title: [Diagnosis and management of acute mesenteric ischemia].
abstract: The prevalence of significant splanchnic arterial stenoses is increasing, but remains mostly asymptomatic due to abundant collateral circulation. Acute insufficiency of mesenteric arterial blood flow accounts for 60 to 70% of cases of mesenteric ischemia and results mostly from a superior mesenteric embolus. Despite major advances have been achieved in understanding the pathogenic mechanisms of bowel ischemia, its prognosis remains dismal with mortality rates about 60%. The diagnosis of acute mesenteric ischemia depends upon a high clinical suspicion, especially in patients with known risk factors. Rapid diagnosis is essential to prevent intestinal infarction. However, early signs and symptoms of mesenteric ischemia are non specific, and definitive diagnosis often requires radiologic examinations. Early and liberal implementation of angiography has been the major advance over the past 30 years which allowed increasing diagnostic accuracy of acute mesenteric ischemia. CT and MR-based angiographic techniques have emerged as alternatives less invasive and more accurate to analyse splanchnic vessels and evaluate bowel infarction. The goal of treatment of patients with acute mesenteric ischemia is to restore intestinal oxygenation as quickly as possible after initial management that includes rapid hemodynamic monitoring and support. Surgery should not be delayed in patients suspected of having intestinal necrosis.
authors.affiliation: Service d'anesthésie-réanimation II, CHU de Bordeaux, Maison du Haut-Lévêque, groupe hospitalier Sud, université Bordeaux-Segalen, avenue de Magellan, Pessac cedex, France. antoine.dewitte@chu-bordeaux.fr
authors.forename: A
authors.initials: A
authors.lastname: Dewitte
authors.forename: M
authors.initials: M
authors.lastname: Biais
authors.forename: J
authors.initials: J
authors.lastname: Coquin
authors.forename: C
authors.initials: C
authors.lastname: Fleureau
authors.forename: C
authors.initials: C
authors.lastname: Cassinotto
authors.forename: A
authors.initials: A
authors.lastname: Ouattara
authors.forename: G
authors.initials: G
authors.lastname: Janvier
mesh_terms: D000208:Acute Disease; D000792:Angiography; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000628:therapy; D042241:Early Diagnosis; D004617:Embolism / Q000150:complications / Q000628:therapy; D005767:Gastrointestinal Diseases / Q000175:diagnosis; D006801:Humans; D007238:Infarction / Q000175:diagnosis; D007511:Ischemia / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008638:Mesenteric Arteries / Q000473:pathology / Q000503:physiopathology; D065666:Mesenteric Ischemia; D015427:Reperfusion Injury / Q000473:pathology / Q000628:therapy; D013927:Thrombosis / Q000150:complications / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014652:Vascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000628:therapy