If mesenteric ischemia (arterial) and peritonitis (inflammation of the peritoneum) are suspected, immediate laparotomy (surgical opening of the abdomen) is indicated. If peritonitis is not present, the diagnosis of mesenteric ischemia must be confirmed by CT/CT angiography. Caveat. The ischemia tolerance time (time of reduced blood flow that is tolerated) of the intestine is only about 6 hours!
Procedure for acute mesenteric ischemia (AMI) depending on the result of CT/CT angiography.
| Procedure |
Central shutter |
Peripheral shutter |
Verd. a. NOMI* |
| Radiological interventional |
- Catheter embolectomy lysis (dissolution of embolus), possibly stent (vascular bridge).
- In case of failure of endovascular measures or peritonitis (peritonitis): surgical measure required (cooperation of visceral and vascular surgeons).
|
Lysis, vasodilation (vasodilatation). |
Vasodilation (also postoperative after resection). |
| Surgical |
- Laparotomy (surgical opening of the abdomen), embolectomy (removal of the embolus), with resection (removal) of irreversibly damaged intestinal parts if necessary (this reveals a pale light-colored intestine with “zebra markings” that must be resected).
- In no case surgical wound immediately sew up again, because of the high intra-abdominal pressure would cause additional damage, therefore laparostoma, so that a “second look” is possible; e.g. second-look surgery in preserved intestinal segments with uncertain reperfusion (reperfusion).
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* NOMI = non-occlusive mesenteric ischemia (non-occlusive mesenteric ischemia).
