title: Acute mesenteric ischemia (part I) - Incidence, etiologies, and how to improve early diagnosis.
abstract: Acute mesenteric ischemia (AMI) is generally thought to be a rare disease, but in fact, it is more common cause of acute abdomen than appendicitis or ruptured abdominal aortic aneurysm in patients over 75 years of age. In occlusive AMI, surgical treatment without revascularization is associated with as high as 80% overall mortality. It has been shown that early diagnosis with contrast-enhanced computed tomography and revascularization can reduce the overall mortality in AMI by up to 50%. However, only a minority of patients with AMI are being treated actively with revascularization in the United States, and the situation is very likely similar in Europe as well. What can we do to improve diagnostic performance, so that more patients get proper treatment? The diagnosis is a collaborative effort of emergency department surgeons, gastrointestinal and vascular surgeons, and radiologists. The etiological categorization of AMI should be practical and guide the therapy. Furthermore, the limitations of the diagnostic examinations need to be understood with special emphasis on computed tomography findings on patients with slowly progressing "acute-on-chronic" mesenteric ischemia.
authors.affiliation: Heart Center, Kuopio University Hospital, P.O. Box 100, 70029 Kuopio, Finland. Electronic address: jkarkkai@gmail.com.
authors.forename: Jussi M
authors.initials: JM
authors.lastname: Kärkkäinen
authors.affiliation: Department of Clinical Sciences Malmö, Lund University, Sweden. Electronic address: stefan.acosta@med.lu.se.
authors.forename: Stefan
authors.initials: S
authors.lastname: Acosta
mesh_terms: D000208:Acute Disease; D006801:Humans; D065666:Mesenteric Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Acute mesenteric ischemia; Acute on chronic mesenteric ischemia; Computed tomography; Diagnosis; Etiology; Incidence; Mesenteric venous thrombosis; Nonocclusive mesenteric ischemia