Mesenteric ischemia surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Surgery in mesenteric ischemia is done to resect the ischemic bowel in order to prevent the complications. AMI is a real surgical emergency. First and fundamental, essential proof is a high index of suspicion based at the aggregate of history of abrupt onset of abdominal pain, acidosis, and organ failure. This clinical situation ought to prompt imaging (CTA) a good way to establish the prognosis. In parallel with speedy resuscitation and after careful assessment of the CTA, the affected person have to be explored to assess bowel viability, re-establish vascular float, and resect non-feasible bowel. eventually, the employment of harm manipulate strategies and endured critical care resuscitation is important. planned re-assessment of the bowel with further resection or anastomosis and stoma as needed is quintessential. close cooperation between acute care surgeons, radiologists, anesthetists, and the vascular surgeons is vital.
Surgery
- The goals of surgical therapy are as follows:
- Re-establishment blood supply to the ischemic bowel
- Resection of all non-viable areas of the bowel
- Preservation of the viable bowel
- Intestinal viability is defined as the maximum vital element influencing outcome in patients with AMI.
- Non-viable bowel, if unrecognized, can cause multi-organ failure and lead to the death eventually.
- Laparotomy allows to determine the viability of the bowel.
- After preliminary resuscitation, midline laparotomy should be done observed by means of assessment of all areas of the gut with choices for resection of all surely necrotic areas. In instances of uncertainty, intraoperative Doppler can be beneficial.