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World J Gastrointest Pathophysiol. Feb 15, 2016; 7(1): 125-130
Published online Feb 15, 2016. doi: 10.4291/wjgp.v7.i1.125
Mesenteric ischemia: Pathogenesis and challenging diagnostic and therapeutic modalities
Aikaterini Mastoraki, Sotiria Mastoraki, Evgenia Tziava, Stavroula Touloumi, Nikolaos Krinos, Nikolaos Danias, Andreas Lazaris, Nikolaos Arkadopoulos
Aikaterini Mastoraki, Evgenia Tziava, Stavroula Touloumi, Nikolaos Krinos, Nikolaos Danias, Nikolaos Arkadopoulos, 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 12462 Chaidari, Athens, Greece
Sotiria Mastoraki, Andreas Lazaris, Department of Vascular Surgery, Athens University, Medical School, ATTIKON University Hospital, 12462 Chaidari, Athens, Greece
Author contributions: All authors contributed significantly in all stages of this work, they have read and approved the manuscript and confirm that no conflict of interest exists.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Aikaterini Mastoraki, MD, PhD, 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 1 Rimini Str, 12462 Chaidari, Athens, Greece. dr_kamast@yahoo.gr
Telephone: +30-6932-577710 Fax: +30-210-5326412
Received: June 24, 2015
Peer-review started: June 25, 2015
First decision: August 26, 2015
Revised: October 22, 2015
Accepted: January 8, 2016
Article in press: January 11, 2016
Published online: February 15, 2016
Abstract

Mesenteric ischemia (MI) is an uncommon medical condition with high mortality rates. ΜΙ includes inadequate blood supply, inflammatory injury and eventually necrosis of the bowel wall. The disease can be divided into acute and chronic MI (CMI), with the first being subdivided into four categories. Therefore, acute MI (AMI) can occur as a result of arterial embolism, arterial thrombosis, mesenteric venous thrombosis and non-occlusive causes. Bowel damage is in proportion to the mesenteric blood flow decrease and may vary from minimum lesions, due to reversible ischemia, to transmural injury, with subsequent necrosis and perforation. CMI is associated to diffuse atherosclerotic disease in more than 95% of cases, with all major mesenteric arteries presenting stenosis or occlusion. Because of a lack of specific signs or due to its sometime quiet presentation, this condition is frequently diagnosed only at an advanced stage. Computed tomography (CT) imaging and CT angiography contribute to differential diagnosis and management of AMI. Angiography is also the criterion standard for CMI, with mesenteric duplex ultrasonography and magnetic resonance angiography also being of great importance. Therapeutic approach of MI includes both medical and surgical treatment. Surgical procedures include restoration of the blood flow with arteriotomy, endarterectomy or anterograde bypass, while resection of necrotic bowel is always implemented. The aim of this review was to evaluate the results of surgical treatment for MI and to present the recent literature in order to provide an update on the current concepts of surgical management of the disease. Mesh words selected include MI, diagnostic approach and therapeutic management.

Keywords: Acute mesenteric ischemia, Mesenteric ischemia, Chronic diagnostic approach, Therapeutic management, Surgical strategy

Core tip: Mesenteric ischemia (MI) is an uncommon medical condition with high mortality rates. ΜΙ includes inadequate blood supply, inflammatory injury and eventually necrosis of the bowel wall. Because of a lack of specific signs or due to its sometime quiet presentation, this condition is frequently diagnosed only at an advanced stage. Therapeutic approach refers to both medical and surgical treatment. Surgical procedures include restoration of the blood flow with arteriotomy, endarterectomy or anterograde bypass, while resection of necrotic bowel is always implemented.