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      ESTES guidelines: acute mesenteric ischaemia

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          Abstract

          Purpose

          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.

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          Most cited references114

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          Intestinal mucosal lesion in low-flow states. I. A morphological, hemodynamic, and metabolic reappraisal.

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            Acute mesenteric ischemia: a clinical review.

            Acute mesenteric ischemia is a life-threatening vascular emergency that requires early diagnosis and intervention to adequately restore mesenteric blood flow and to prevent bowel necrosis and patient death. The underlying cause is varied, and the prognosis depends on the precise pathologic findings. Despite the progress in understanding the pathogenesis of mesenteric ischemia and the development of modern treatment modalities, acute mesenteric ischemia remains a diagnostic challenge for clinicians, and the delay in diagnosis contributes to the continued high mortality rate. Early diagnosis and prompt effective treatment are essential to improve the clinical outcome.
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              Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.

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                Author and article information

                Contributors
                +44 1482 875875 , jonathan.tilsed@hey.nhs.uk
                Journal
                Eur J Trauma Emerg Surg
                Eur J Trauma Emerg Surg
                European Journal of Trauma and Emergency Surgery
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1863-9933
                1863-9941
                28 January 2016
                28 January 2016
                2016
                : 42
                : 253-270
                Affiliations
                [ ]Surgery Health Care Group, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
                [ ]Emergency Department, Istituto Clinico Città Studi, Milan, Italy
                [ ]Emergency Surgery and Trauma Unit, Humanitas Research Hospital, Rozzano, Italy
                [ ]Department of General Surgery, Ospedale di Legnano, Milan, Italy
                [ ]Servicio de Cirugía General y Digestiva, Hospital Universitario de Torrevieja, Torrevieja, Spain
                [ ]Surgery 1–Tondela-Viseu Hospital Centre, Viseu, Portugal
                [ ]Department of Surgery, Milton Keynes Hospital NHS Foundation Trust, Milton Keynes, UK
                [ ]2nd Surgical Department, Kepler University Clinic Linz, Linz, Austria
                [ ]Division of Trauma and Acute Care Surgery, Mafraq Hospital, Abu Dhabi, United Arab Emirates
                [ ]Department of Angiology and Vacular Surgery, University Hospital of Torrevieja, Torrevieja, Spain
                [ ]Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
                [ ]2nd Surgical Department, Santo André Hospital, Leiria, Portugal
                [ ]Servicio de Cirugía General y Digestiva, Hospital Galdakao Usansolo, Vizcaya, Spain
                [ ]Department of Surgery, Medical School, Hacettepe University, 06100 Ankara, Turkey
                [ ]General Surgery Department, Hospital São Teotónio, Viseu, Portugal
                [ ]Department of Surgery/Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
                [ ]Department of General Surgery, Rhodes General Hospital, Rhodes, Greece
                [ ]General Surgery 2 and Emergency Surgery, University General Hospital Gregorio Marañón, Madrid, Spain
                [ ]Department of Surgery, Galdakao-Usansolo Hospital, Galdakao, Vizcaya Spain
                [ ]Department of Clinical Medicine, University of Bergen, Bergen, Norway
                [ ]Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
                [ ]Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Çapa, Istanbul, Turkey
                Article
                634
                10.1007/s00068-016-0634-0
                4830881
                26820988
                2d6d9d48-ee43-432e-b49d-7ed8f6441782
                © The Author(s) 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Categories
                ESTES Guideline
                Custom metadata
                © Springer-Verlag Berlin Heidelberg 2016

                Emergency medicine & Trauma
                acute mesenteric ischaemia,diagnosis,clinical management,guidelines

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