Mesenteric ischemia surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Surgery may be needed to treat mesenteric ischemia. Surgery for chronic mesenteric artery ischemia involves removing the blockage and reconnecting the arteries to the aorta. A bypass around the blockage is another procedure. It is usually done with a plastic tube graft. An alternative to surgery is a stent. It may be inserted to enlarge the blockage in the mesenteric artery or deliver medicine directly to the affected area. This is a new technique and it should only be done by experienced health care providers. The outcome is usually better with surgery. Surgical revascularisation remains the treatment of choice for mesenteric ischemia, but thrombolytic medical treatment and vascular interventional radiological techniques have a growing role [1].
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.
References
- ↑ Sreenarasimhaiah J (2003). "Diagnosis and management of intestinal ischaemic disorders". BMJ. 326 (7403): 1372–6. doi:10.1136/bmj.326.7403.1372. PMID 12816826.