Table 3.
Typical clinical presentation and recanalisation options depending on the type of acute mesenteric ischaemia.
Typical clinical presentation | Recanalisation options (Laparoscopic bowel evaluation is driven by the prediction of transmural necrosis) |
|
---|---|---|
Atherosclerotic AMI | Possible history of chronic mesenteric ischaemia Sudden abdominal pain in a patient with multi-arterial disease |
Endovascular revascularisation:
Open revascularisation:
|
Embolic AMI | Sudden marked pain in a patient with a history of atrial fibrillation | Endovascular revascularisation:
Open revascularisation:
|
Isolated SMA dissection | Sudden marked abdominal pain (epigastric) in middle-aged males without known atherosclerosis | Revascularisation only if bowel ischaemia (low evidence):
|
Venous AMI | Abdominal pain and inflammatory syndrome in females with history of venous thrombosis | Anticoagulation therapy. If worsening despite adequate anticoagulation:
|
Non-occlusive mesenteric ischaemia | Intensive care unit patient with shock and abdominal pain/distension | Intensive resuscitation. Local intra-arterial vasodilator infusion (low evidence) |
Ischaemic colitis | Abdominal guarding with inflammatory syndrome mimicking infectious colitis. | No revascularisation. |
AMI, acute mesenteric ischaemia.