ACUTE AND CHRONIC MESENTERIC ISCHEMIA

Diagnosis and treatment of acute and chronic bowel ischemia remain complex issues of modern surgery. Acute mesenteric ischemia is diagnosed with a delay, due to this time is lost for performing thrombolysis, endovascular interventions, patients undergo extensive resection of the intestine already for gangrene, with high mortality. Chronic forms of bowel ischemia are also diagnosed lately, with the development of severe eating disorders. The review presents modern approaches using the most informative methods and equipment for timely diagnosis and rational selection of a method for treating, recommendations based on the evidence-based medicine principles. The main clinical symptoms of acute and chronic ischemia in occlusive lesions of mesenteric arteries are presented, the presence in the anamnesis of other peripheral arterial disease manifestations, such as thromboembolism, cardiac pathology (atrial fibrillation), is noted as important. The most accurate method of diagnosing acute mesenteric ischemia is contrast-enhanced computed tomography, the possibilities of ultrasound studies and magnetic resonance imaging are discussed. Emergency revascularization is the main method of saving patients' intestines and often lives. Endovascular interventions are preferable, thrombolysis is possible. Open surgical procedure is required in approximately 20-30% of cases as a rescue operation, but at times it may be required to visualize the state of the intestine. In chronic mesenteric ischemia, duplex ultrasonography is recommended as the first line of diagnosis. With a symptomatic form of chronic intestinal ischemia, revascularization is indicated, at that endovascular and open operations have approximately the same efficacy.

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