title: ESTES guidelines: acute mesenteric ischaemia.
abstract: OBJECTIVE
  Acute mesenteric ischaemia (AMI) accounts for about 1:1000 acute hospital admissions. Untreated, AMI will cause mesenteric infarction, intestinal necrosis, an overwhelming inflammatory response and death. Early intervention can halt and reverse this process leading to a full recovery, but the diagnosis of AMI is difficult and failure to recognize AMI before intestinal necrosis has developed is responsible for the high mortality of the disease. Early diagnosis and prompt treatment are the goals of modern therapy, but there are no randomized controlled trials to guide treatment and the published literature contains a high ratio of reviews to original data. Much of that data comes from case reports and often small, retrospective series with no clearly defined treatment criteria.
  
  
  METHODS
  A study group of the European Society for Trauma and Emergency Surgery (ESTES) was formed in 2013 with the aim of developing guidelines for the management of AMI. A comprehensive literature search was performed using the Medical Subject Heading (MeSH) thesaurus keywords "mesenteric ischaemia", "bowel ischaemia" and "bowel infarction". The bibliographies of relevant articles were screened for additional publications. After an initial systematic review of the literature by the whole group, a steering group formulated questions using a modified Delphi process. The evidence was then reviewed to answer these questions, and recommendations formulated and agreed by the whole group.
  
  
  RESULTS
  The resultant recommendations are presented in this paper.
  
  
  CONCLUSIONS
  The aim of these guidelines is to provide recommendations for practice that will lead to improved outcomes for patients.
authors.affiliation: Surgery Health Care Group, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK. jonathan.tilsed@hey.nhs.uk.
authors.forename: J V T
authors.initials: JV
authors.lastname: Tilsed
authors.affiliation: Emergency Department, Istituto Clinico Città Studi, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Casamassima
authors.affiliation: Emergency Surgery and Trauma Unit, Humanitas Research Hospital, Rozzano, Italy.
authors.forename: H
authors.initials: H
authors.lastname: Kurihara
authors.affiliation: Department of General Surgery, Ospedale di Legnano, Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Mariani
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Universitario de Torrevieja, Torrevieja, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Martinez
authors.affiliation: Surgery 1-Tondela-Viseu Hospital Centre, Viseu, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Pereira
authors.affiliation: Department of Surgery, Milton Keynes Hospital NHS Foundation Trust, Milton Keynes, UK.
authors.forename: L
authors.initials: L
authors.lastname: Ponchietti
authors.affiliation: 2nd Surgical Department, Kepler University Clinic Linz, Linz, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Shamiyeh
authors.affiliation: Division of Trauma and Acute Care Surgery, Mafraq Hospital, Abu Dhabi, United Arab Emirates.
authors.forename: F
authors.initials: F
authors.lastname: Al-Ayoubi
authors.affiliation: Department of Angiology and Vacular Surgery, University Hospital of Torrevieja, Torrevieja, Spain.
authors.forename: L A B
authors.initials: LA
authors.lastname: Barco
authors.affiliation: Emergency Surgery and Trauma Unit, Humanitas Research Hospital, Rozzano, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Ceolin
authors.affiliation: Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
authors.forename: A J G
authors.initials: AJ
authors.lastname: D'Almeida
authors.affiliation: 2nd Surgical Department, Santo André Hospital, Leiria, Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Hilario
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Galdakao Usansolo, Vizcaya, Spain.
authors.forename: A L
authors.initials: AL
authors.lastname: Olavarria
authors.affiliation: Department of Surgery, Medical School, Hacettepe University, 06100, Ankara, Turkey.
authors.forename: M M
authors.initials: MM
authors.lastname: Ozmen
authors.affiliation: General Surgery Department, Hospital São Teotónio, Viseu, Portugal.
authors.forename: L F
authors.initials: LF
authors.lastname: Pinheiro
authors.affiliation: Department of Surgery/Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Poeze
authors.affiliation: Department of General Surgery, Rhodes General Hospital, Rhodes, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Triantos
authors.affiliation: General Surgery 2 and Emergency Surgery, University General Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: F T
authors.initials: FT
authors.lastname: Fuentes
authors.affiliation: Department of Surgery, Galdakao-Usansolo Hospital, Galdakao, Vizcaya, Spain.
authors.forename: S U
authors.initials: SU
authors.lastname: Sierra
authors.affiliation: Department of Clinical Medicine, University of Bergen, Bergen, Norway.|Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Soreide
authors.affiliation: Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Çapa, Istanbul, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Yanar
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use*; D042241:Early Diagnosis; D061345:Early Medical Intervention / Q000379:methods; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D065666:Mesenteric Ischemia / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D061330:Multidetector Computed Tomography / Q000379:methods; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D018570:Risk Assessment / Q000379:methods; D063189:Symptom Assessment / Q000379:methods; D014656:Vascular Surgical Procedures / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants
keywords: Acute mesenteric ischaemia; Clinical management; Diagnosis; Guidelines
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