Acute mesenteric ischaemia—Challenging the multidisciplinary emergency service

Addressing acute conditions which represent an interface between emergency general and vascular surgery is challenging.

One of these conditions is acute mesenteric ischaemia (AMI). AMI is a rare, rapidly progressing, fatal condition. All types of aetiologies call for very different therapies and outcome among the subgroups differ significantly. While the prognosis of acute on chronic thrombosis of the superior mesenteric artery (SMA) and non-occlusive mesenteric ischaemia (NOMI) is generally poor, embolisation of the SMA and acute mesenteric venous thrombosis can be treated successfully if diagnosed early. Systemic anticoagulation should commence once the diagnosis of AMI is established and this alone may be therapeutic in acute mesenteric venous thrombosis. The commonest aetiology – embolisation of the superior mesenteric artery (SMA) – is successfully treatable by embolectomy, especially before bowel necrosis occurs.

If survival is to be achieved, a well co-ordinated reperfusion strategy – delivered by a multidisciplinary team – is required. The importance of interdisciplinary communication between the emergency general surgical, medical and vascular service is highlighted.