Mesenteric ischemia medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Overview

Mesenteric ischemia is a medical emergency and requires prompt treatment. The mainstay of treatment is surgery if bowel necrosis or gangrene has occurred , whereas medical therapy is considered initially for hemodynamically unstable patients.

Medical Therapy

• Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
• Pharmacologic medical therapies for mesenteric ischemia include heparin, [therapy 2], and/or [therapy 3].
• Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Initial management:

Mesenteric ischemia is an acute emergency condition that requires prompt intervention. The outline of initial medical management of all types of meseneteric ischemia includes:

• Pain control
• Fluid resuscitation
• Hemodynamic support and monitoring
• Correction of electrolyte abnormalities
• Anticoagulation
• Broad sprectrum antibiotics
• Gastrointestinal decompression

Cause specific management of mesenteric ischemia:

Etiology	Management
Superior mesenteric artery embolism	Embolectomy of superior mesenteric artery Anticoagulation Assesment of bowel viability Resect bowel if necrosis has occurred
Mesenteric arterial thrombosis	Anticoagulation Endovascular techniques when possible Aorto-mesenetric bypass Reassessment for bowel viability Resection if there is bowel necrosis
Non occlusive mesenteric ischemia	Palpation of proximal vessels for patency

Further

Multimodal management of mesenteric ischemia
Early management					Late management
Pathophysiological events	Vascular occlusion	Splanchnic hypoperfusion	Intestinal hypoxia	Intestinal barrier injury Translocation Local inflammatory pathway	Systemic inflammatory pathways	Necrosis Organ failure
Treatment strategy	Heparin Aspirin Revascularization	Oxygen Blood volume resuscitation Transfusion		Oral antibiotics	Intravenous antibiotics	Intestinal resection