Acute intestinal ischaemia

The subsets of acute mesenteric ischaemia include mesenteric arterial occlusion (by embolus or thrombosis), mesenteric venous thrombosis and non-occlusive mesenteric ischaemia. Despite advances in pathophysiology, laboratory diagnosis and imaging techniques, acute mesenteric ischaemia is still associated with mortality rates of more than 60% and continues to be a challenging diagnostic problem. The key to a better outcome (and the main problem in clinical practice) is early diagnosis. Clinical presentation may be unspecific, but is often characterized by an initial discrepancy between severe subjective pain and relatively unspectacular findings on physical examination. Up to now, there are no simple and non-invasive diagnostic tests of sufficient sensitivity and specificity; thus, angiography remains the cornerstone of diagnosis and should be performed early in all patients in which mesenteric ischaemia is a realistic differential diagnosis. Treatment for obstructive mesenteric arterial syndromes and most patients with mesenteric venous thrombosis is surgical, whereas nonocclusive mesenteric ischaemia may be managed by pharmacological vasodilation.