Mesenteric ischemia (MI) is an uncommon medical condition with high mortality rates.
ΜΙ includes inadequate blood supply, inflammatory injury and eventually necrosis of
the bowel wall. The disease can be divided into acute and chronic MI (CMI), with the
first being subdivided into four categories. Therefore, acute MI (AMI) can occur as
a result of arterial embolism, arterial thrombosis, mesenteric venous thrombosis and
non-occlusive causes. Bowel damage is in proportion to the mesenteric blood flow decrease
and may vary from minimum lesions, due to reversible ischemia, to transmural injury,
with subsequent necrosis and perforation. CMI is associated to diffuse atherosclerotic
disease in more than 95% of cases, with all major mesenteric arteries presenting stenosis
or occlusion. Because of a lack of specific signs or due to its sometime quiet presentation,
this condition is frequently diagnosed only at an advanced stage. Computed tomography
(CT) imaging and CT angiography contribute to differential diagnosis and management
of AMI. Angiography is also the criterion standard for CMI, with mesenteric duplex
ultrasonography and magnetic resonance angiography also being of great importance.
Therapeutic approach of MI includes both medical and surgical treatment. Surgical
procedures include restoration of the blood flow with arteriotomy, endarterectomy
or anterograde bypass, while resection of necrotic bowel is always implemented. The
aim of this review was to evaluate the results of surgical treatment for MI and to
present the recent literature in order to provide an update on the current concepts
of surgical management of the disease. Mesh words selected include MI, diagnostic
approach and therapeutic management.