Mesenteric ischemia surgery

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

Overview

Surgery in mesenteric ischemia is done to resect the ischemic bowel in order to prevent the complications. However, in case of acute embolic type of mesenteric ischemia, early laparotomy and surgical resection is the mainstay of treatment.

Surgery

• The goals of surgical therapy are as follows:
  • Re-establishment blood supply to the ischemic bowel
  • Resection of all non-viable areas of the bowel
  • Preservation of the viable bowel

• Intestinal viability is defined as the maximum vital element influencing outcome in patients with AMI.
• Non-viable bowel, if unrecognized, can cause multi-organ failure and lead to the death eventually.
• Laparotomy allows to determine the viability of the bowel.

• After preliminary resuscitation, midline laparotomy should be done to observe the areas of gut with choices for resection of all the necrotic areas. In instances of uncertainty, intraoperative Doppler can be beneficial.

Surgical procedure options:

• Balloon catheter embolectomy of the superior mesenteric artery
• For restoration of blood flow in acute mesenteric ischemia, antegrade aorto-mesenteric bypass from supraceliac aorta is the best choice.
• A new hybrid endovascular-surgical technique for managing mesenteric ischemia has been proposed.