and beneficial effect of vasodilator therapy (intravenous or local intra-arterial). Medical management of AMI is supportive, including aiming of euvolemia and balanced systemic oxygen demand/delivery. Enteral nutrition should be withheld during ongoing ischemia-reperfusion injury and be started at low rate after revascularization of the (remaining) bowel is convincingly achieved. SUMMARY: Clinical suspicion leading to tri-phasic CT-angiography is a mainstay for diagnosis. Diagnosis of nonocclusive mesenteric ischemia and early intestinal injury remains challenging. Multidisciplinary team effort may improve the outcome of AMI.
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Preliminary evidence suggests that treatment of AMI in especially dedicated centers using a multidisciplinary approach improves outcomes.
“Preliminary evidence suggests that treatment of AMI in especially dedicated centers using a multidisciplinary approach improves outcomes.”
From Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. (2022) · cites this paper as [143]
Recent published evidence suggests that treatment of occlusive AMI in "intestine stroke centers" using a multidisciplinary approach improves outcomes.
“Recent published evidence suggests that treatment of occlusive AMI in “intestine stroke centers” using a multidisciplinary approach improves outcomes [142, 143].”
From Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. (2022) · cites this paper as [143]
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Self-citation
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Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery.
Bala, M., Catena, F., Kashuk, J., De Simone, B., Gomes, C. A., Weber, D., Sartelli, M., Coccolini, F., Kluger, Y., Abu-Zidan, F. M., et al. (2022) · World Journal of Emergency Surgery · doi:10.1186/s13017-022-00443-x · Cited by 380 · see citing works
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High risk and low prevalence diseases: Mesenteric ischemia
Molyneux, K., Beck‐Esmay, J., Koyfman, A., & Long, B. (2023) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2023.01.001 · Cited by 35 · see citing works
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Anaesthesia for vascular emergencies – a state of the art review
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“Non-occlusive mesenteric ischaemia is ideally treated with management of the shocked state, avoidance of vasopressors and, potentially, with intra-arterial infusions of vasodilators [56].”
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“CT angiography is valuable, and identifies vessel occlusion or local complications requiring surgical intervention.(9) Treatment depends on the aetiology, © 2022 The Authors.”
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Tricky acute mesenteric ischemia: what can we do?
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Can Biomarkers be used for Prognosis Prediction in Patients with Acute Mesenteric Ischemia?
Çınaroğlu, O. S., Bora, E. S., Efgan, M. G., Çınaroğlu, D., & Payza, U. (2023) · Istanbul Medical Journal · doi:10.4274/imj.galenos.2023.73483 · Cited by 2 · see citing works
“For instance, Reintam Blaser et al. (10) reported that only 31.8% of the patients underwent surgery; however, Yıldırım et al. (11) showed that 77.8% of the patients underwent surgery.”
BackgroundInfluentialImpact on the prognosis with the creation of a dedicated stroke to mesenteric ischaemia
Rudondy, V., Barral, P.-A., Markarian, T., Chopinet, S., Barraud, M., Gaudry, M., Bourenne, J., Nafati, C., Grigoresco, B., Lagier, D., et al. (2025) · World Journal of Emergency Surgery · doi:10.1186/s13017-025-00627-1 · Cited by 2 · see citing works
“Furthermore, there is no specific biological marker for diagnosing AMI [6, 7].”
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Early identification of non-occlusive acute mesenteric ischemia
Guo, H., Chen, D., Chen, M., Liu, X., & Liu, J. (2024) · Journal of Translational Critical Care Medicine · doi:10.1097/jtccm-d-24-00017 · Cited by 2 · see citing works
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“Despite current improvements in surgical techniques, the mortality rate due to acute mesenteric ischemia remains high at more than 50%[2].”
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“Thus, clinical suspicion leading to CTA becomes a mainstay for diagnosis MAE [11].”
Acute mesenteric ischemia: current status of an unsolved problem
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Mesenteric ischemia in the acute care setting
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Superior Mesenteric Artery Stenosis Presenting as Chest Pain: Danger in Disguise
Mahajan, S. N., Pantbalekundri, N., Khurana, K., & Kadu, A. (2023) · Cureus · doi:10.7759/cureus.50922
“There are minimal natural history data available for the clinical course of asymptomatic diseases involving the major mesenteric arteries in comparison to carotid, coronary, renal, and peripheral vascular diseases [7].”
BackgroundMesenteric ischemia in the acute care setting
Bagley, K., & Schuller, J. G. (2024) · Nursing · doi:10.1097/01.nurse.0000998028.77929.e0 · Cited by 1 · see citing works
Vascular Disorders of the Intestine
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Bala, M., Catena, F., Kashuk, J., De Simone, B., Gomes, C. A., Weber, D., Sartelli, M., Coccolini, F., Kluger, Y., Abu-Zidan, F. M., et al. (2022) · Figshare · doi:10.6084/m9.figshare.21368764
Acute Non-Occlusive Mesenteric Ischemia
Timerbulatov, S. V., Радиковна, Г. А., Плечев, В. В., Garaev, R. R., & Timerbulatov, V. M. (2025) · Creative Surgery and Oncology · doi:10.24060/2076-3093-2025-15-4-390-401
Yıldırım, E., Sezgin, A. S., Kirsan, K., Feyzioglu, C., Say, A. N., Şenyiğit, A., ÖZYİĞİT, Ö., & Uzun, H. (2026) · Exploration of Digestive Diseases · doi:10.37349/edd.2026.1005119
Acute mesenteric ischemia in cirrhosis: Diagnostic and management challenges
Hassan, A. S., Laor, B., & Benmassaoud, A. (2026) · World Journal of Hepatology · doi:10.4254/wjh.v18.i4.114916
- Authors
- Reintam Blaser, A., Acosta, S., & Arabi, Y. M.
- Affiliations
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia
- Lund University (SE)
- King Saud bin Abdulaziz University for Health Sciences (SA)
- Venue
- Current Opinion in Critical Care
- Published
- 2020-12-30
- Volume
- 27
- Issue
- 2
- Pages
- 183-192
- ISSN
- 1070-5295 (ISSN-L)
- 1531-7072
- OpenAlex
- W3120345087
- Cited by
- 33
- References
- 95
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 5 · 2023: 10 · 2022: 6 · 2021: 3
- FWCI
- 1.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Opinion in Critical Care (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (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, nonocclusive mesenteric ischemia, endovascular revascularization, damage control surgery, superior mesenteric artery stenosis, vasodilator therapy, intestinal mucosal injury, enteral nutrition, ischemia-reperfusion injury, critically ill patients, multidisciplinary care
- MeSH terms
- Acute Disease, Angiography, Humans, Intestines, Tomography, X-Ray Computed, Mesenteric Ischemia
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