Hess, Benjamin; Cahenzli, Martin; Forbes, Alastair; Burgos, Rosa; Coccolini, Federico; Corcos, Olivier; Holst, Mette; Irtun, Øivind; Klek, Stanislaw; Pironi, Loris; Rasmussen, Henrik Højgaard; Serlie, Mireille J; Thibault, Ronan; Gabe, Simon; Reintam Blaser, Annika (2023). Management of acute mesenteric ischaemia: Results of a worldwide survey. Clinical Nutrition ESPEN, 54, pp. 194-205. Elsevier 10.1016/j.clnesp.2022.12.022
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BACKGROUND
Acute mesenteric ischaemia (AMI) is a condition with high mortality. This survey assesses current attitudes and practices to manage AMI worldwide.
METHODS
A questionnaire survey about the practices of diagnosing and managing AMI, endorsed by several specialist societies, was sent to different medical specialists and hospitals worldwide. Data from individual health care professionals and from medical teams were collected.
RESULTS
We collected 493 individual forms from 71 countries and 94 team forms from 34 countries. Almost half of respondents were surgeons, and most of the responding teams (70%) were led by surgeons. Most of the respondents indicated that diagnosis of AMI is often delayed but rarely missed. Emergency revascularisation is often considered for patients with AMI but rarely in cases of transmural ischaemia (intestinal infarction). Responses from team hospitals with a dedicated special unit (14 team forms) indicated more aggressive revascularisation. Abdominopelvic CT-scan with intravenous contrast was suggested as the most useful diagnostic test, indicated by approximately 90% of respondents. Medical history and risk factors were thought to be more important in diagnosis of AMI without transmural ischaemia, whereas for intestinal infarction, plasma lactate concentrations and surgical exploration were considered more useful. In elderly patients, a palliative approach is often chosen over extensive bowel resection. There was a large variability in anticoagulant treatment, as well as in timing of surgery to restore bowel continuity.
CONCLUSIONS
Delayed diagnosis of AMI is common despite wide availability of an adequate imaging modality, i.e. CT-scan. Large variability in treatment approaches exists, indicating the need for updated guidelines. Increased awareness and knowledge of AMI may improve current practice until more robust evidence becomes available. Adherence to the existing guidelines may help in improving differences in treatment and outcomes.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2405-4577 |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
27 Mar 2023 12:50 |
Last Modified: |
28 Mar 2023 15:25 |
Publisher DOI: |
10.1016/j.clnesp.2022.12.022 |
PubMed ID: |
36963863 |
Additional Information: |
Lukas Widmer is Collaborator of ESPEN Special Interest Group on Acute Intestinal Failure ESPEN (European Society for Clinical Nutrition and Metabolism) with Affiliation Department of Visceral Surgery and Medicine, University Hospital Inselspital, Bern, Switzerland |
Uncontrolled Keywords: |
Acute mesenteric infarction Acute mesenteric ischaemia Intestinal failure NOMI (Non-occlusive mesenteric ischaemia) Occlusive intestinal ischaemia Survey Treatment |
BORIS DOI: |
10.48350/180664 |
URI: |
https://boris.unibe.ch/id/eprint/180664 |
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