ICU · GI/Nutrition

Acute mesenteric ischaemia

Also known as Mesenteric ischaemia · Bowel ischaemia · Intestinal infarction · Non-occlusive mesenteric ischaemia (NOMI) · SMA embolism · Mesenteric venous thrombosis

Acute mesenteric ischaemia is a life-threatening vascular emergency of the bowel. Four types: (1) SMA embolus (1 — atrial fibrillation, 50%), (2) SMA thrombosis (pre-existing atherosclerosis, 25%), (3) Non-occlusive (NOMI — low-flow state, 20%), (4) Mesenteric venous thrombosis (5%). Presents with SEVERE abdominal pain OUT OF PROPORTION to examination findings. Diagnosis: CT angiography (gold standard — shows occlusion, bowel wall thickening, pneumatosis, portal venous gas). Lactate elevated (late sign — bowel infarction). Management by type: emboli to embolectomy, thrombosis to bypass/stent, NOMI to intra-arterial papaverine, venous thrombosis to anticoagulation. Mortality 50-80% overall, highest for SMA thrombosis. WSES staging guides operative vs endovascular strategy. Time is bowel.