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Mesenteric ischemia: Pathogenesis and challenging diagnostic and therapeutic modalities.

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      Abstract

      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.

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      [1 ] Aikaterini Mastoraki, Evgenia Tziava, Stavroula Touloumi, Nikolaos Krinos, Nikolaos Danias, Nikolaos Arkadopoulos, 4 Department of Surgery, Athens University, Medical School, ATTIKON University Hospital, 12462 Chaidari, Athens, Greece.
      Journal
      World J Gastrointest Pathophysiol
      World journal of gastrointestinal pathophysiology
      Baishideng Publishing Group Inc.
      2150-5330
      2150-5330
      Feb 15 2016
      : 7
      : 1
      26909235 10.4291/wjgp.v7.i1.125 4753178

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