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Acute mesenteric ischemia: the challenge of gastroenterology.

Surgery Today

therapy, mortality, diagnosis, Vascular Diseases, Treatment Outcome, Tomography, X-Ray Computed, Survival Rate, Severity of Illness Index, Prognosis, Phlebography, Mesenteric Veins, Mesenteric Vascular Occlusion, Male, Magnetic Resonance Imaging, Ischemia, blood supply, Intestines, Humans, trends, standards, Gastroenterology, therapeutic use, Fibrinolytic Agents, Female, methods, Embolectomy, Diagnostic Imaging, Critical Illness, Combined Modality Therapy, Acute Disease

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      Intestinal ischemia has been classified into three major categories based on its clinical features, namely, acute mesenteric ischemia (AMI), chronic mesenteric ischemia (intestinal angina), and colonic ischemia (ischemic colitis). Acute mesenteric ischemia is not an isolated clinical entity, but a complex of diseases, including acute mesenteric arterial embolus and thrombus, mesenteric venous thrombus, and nonocclusive mesenteric ischemia (NOMI). These diseases have common clinical features caused by impaired blood perfusion to the intestine, bacterial translocation, and systemic inflammatory response syndrome. Reperfusion injury, which exacerbates the ischemic damage of the intestinal microcirculation, is another important feature of AMI. There is substantial evidence that the mortality associated with AMI varies according to its cause. Nonocclusive mesenteric ischemia is the most lethal form of AMI because of the poor understanding of its pathophysiology and its mild and nonspecific symptoms, which often delay its diagnosis. Mesenteric venous thrombosis is much less lethal than acute thromboembolism of the superior mesenteric artery and NOMI. We present an overview of the current understanding of AMI based on reported evidence. Although AMI is still lethal and in-hospital mortality rates have remained high over the last few decades, accumulated knowledge on this condition is expected to improve its prognosis.

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