Langenbeck's Archives of Surgery

, Volume 396, Issue 1, pp 3–11 | Cite as

Intestinal ischemia: current treatment concepts

  • Philipp Renner
  • Klaus Kienle
  • Marc H. Dahlke
  • Peter Heiss
  • Karin Pfister
  • Christian Stroszczynski
  • Pompiliu Piso
  • Hans J. Schlitt
Review Article

Abstract

Purpose

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.

Conclusion

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.

Keywords

Intestinal hypoxia Acute mesenteric ischemia Chronic mesenteric ischemia Colonic ischemia 

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Philipp Renner
    • 1
  • Klaus Kienle
    • 1
  • Marc H. Dahlke
    • 1
  • Peter Heiss
    • 2
  • Karin Pfister
    • 1
  • Christian Stroszczynski
    • 2
  • Pompiliu Piso
    • 1
  • Hans J. Schlitt
    • 1
  1. 1.Klinik und Poliklinik für ChirurgieUniversitätsklinikum RegensburgRegensburgGermany
  2. 2.Institut für RöntgendiagnostikUniversitätsklinikum RegensburgRegensburgGermany

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