Acute mesenteric ischaemia

Abstract

Acute Mesenteric Ischaemia (AMI) is an uncommon vascular emergency where the diagnosis is often difficult and overlooked and delay in diagnosis results in a grave outcome. Although extravascular events like intussusception, volvulus, strangulated hernia and adhesive obstruction in neglected cases can result intestinal gangrene, this contribution will be limited to acute mesenteric ischaemia as a primary event. AMI consists of four pathologic processes (arterial thrombosis, arterial embolism, Non Occlusive Mesenteric Ischaemia (NOMI) and mesenteric venous thrombosis (MVT)) with similar clinical presentation and one potentially fatal pathological endpoint- intestinal gangrene. The clinical setting and the patient's risk profile often give the clue to the etiological process while the presentation is dominated by severe unrelenting abdominal pain out of proportion to the physical findings. The key to the successful management depends on the surgeon's ability to suspect the diagnosis, pursue appropriate investigations and institute aggressive treatment. The mortality remains high due to difficulty and delay in the diagnosis.