Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery

Miklosh Bala¹, Fausto Catena², Jeffry Kashuk³, Belinda De Simone⁴, Carlos Augusto Gomes⁵, Dieter Weber⁶, Massimo Sartelli⁷, Federico Coccolini⁸, Yoram Kluger⁹, Fikri M Abu-Zidan¹⁰, Edoardo Picetti¹¹, Luca Ansaloni¹², Goran Augustin¹³, Walter L Biffl¹⁴, Marco Ceresoli¹⁵, Osvaldo Chiara¹⁶, Massimo Chiarugi⁸, Raul Coimbra¹⁷, Yunfeng Cui¹⁸, Dimitris Damaskos¹⁹, Salomone Di Saverio²⁰, Joseph M Galante²¹, Vladimir Khokha²², Andrew W Kirkpatrick²³, Kenji Inaba²⁴, Ari Leppäniemi²⁵, Andrey Litvin²⁶, Andrew B Peitzman²⁷, Vishal G Shelat²⁸, Michael Sugrue²⁹, Matti Tolonen²⁵, Sandro Rizoli³⁰, Ibrahima Sall³¹, Solomon G Beka³², Isidoro Di Carlo³³, Richard Ten Broek³⁴, Chirika Mircea³⁵, Giovanni Tebala³⁶, Michele Pisano³⁷, Harry van Goor³⁴, Ronald V Maier³⁸, Hans Jeekel³⁹, Ian Civil⁴⁰, Andreas Hecker⁴¹, Edward Tan³⁴, Kjetil Soreide⁴², Matthew J Lee⁴³, Imtiaz Wani⁴⁴, Luigi Bonavina⁴⁵, Mark A Malangoni⁴⁶, Kaoru Koike⁴⁷, George C Velmahos⁴⁸, Gustavo P Fraga⁴⁹, Andreas Fette⁵⁰, Nicola de'Angelis⁵¹, Zsolt J Balogh⁵², Thomas M Scalea⁵³, Gabriele Sganga⁵⁴, Michael D Kelly⁵⁵, Jim Khan⁵⁶, Philip F Stahel⁵⁷, Ernest E Moore⁵⁸

Affiliations

¹ Director of Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, POB 12000, 91120, Jerusalem, Israel. rbalam@hadassah.org.il.
² General and Emergency Surgery Department, Bufalini Hospital, Cesena, Italy.
³ Tel Aviv Sackler School of Medicine, Tel Aviv, Israel.
⁴ Department of General, Digestive and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal De Poissy/St Germain en Laye, Poissy, France.
⁵ Department of Surgery, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Hospital Universitário Terezinha de Jesus, Juiz de Fora, Brazil.
⁶ Department of General Surgery, Royal Perth Hospital, The University of Western Australia, Perth, Australia.
⁷ Department of Surgery, Macerata Hospital, Macerata, Italy.
⁸ Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy.
⁹ Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.
¹⁰ Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
¹¹ Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Parma, Parma, Italy.
¹² Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
¹³ Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
¹⁴ Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA.
¹⁵ Emergency and General Surgery Department, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
¹⁶ Emergency Department, Niguarda Ca'Granda Hospital, Milan, Italy.
¹⁷ CECORC Research Center, Riverside University Health System, Loma Linda University, Loma Linda, USA.
¹⁸ Department of Surgery, Nankai Clinical School of Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China.
¹⁹ Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
²⁰ General Surgery Department Hospital of San Benedetto del Tronto, Marche region, Italy.
²¹ Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA.
²² Department of Emergency Surgery, City Hospital, Mozyr, Belarus.
²³ General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada.
²⁴ Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA, USA.
²⁵ Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
²⁶ Department of Surgical Disciplines, Regional Clinical Hospital, Immanuel Kant Baltic Federal University, Kaliningrad, Russia.
²⁷ Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA.
²⁸ Department of General Surgery, Tan Tock Seng Hospital, Novena, Singapore.
²⁹ Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland.
³⁰ Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar.
³¹ General Surgery Department, Military Teaching Hospital, Dakar, Senegal.
³² Ethiopian Air Force Hospital, Bishoftu, Ethiopia.
³³ Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy.
³⁴ Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
³⁵ Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.
³⁶ Department of Digestive and Emergency Surgery, S.Maria Hospital Trust, Terni, Italy.
³⁷ General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy.
³⁸ Harborview Medical Center, University of Washington School of Medicine, Seattle, WA, USA.
³⁹ Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
⁴⁰ Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
⁴¹ Emergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany.
⁴² HPB Unit, Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
⁴³ Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
⁴⁴ Government Gousia Hospital, Srinagar, India.
⁴⁵ Department of Surgery, IRCCS Policlinico San Donato, University of Milano, Milano, Italy.
⁴⁶ Case Western Reserve University School of Medicine, Cleveland, USA.
⁴⁷ Kyoto Medical Center, Kyoto, Japan.
⁴⁸ Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, PA, USA.
⁴⁹ Division of Trauma Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil.
⁵⁰ Pediatric Surgery, Children's Care Center, SRH Klinikum Suhl, Suhl, Thueringen, Germany.
⁵¹ Unit of Digestive and HPB Surgery, Faculty of Medicine, University of Paris, Paris, France.
⁵² John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia.
⁵³ Cowley Shock Trauma Center at the University of Maryland, Baltimore, MD, USA.
⁵⁴ Emergency Surgery and Trauma, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
⁵⁵ Department of General Surgery, Albury Hospital, Albury, Australia.
⁵⁶ University of Portsmouth, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
⁵⁷ College of Osteopathic Medicine, Rocky Vista University, Parker, CO, USA.
⁵⁸ Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA.

PMID: 36261857
PMCID: PMC9580452
DOI: 10.1186/s13017-022-00443-x

Review

Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery

Miklosh Bala et al. World J Emerg Surg. 2022.

. 2022 Oct 19;17(1):54.

doi: 10.1186/s13017-022-00443-x.

Authors

Affiliations

¹ Director of Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, POB 12000, 91120, Jerusalem, Israel. rbalam@hadassah.org.il.
² General and Emergency Surgery Department, Bufalini Hospital, Cesena, Italy.
³ Tel Aviv Sackler School of Medicine, Tel Aviv, Israel.
⁴ Department of General, Digestive and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal De Poissy/St Germain en Laye, Poissy, France.
⁵ Department of Surgery, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Hospital Universitário Terezinha de Jesus, Juiz de Fora, Brazil.
⁶ Department of General Surgery, Royal Perth Hospital, The University of Western Australia, Perth, Australia.
⁷ Department of Surgery, Macerata Hospital, Macerata, Italy.
⁸ Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy.
⁹ Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.
¹⁰ Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
¹¹ Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Parma, Parma, Italy.
¹² Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
¹³ Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
¹⁴ Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA.
¹⁵ Emergency and General Surgery Department, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
¹⁶ Emergency Department, Niguarda Ca'Granda Hospital, Milan, Italy.
¹⁷ CECORC Research Center, Riverside University Health System, Loma Linda University, Loma Linda, USA.
¹⁸ Department of Surgery, Nankai Clinical School of Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China.
¹⁹ Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
²⁰ General Surgery Department Hospital of San Benedetto del Tronto, Marche region, Italy.
²¹ Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA.
²² Department of Emergency Surgery, City Hospital, Mozyr, Belarus.
²³ General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada.
²⁴ Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA, USA.
²⁵ Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
²⁶ Department of Surgical Disciplines, Regional Clinical Hospital, Immanuel Kant Baltic Federal University, Kaliningrad, Russia.
²⁷ Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA.
²⁸ Department of General Surgery, Tan Tock Seng Hospital, Novena, Singapore.
²⁹ Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland.
³⁰ Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar.
³¹ General Surgery Department, Military Teaching Hospital, Dakar, Senegal.
³² Ethiopian Air Force Hospital, Bishoftu, Ethiopia.
³³ Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy.
³⁴ Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
³⁵ Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.
³⁶ Department of Digestive and Emergency Surgery, S.Maria Hospital Trust, Terni, Italy.
³⁷ General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy.
³⁸ Harborview Medical Center, University of Washington School of Medicine, Seattle, WA, USA.
³⁹ Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
⁴⁰ Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
⁴¹ Emergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany.
⁴² HPB Unit, Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
⁴³ Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
⁴⁴ Government Gousia Hospital, Srinagar, India.
⁴⁵ Department of Surgery, IRCCS Policlinico San Donato, University of Milano, Milano, Italy.
⁴⁶ Case Western Reserve University School of Medicine, Cleveland, USA.
⁴⁷ Kyoto Medical Center, Kyoto, Japan.
⁴⁸ Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, PA, USA.
⁴⁹ Division of Trauma Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, Brazil.
⁵⁰ Pediatric Surgery, Children's Care Center, SRH Klinikum Suhl, Suhl, Thueringen, Germany.
⁵¹ Unit of Digestive and HPB Surgery, Faculty of Medicine, University of Paris, Paris, France.
⁵² John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia.
⁵³ Cowley Shock Trauma Center at the University of Maryland, Baltimore, MD, USA.
⁵⁴ Emergency Surgery and Trauma, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
⁵⁵ Department of General Surgery, Albury Hospital, Albury, Australia.
⁵⁶ University of Portsmouth, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
⁵⁷ College of Osteopathic Medicine, Rocky Vista University, Parker, CO, USA.
⁵⁸ Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA.

PMID: 36261857
PMCID: PMC9580452
DOI: 10.1186/s13017-022-00443-x

Abstract

Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process may progress to life-threatening intestinal necrosis. The incidence is low, estimated at 0.09-0.2% of all acute surgical admissions, but increases with age. Although the entity is an uncommon cause of abdominal pain, diligence is required because if untreated, mortality remains in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques is evolving and provides new treatment options. Lastly, a focused multidisciplinary approach based on early diagnosis and individualized treatment is essential. Thus, we believe that updated guidelines from World Society of Emergency Surgery are warranted, in order to provide the most recent and practical recommendations for diagnosis and treatment of AMI.

Keywords: Bowel ischemia; Guidelines; Mesenteric arterial occlusion; Mesenteric artery stenting; Mesenteric ischemia; Recommendations; World Society of Emergency Surgery.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Management algorithm for patients with AMI

See this image and copyright information in PMC

References

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Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery

Affiliations

Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources