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<p>Mesenteric ischemia is a&#xa0;highly acute condition associated with an in-hospital mortality rate of 60–90%, which has shown little improvement in recent decades.&#xa0;The primary reasons for this are the often nonspecific clinical presentation and delayed diagnosis.</p><p>Contrast-enhanced computed tomography (CT) angiography is considered the diagnostic procedure of choice. It enables the detection of vascular occlusions and indirect signs of ischemia, such as bowel wall edema, pneumatosis intestinalis or accumulation of portal venous gas. Laboratory parameters, such as lactate levels or markers of inflammation, can provide clues but lack sufficient sensitivity and specificity; consequently, the definitive assessment of bowel viability is often performed via exploratory laparoscopy or laparotomy.</p><p>Rapid diagnosis, hemodynamic stabilization, antibiotic therapy and timely surgical intervention are crucial for the prognosis. In addition to restoring blood flow, the resection of necrotic bowel segments &#xa0; to&#xa0;prevent septic complications is a primary objective. Second-look surgery and the restoration of gastrointestinal continuity are frequently required.</p><p>Vascular surgery plays a&#xa0;pivotal role, particularly in revascularization and should be integrated into the treatment plan as early as possible; however, given the predominant intestinal pathology and the requirements of postoperative management, primary inpatient care on a&#xa0;general surgery ward appears to be medically appropriate and logistically practical.&#xa0; Vascular surgery remains an indispensable interdisciplinary partner in this context.</p>

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Betreuung von Patientinnen und Patienten mit akuter Mesenterialischämie auf einer allgemeinchirurgischen Station

  • 期刊论文

  • 发表日期：

    2026年7月17日

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  • Rainer Grotelüschen

摘要

Mesenteric ischemia is a highly acute condition associated with an in-hospital mortality rate of 60–90%, which has shown little improvement in recent decades. The primary reasons for this are the often nonspecific clinical presentation and delayed diagnosis.

Contrast-enhanced computed tomography (CT) angiography is considered the diagnostic procedure of choice. It enables the detection of vascular occlusions and indirect signs of ischemia, such as bowel wall edema, pneumatosis intestinalis or accumulation of portal venous gas. Laboratory parameters, such as lactate levels or markers of inflammation, can provide clues but lack sufficient sensitivity and specificity; consequently, the definitive assessment of bowel viability is often performed via exploratory laparoscopy or laparotomy.

Rapid diagnosis, hemodynamic stabilization, antibiotic therapy and timely surgical intervention are crucial for the prognosis. In addition to restoring blood flow, the resection of necrotic bowel segments   to prevent septic complications is a primary objective. Second-look surgery and the restoration of gastrointestinal continuity are frequently required.

Vascular surgery plays a pivotal role, particularly in revascularization and should be integrated into the treatment plan as early as possible; however, given the predominant intestinal pathology and the requirements of postoperative management, primary inpatient care on a general surgery ward appears to be medically appropriate and logistically practical.  Vascular surgery remains an indispensable interdisciplinary partner in this context.