title: Intestinal ischemia: current treatment concepts.
abstract: OBJECTIVE
  Mesenteric ischemia is a condition well-known among physicians treating patients with abdominal symptoms. Even so, mortality rates have not decreased significantly over the last decades. The purpose of this article is to review current treatment concepts of acute and chronic mesenteric ischemia.
  
  
  RESULTS
  Early diagnosis is one of the most important features that determine a patient's prognosis. Conventional angiography and multidetector computed tomography are therefore appropriate to quickly diagnose mesenteric ischemia, the latter being commonly more available. Once a patient presents with signs of peritonitis, instant laparotomy is indicated, and infarcted bowel segments need to be resected, followed by a second-look operation if necessary. If bowel necrosis is clinically not suspected, different approaches should be applied according to source and nature of mesenteric ischemia. Besides established surgical treatment concepts, more and more interventional procedures are developed and evaluated. However, superiority of these new techniques could only be shown for selected patient groups so far. In chronic mesenteric ischemia, interventional approaches seem to be an attractive alternative in patients who are in a condition too bad to undergo surgery. Patients with colonic ischemia are treated best in a conservative manner and by resolving the underlying cause, if identified.
  
  
  CONCLUSIONS
  Patients with acute mesenteric ischemia are still at highest risk for a fatal course of disease. New diagnostic and therapeutic developments have not been tested in larger studies yet, neither has any of these methods led to an increased survival in studies published so far. Taken together, mesenteric ischemia requires high awareness, earliest possible diagnosis, and treatment by an experienced interdisciplinary team of gastroenterologists, radiologists, and surgeons.
authors.affiliation: Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Renner
authors.forename: Klaus
authors.initials: K
authors.lastname: Kienle
authors.forename: Marc H
authors.initials: MH
authors.lastname: Dahlke
authors.forename: Peter
authors.initials: P
authors.lastname: Heiss
authors.forename: Karin
authors.initials: K
authors.lastname: Pfister
authors.forename: Christian
authors.initials: C
authors.lastname: Stroszczynski
authors.forename: Pompiliu
authors.initials: P
authors.lastname: Piso
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Schlitt
mesh_terms: D000208:Acute Disease; D000792:Angiography; D002908:Chronic Disease; D003106:Colon / Q000098:blood supply; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D004617:Embolism / Q000175:diagnosis / Q000601:surgery; D004630:Emergencies; D006801:Humans; D007238:Infarction / Q000175:diagnosis / Q000601:surgery; D007422:Intestines / Q000098:blood supply*; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008638:Mesenteric Arteries / Q000601:surgery; D008641:Mesenteric Vascular Occlusion / Q000175:diagnosis / Q000601:surgery; D008642:Mesenteric Veins / Q000601:surgery; D008643:Mesentery / Q000098:blood supply*; D010538:Peritonitis / Q000175:diagnosis / Q000601:surgery; D012086:Reoperation; D013927:Thrombosis / Q000175:diagnosis / Q000601:surgery; D036542:Tomography, Spiral Computed