Part 8/Chapter 48/18-min read

Acute Mesenteric Ischemia, NOMI, and Bowel-Viability Pathways

Acute mesenteric ischemia is a vascular emergency because diagnostic delay turns a potentially reversible perfusion problem into transmural infarction. Management begins with clinical suspicion and dual-phase CT angiography, then rapid selection of endovascular, open, or hybrid revascularization, NOMI-specific hemodynamic rescue with selective vasodilator therapy where appropriate, and deliberate bowel-viability planning when viability is uncertain.

Edited by Tal M. Hörer MD, PhD · David T. McGreevy MD, PhD·Reviewed ·8 sections · 63 references

Listen to this chapter10 min · AI audio edition · two hostsAI narration

Emergency handoff / trauma debrief: Urgent but calm: frame the initial recognition, the sequence of decisions, transfer/workflow, and what changes the plan.

Choose the hosts

Why this is a vascular emergency

Acute mesenteric ischemia should be approached as a vascular emergency before it becomes an abdominal catastrophe. Across modern series and systematic syntheses, pooled 30-day mortality commonly sits in the 40 to 60 percent range, and the gains from better imaging and endovascular capability have not translated into a simple, uniform survival improvement . The clinical reason is straightforward: the small bowel has limited tolerance for interrupted arterial inflow, impaired venous outflow, or profound low-flow vasoconstriction. A patient may still be salvageable while the pain is severe and the abdomen is soft; the same patient may be beyond bowel salvage once peritonitis, shock, and transmural infarction have declared themselves .

Risk FactorsAcute mesenteric ischemia: red-flag presentations
  • Adults with acute mesenteric ischemia diagnosed in hospital
    Action
    Lower mortality in selected single-center series with multidisciplinary pathways; mortality higher in older patients, with delayed diagnosis, and in non-occlusive disease.
    Why it matters
    Acute mesenteric ischemia carries a pooled 30-day mortality of approximately 40 to 60 percent across modern series and systematic reviews; survival has not improved dramatically despite advances in imaging and endovascular revascularization.
    Citation
  • Adults presenting with acute abdominal pain in whom mesenteric ischemia is on the differential
    Action
    A soft abdomen with severe pain in an older patient with cardiovascular risk is a high-yield red flag; peritonitis suggests transmural infarction and a more aggressive trajectory.
    Why it matters
    The classical presentation is sudden severe abdominal pain that is disproportionate to physical examination findings, often in a patient with atrial fibrillation, recent cardiac event, peripheral arterial disease, or a known thromboembolic source.
    Citation

The initial priority is to determine whether the presentation is dangerous enough to trigger an emergency mesenteric pathway. The mechanism may be embolic superior mesenteric artery occlusion, acute thrombosis on chronic atherosclerotic disease, mesenteric venous thrombosis, or non-occlusive mesenteric ischemia in a low-flow state. These mechanisms differ in treatment, but they share one early problem: symptoms and laboratory abnormalities may be non-specific while irreversible injury is already developing. A vascular service that waits for a classic triad, a rising lactate, or overt peritonitis will diagnose too late.

Severe unexplained abdominal pain in a cardiovascular-risk patient should be treated as a time-sensitive perfusion problem until CT angiography proves otherwise. Early involvement of vascular surgery, acute-care surgery, anesthesia or intensive care, and interventional radiology prevents the common sequence in which imaging, resuscitation, laparotomy, and revascularization are considered one after another rather than in parallel.

Presentation, biomarkers, and pretest probability

The red flag is pain out of proportion to the examination, especially when the patient has atrial fibrillation, a recent myocardial infarction or cardiac intervention, known peripheral arterial disease, heart failure, or another plausible embolic source . In the early arterial presentation the patient may have severe, persistent, poorly localized abdominal pain with little guarding. In a thrombotic presentation there may be a history of chronic post-prandial symptoms or weight loss, but absence of that history does not make acute thrombosis safe to exclude. Peritonitis, abdominal rigidity, persistent metabolic deterioration, or shock should be treated as evidence that the decision has moved from diagnosis alone to simultaneous revascularization and bowel inspection.

Serum lactate is useful when elevated, but unsafe as a gatekeeper. Observational data document patients with confirmed acute mesenteric ischemia, including transmural disease, who had normal lactate at presentation; delayed or isolated lactate testing can therefore produce false reassurance . Lactate reflects systemic hypoperfusion and later metabolic failure more reliably than early mucosal ischemia. A rising lactate in the right patient should intensify urgency, but a normal value should not postpone CT angiography when the history and risk profile are concerning.

Other blood tests can refine the picture but do not replace imaging. Leucocytosis, acidosis, haemoconcentration, renal dysfunction, and coagulation abnormalities may support severity or operative risk, but they are not sufficiently accurate to rule the disease in or out. Systematic syntheses of intestinal fatty acid binding protein, D-dimer, alpha-glutathione S-transferase, and broader haematological markers show moderate diagnostic performance rather than a stand-alone diagnostic solution . The safe decision rule is simple: high pretest probability goes to contrast-enhanced CT angiography, with biomarkers interpreted around that decision rather than before it.

Imaging anchor: dual-phase CT angiography

Dual-phase contrast-enhanced CT angiography is the diagnostic reference point for suspected acute mesenteric ischemia. Modern systematic syntheses report pooled CT sensitivity of approximately 93 to 96 percent and specificity above 90 percent when arterial and portal-venous phases are obtained, which is why CT angiography has become the first-line test for both occlusive disease and the imaging assessment of non-occlusive patterns . The protocol matters. A portal-venous phase alone may show late bowel injury but miss the arterial lesion that determines treatment; an unenhanced scan may delay the diagnosis while appearing falsely reassuring.

The scan should answer four operative questions. First, is there an occluded or critically stenosed superior mesenteric artery, celiac axis, or venous outflow problem? Second, does the pattern suggest embolus, in-situ thrombosis over chronic ostial disease, venous thrombosis, or NOMI? Third, are there signs of bowel injury such as reduced mural enhancement, pneumatosis, portal venous gas, free fluid, or perforation? Fourth, is there enough anatomic information to plan an endovascular, open, or hybrid route without repeating diagnostic steps? Contemporary radiology literature emphasises that diagnosis and treatment planning are inseparable in this disease: the report should not stop at “possible ischemia” when the vascular target and bowel-risk signs can be described .

Renal dysfunction must not delay diagnosis. Society guidance supports contrast-enhanced imaging when acute mesenteric ischemia is suspected, with renal-protective strategies managed around the scan rather than by withholding it . Duplex ultrasound can identify mesenteric disease in selected settings, but in the acute pathway it is operator-dependent, slower to operationalise in many hospitals, and not a substitute for CT angiography when bowel viability is at stake .

DiagnosticSuspected acute mesenteric ischemia: stepwise diagnostic pathway
  • Send arterial lactate and a full coagulation/biomarker panel; do not wait for the result before imaging
    Trigger
    High pretest probability after history and examination
    Branch / Endpoint
    If pretest probability is high, proceed to CT angiography regardless of lactate value
    Citation
  • Dual-phase CT angiography with arterial and portal-venous phases
    Trigger
    Suspected acute mesenteric ischemia after history, examination, and lactate
    Branch / Endpoint
    If positive: emergency vascular consult and theatre/interventional radiology pathway; if negative and pretest probability remains high, escalate to mesenteric angiography or operative exploration
    Citation

Time to revascularisation is the dominant lever

Once acute mesenteric ischemia is suspected, the clock is a bowel-viability clock. Society guidance and pooled clinical series consistently frame delay to diagnosis and revascularization as the modifiable variable most closely tied to survival; transmural infarction risk rises sharply when symptom duration passes roughly 24 hours, and restoring flow after irreversible necrosis cannot convert dead bowel into viable bowel . This is the reason the disease should be handled more like acute limb ischemia than like undifferentiated abdominal pain: the diagnostic, vascular, and operative pathways have to move at the same time.

Decision threshold

Confirmed acute mesenteric ischemia

Which threshold or scenario changes the management action?

  1. Confirmed acute mesenteric ischemia
    Treat as a vascular emergency; pooled series show transmural infarction risk rising sharply beyond 24 hours from symptom onset
    Activate a vascular emergency pathway: simultaneous theatre and interventional radiology preparation
    Pre-existing collateralisation, etiology (embolic vs thrombotic vs NOMI), and patient fitness
  2. Adults requiring laparotomy for peritonitis with simultaneous need for SMA revascularization
    Anatomy precludes safe percutaneous antegrade crossing of the mesenteric origin or peritonitis demands bowel inspection
    Plan ROMS or open thromboendarterectomy with intraoperative completion angiography
    Operator and center experience; chronic atherosclerotic versus acute embolic etiology
  3. Intraoperative bowel-viability decision after revascularization
    Borderline color, peristalsis, or doppler signal
    Use indocyanine green angiography, contrast-enhanced ultrasound, or planned second-look laparotomy at 24–48 hours
    Operator and center experience; availability of imaging adjuncts
Source · ·

Major society documents emphasise urgency more than a single numeric hospital benchmark . A useful local pathway defines the interval from emergency presentation or in-hospital clinical trigger to completed CT angiography, vascular decision, and first attempt at revascularization. That interval should be auditable, because the patient can lose salvageable bowel while teams debate admission location, wait for creatinine correction, or sequence general surgery and vascular assessment rather than activating both.

A functioning pathway has several features. The CT request is labeled as suspected mesenteric ischemia, not generic abdominal pain; the scanner protocol includes arterial and portal-venous phases; the vascular surgeon and interventional radiology operator see the images early; the operating theatre and endovascular suite are treated as alternative routes, not competing silos; and laparotomy is not delayed when peritonitis is present. ESTES, WSES, and ESVS guidance all support urgent multidisciplinary management rather than serial reassessment once the diagnosis is plausible . Mortality-predictor analyses reinforce the same point: age, organ failure, transmural infarction, and NOMI etiology may be fixed at presentation, but diagnostic delay is the lever the system can still change .

Endovascular, open, and hybrid (ROMS) revascularisation

For occlusive arterial acute mesenteric ischemia, the first revascularization decision is whether an endovascular route can restore flow quickly enough and safely enough for the patient in front of the team. Pooled comparative analyses associate endovascular-first treatment with lower perioperative mortality than primary open revascularization, and that direction is consistent across contemporary systematic syntheses; the limitation is that endovascular cohorts often include patients without frank peritonitis or with anatomy more suitable for percutaneous treatment, and randomized comparative trials are absent . The conclusion is not that open surgery is obsolete, but that endovascular capability should be immediately available when the lesion and patient are suitable.

Revascularization strategy: endovascular versus open and adjunctive vasodilator therapy

  • Population
    Adults with occlusive acute mesenteric ischemia
    Intervention
    Endovascular revascularization (aspiration thrombectomy, stenting, catheter-directed thrombolysis)
    Comparator
    Open mesenteric revascularization (embolectomy, bypass, endarterectomy)
    N
    Pooled observational data; no randomized trial
    Follow-up
    In-hospital and 30-day
    Primary outcome
    Perioperative mortality and bowel resection
    Key result
    Lower in-hospital mortality with endovascular-first when anatomy permits; consistent direction across systematic reviews
    Limitation
    Selection bias (endovascular case series often have less peritonitis); no randomized data
    Citation

  • Population
    Adults after revascularization for acute mesenteric ischemia
    Intervention
    Selective mesenteric intra-arterial vasodilator infusion
    Comparator
    Standard postoperative care
    N
    Pooled observational analyses across centers
    Follow-up
    30 days
    Primary outcome
    30-day mortality
    Key result
    Lower 30-day mortality with adjuvant vasodilator therapy in pooled analyses
    Limitation
    Observational; center and case-mix variation; no randomized data
    Citation

Anatomy determines much of the choice. A fresh embolus in the proximal or mid superior mesenteric artery may be approached with aspiration thrombectomy, catheter-directed techniques, or adjunctive stenting when a fixed lesion is present. Acute thrombosis at an atherosclerotic ostium often behaves differently: crossing may be difficult, the landing zone may require stenting, and bowel inspection may be needed if symptoms have been prolonged . Peritonitis changes the priority because the abdomen must be opened to determine what bowel is viable and what must be resected. In that setting, an endovascular-only success can still be an incomplete operation if dead bowel remains unrecognised.

Hybrid retrograde open mesenteric stenting fills the gap between a purely percutaneous strategy and a conventional open bypass or endarterectomy. At laparotomy, the surgeon can inspect the bowel, expose the superior mesenteric artery, gain retrograde access, and stent the diseased origin under fluoroscopic control. ROMS is particularly useful when percutaneous antegrade crossing is unsafe or unsuccessful and when the patient already needs laparotomy for peritonitis or uncertain bowel viability; reported outcomes remain series-level and center-specific . Primary open embolectomy, endarterectomy, or bypass remains appropriate when the anatomy is unsuitable for endovascular repair, when endovascular treatment fails, or when an open route is the fastest reliable way to restore inflow .

Adjunctive vasodilator therapy after revascularization is best understood as support for a vulnerable mesenteric circulation rather than as a substitute for reopening the artery. Observational analyses have associated postoperative or perioperative selective intra-arterial vasodilator therapy with lower mortality in selected acute mesenteric ischemia cohorts, but use, agent, dose, and duration vary across centers . The core surgical principle remains unchanged: restore flow, assess bowel, resect only clearly non-viable bowel, and plan a second look when the border is uncertain.

Non-occlusive mesenteric ischemia (NOMI)

NOMI is characterized by mesenteric hypoperfusion in a patient whose arterial trunk may remain patent. The typical setting is shock, high-dose vasopressor exposure, severe heart failure, sepsis, refractory cardiac arrest, or the postoperative cardiac-surgery and intensive-care environment, where splanchnic vasoconstriction and low flow injure bowel without a discrete occluding lesion on CT angiography . The diagnosis is difficult because the patient may be sedated, ventilated, or unable to report the pain pattern that would trigger suspicion in the emergency department. Unexplained lactate rise, feeding intolerance, abdominal distension, escalating vasopressor requirement, or new CT bowel-hypoperfusion signs in this setting should lower the threshold for mesenteric imaging and specialist assessment.

TreatmentNon-occlusive mesenteric ischemia (NOMI) pathway
  • Evidence source
    Takeaway
    Non-occlusive mesenteric ischemia is managed by reversing the underlying low-flow state (hemodynamic resuscitation, withdrawal of vasoconstrictors where possible) and by selective mesenteric intra-arterial vasodilator infusion (papaverine or alprostadil/iloprost) where the diagnosis is confirmed; pooled observational analyses link vasodilator therapy to lower mortality but the signal is series-level rather than randomized.
    Population
    Adults with non-occlusive mesenteric ischemia (NOMI), most commonly in intensive care after cardiac surgery, with shock, or on high-dose vasopressor support
    Caveat
    NOMI mortality remains very high (50–70 percent in pooled NOMI-specific series) even with vasodilator therapy; treatment of the underlying low-flow state is the primary task and vasodilator infusion is an adjunct.
    Citation

The first treatment is correction of the low-flow state. That means volume and perfusion optimization, reduction of vasoconstrictor burden where clinically possible, treatment of the septic or cardiac driver, and early recognition that bowel ischemia may itself be worsening shock. Selective mesenteric intra-arterial vasodilator infusion, using papaverine or prostaglandin agents such as alprostadil or iloprost according to local protocol, is an adjunct when NOMI is confirmed or strongly suspected and the patient can undergo catheter-directed treatment. Nationwide and pooled observational analyses link vasodilator therapy with lower mortality in NOMI cohorts, but the evidence remains non-randomized and practice varies by center .

Vasodilator infusion should not be mistaken for definitive source control. NOMI mortality remains very high in contemporary cohorts, often because the same shock state that produced bowel hypoperfusion also produces renal failure, respiratory failure, and circulatory collapse . The catheter can improve mesenteric tone, but it cannot reverse transmural necrosis. Peritonitis, perforation, pneumatosis with clinical deterioration, or persistent organ failure despite hemodynamic correction should trigger operative inspection, even if an angiographic spasm pattern has improved.

Bowel-viability assessment and second-look laparotomy

Bowel viability is a decision made after flow, time, and inspection are brought together. At laparotomy the surgeon first identifies frankly necrotic bowel that must be resected, but the harder decision is the borderline segment: dusky bowel after revascularization, questionable peristalsis, a weak mesenteric signal, or a segment that may improve once inflow and systemic perfusion recover. Traditional assessment by color, peristalsis, arterial pulsation, bleeding at the cut edge, and Doppler signal remains necessary, but it is subjective and can lead either to excessive resection or to retained necrosis .

Adjunct perfusion tools are most useful at this borderline. Indocyanine green fluorescence angiography can show whether microvascular perfusion reaches the bowel wall after revascularization, and selected series report that it can reduce extended bowel resection by clarifying the margin between perfused and non-perfused bowel . Contrast-enhanced ultrasound and tissue-spectroscopy approaches are also described as methods to supplement inspection, but their use is center-dependent and the literature remains largely observational or developmental rather than definitive . These tools should sharpen the operative decision; they should not replace clinical judgment when the patient is unstable or the bowel is clearly infarcted.

A planned second-look laparotomy is the safety valve for uncertainty. When the bowel is borderline but not frankly dead, especially after delayed revascularization or profound shock, leaving questionable segments in situ and returning at 24 to 48 hours can avoid an over-cautious massive resection while protecting the patient from missed necrosis . This strategy requires deliberate planning at the index operation: document which segments are at risk, whether the abdomen is left open or temporarily closed, what physiologic targets must be corrected in intensive care, and what finding at the second look will trigger further resection.

What still drives 30-day mortality

Patients who die after acute mesenteric ischemia typically succumb because the disease was recognised late, the bowel was already necrotic, or the systemic illness was too advanced to survive. Systematic syntheses and operative cohorts repeatedly identify age, bowel necrosis at the index operation, organ failure including renal failure and high SOFA score, delayed diagnosis, and non-occlusive etiology as dominant predictors of 30-day mortality . The precise effect size varies by cohort because an endovascular series with fewer peritonitic patients is not the same population as an emergency laparotomy series with established infarction .

30-day mortality predictors after acute mesenteric ischemia
  • 30-day mortality predictors
    Effect estimate
    —
    Takeaway
    Modifiable predictor is delay to diagnosis; structural pathway design should target this.
    Evidence type
    Pooled systematic reviews and registry analyses
    Direction
    Higher mortality with bowel necrosis, organ failure, delay to diagnosis, and NOMI etiology
    Certainty
    Moderate (observational)
    Guideline stanceDrives quality auditing and pathway designCitation

This distinction matters when interpreting endovascular and open outcomes. Endovascular-first treatment may reduce perioperative mortality in anatomically suitable occlusive disease, but it cannot erase the mortality penalty of transmural bowel necrosis, severe shock, or delayed presentation. Conversely, open or hybrid treatment may look worse in pooled comparisons because the patient has already declared a need for laparotomy. The pathway should therefore measure two outcomes together: technical restoration of mesenteric flow and bowel/physiologic rescue. A patent superior mesenteric artery is not a success if the bowel is dead, and a careful laparotomy is not enough if inflow has not been restored.

The modifiable lesson is delay. Diagnostic meta-analyses, management syntheses, and contemporary pathway discussions all point toward earlier recognition, faster CT angiography, and faster mobilization of the revascularization route as the system-level opportunity . ICU cohorts, COVID-era database analyses, elderly series, and studies of racial and gender disparities show that outcomes are also shaped by access, baseline frailty, competing organ failure, and how quickly atypical or high-risk presentations are acted on . A mature mesenteric ischemia program audits missed triggers, time to CT, time to vascular decision, time to revascularization, bowel-resection burden, second-look findings, and survival, because those are the points where a lethal presentation can still be converted into a salvage pathway.

References

  1. 1.
    Editor's Choice - Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). 2017.
    PubMed-indexed articleClinical practice guideline2017

    Editor's Choice - Management of the Diseases of Mesenteric Arteries and Veins: Clinical Practice Guidelines of the European Society of Vascular Surgery (ESVS). 2017. doi:10.1016/j.ejvs.2017.01.010.

    PubMedDOI
  2. 2.
    Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy. European radiology. 2002.
    PubMed-indexed articleReview2002

    Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy. European radiology. 2002. doi:10.1007/s00330-001-1220-2.

    PubMedDOI
  3. 3.
    Operative assessment of intestinal viability. The Surgical clinics of North America. 1992.
    PubMed-indexed articleReview1992

    Operative assessment of intestinal viability. The Surgical clinics of North America. 1992. doi:10.1016/s0039-6109(16)45632-x.

    PubMedDOI
  4. 4.
    Acute mesenteric ischemia. Current gastroenterology reports. 2008.
    PubMed-indexed articleReview2008

    Acute mesenteric ischemia. Current gastroenterology reports. 2008. doi:10.1007/s11894-008-0065-0.

    PubMedDOI
  5. 5.
    Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis. Radiology. 2010.
    PubMed-indexed articleMeta-analysis / systematic review2010

    Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis. Radiology. 2010. doi:10.1148/radiol.10091938.

    PubMedDOI
  6. 6.
    The diagnosis of acute mesenteric ischemia: A systematic review and meta-analysis. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2013.
    PubMed-indexed articleMeta-analysis / systematic review2013

    The diagnosis of acute mesenteric ischemia: A systematic review and meta-analysis. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2013. doi:10.1111/acem.12254.

    PubMedDOI
  7. 7.
    Determination of intestinal viability. The Veterinary clinics of North America. Equine practice. 1989.
    PubMed-indexed article1989

    Determination of intestinal viability. The Veterinary clinics of North America. Equine practice. 1989. doi:10.1016/s0749-0739(17)30590-4.

    PubMedDOI
  8. 8.
    Management of Acute Mesenteric Ischemia: A Critical Review and Treatment Algorithm. Vascular and endovascular surgery. 2016.
    PubMed-indexed articleReview2016

    Management of Acute Mesenteric Ischemia: A Critical Review and Treatment Algorithm. Vascular and endovascular surgery. 2016. doi:10.1177/1538574416639151.

    PubMedDOI
  9. 9.
    Acute mesenteric ischemia (Part II) - Vascular and endovascular surgical approaches. Best practice & research. Clinical gastroenterology. 2017.
    PubMed-indexed articleReview2017

    Acute mesenteric ischemia (Part II) - Vascular and endovascular surgical approaches. Best practice & research. Clinical gastroenterology. 2017. doi:10.1016/j.bpg.2016.11.003.

    PubMedDOI
  10. 10.
    Diagnostic accuracy of novel serological biomarkers to detect acute mesenteric ischemia: a systematic review and meta-analysis. Internal and emergency medicine. 2017.
    PubMed-indexed articleMeta-analysis / systematic review2017

    Diagnostic accuracy of novel serological biomarkers to detect acute mesenteric ischemia: a systematic review and meta-analysis. Internal and emergency medicine. 2017. doi:10.1007/s11739-017-1668-y.

    PubMedDOI
  11. 11.
    Acute Mesenteric Ischemia: Multidetector CT Findings and Endovascular Management. Radiographics : a review publication of the Radiological Society of North America, Inc. 2018.
    PubMed-indexed articleReview2018

    Acute Mesenteric Ischemia: Multidetector CT Findings and Endovascular Management. Radiographics : a review publication of the Radiological Society of North America, Inc. 2018. doi:10.1148/rg.2018170163.

    PubMedDOI
  12. 12.
    Indocyanine Green Tissue Angiography Can Reduce Extended Bowel Resections in Acute Mesenteric Ischemia. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2018.
    PubMed-indexed article2018

    Indocyanine Green Tissue Angiography Can Reduce Extended Bowel Resections in Acute Mesenteric Ischemia. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2018. doi:10.1007/s11605-018-3855-1.

    PubMedDOI
  13. 13.
    Contemporary Management of Acute Mesenteric Ischemia in the Endovascular Era. Vascular and endovascular surgery. 2019.
    PubMed-indexed articleReview2019

    Contemporary Management of Acute Mesenteric Ischemia in the Endovascular Era. Vascular and endovascular surgery. 2019. doi:10.1177/1538574418805228.

    PubMedDOI
  14. 14.
    Diagnostic accuracy of hematological parameters in Acute mesenteric ischemia-A systematic review. International journal of surgery (London, England). 2019.
    PubMed-indexed articleMeta-analysis / systematic review2019

    Diagnostic accuracy of hematological parameters in Acute mesenteric ischemia-A systematic review. International journal of surgery (London, England). 2019. doi:10.1016/j.ijsu.2019.04.005.

    PubMedDOI
  15. 15.
    Open abdomen in acute mesenteric ischemia. Anaesthesiology intensive therapy. 2019.
    PubMed-indexed article2019

    Open abdomen in acute mesenteric ischemia. Anaesthesiology intensive therapy. 2019. doi:10.5114/ait.2019.86280.

    PubMedDOI
  16. 16.
    Techniques for intraoperative evaluation of bowel viability in mesenteric ischemia: A review. American journal of surgery. 2020.
    PubMed-indexed articleReview2020

    Techniques for intraoperative evaluation of bowel viability in mesenteric ischemia: A review. American journal of surgery. 2020. doi:10.1016/j.amjsurg.2020.01.042.

    PubMedDOI
  17. 17.
    Predictors of bowel necrosis in patients with acute mesenteric ischemia: systematic review and meta-analysis. Updates in surgery. 2021.
    PubMed-indexed articleMeta-analysis / systematic review2021

    Predictors of bowel necrosis in patients with acute mesenteric ischemia: systematic review and meta-analysis. Updates in surgery. 2021. doi:10.1007/s13304-020-00857-9.

    PubMedDOI
  18. 18.
    Preoperative Risk Factors for Short-Term Postoperative Mortality of Acute Mesenteric Ischemia after Laparotomy: A Systematic Review and Meta-Analysis. Emergency medicine international. 2020.
    PubMed-indexed articleMeta-analysis / systematic review2020

    Preoperative Risk Factors for Short-Term Postoperative Mortality of Acute Mesenteric Ischemia after Laparotomy: A Systematic Review and Meta-Analysis. Emergency medicine international. 2020. doi:10.1155/2020/1382475.

    PubMedDOI
  19. 19.
    Contrast-enhanced ultrasonographic findings of non-occlusive mesenteric ischemia: a case series. Abdominal radiology (New York). 2022.
    PubMed-indexed articleCase report2022

    Contrast-enhanced ultrasonographic findings of non-occlusive mesenteric ischemia: a case series. Abdominal radiology (New York). 2022. doi:10.1007/s00261-021-03002-1.

    PubMedDOI
  20. 20.
    Outcomes of different acute mesenteric ischemia therapies in the last 20 years: A meta-analysis and systematic review. Vascular. 2022.
    PubMed-indexed articleMeta-analysis / systematic review2022

    Outcomes of different acute mesenteric ischemia therapies in the last 20 years: A meta-analysis and systematic review. Vascular. 2022. doi:10.1177/17085381211024503.

    PubMedDOI
  21. 21.
    Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence. World journal of gastroenterology. 2021.
    PubMed-indexed articleReview2021

    Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence. World journal of gastroenterology. 2021. doi:10.3748/wjg.v27.i26.4088.

    PubMedDOI
  22. 22.
    Multidisciplinary management of acute mesenteric ischemia: Surgery and endovascular intervention. World journal of gastrointestinal surgery. 2021.
    PubMed-indexed articleReview2021

    Multidisciplinary management of acute mesenteric ischemia: Surgery and endovascular intervention. World journal of gastrointestinal surgery. 2021. doi:10.4240/wjgs.v13.i8.806.

    PubMedDOI
  23. 23.
    Predictors of Mortality in Acute Mesenteric Ischemia: A Systematic Review and Meta-Analysis. The Journal of surgical research. 2022.
    PubMed-indexed articleMeta-analysis / systematic review2022

    Predictors of Mortality in Acute Mesenteric Ischemia: A Systematic Review and Meta-Analysis. The Journal of surgical research. 2022. doi:10.1016/j.jss.2022.01.022.

    PubMedDOI
  24. 24.
    Small intestinal viability assessment using dielectric relaxation spectroscopy and deep learning. Scientific reports. 2022.
    PubMed-indexed article2022

    Small intestinal viability assessment using dielectric relaxation spectroscopy and deep learning. Scientific reports. 2022. doi:10.1038/s41598-022-07140-4.

    PubMedDOI
  25. 25.
    [CT angiography and endovascular treatment in acute mesenteric ischemia]. Khirurgiia. 2022.
    PubMed-indexed article2022

    [CT angiography and endovascular treatment in acute mesenteric ischemia]. Khirurgiia. 2022. doi:10.17116/hirurgia202203150.

    PubMedDOI
  26. 26.
    Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World journal of emergency surgery : WJES. 2022.
    PubMed-indexed articleClinical practice guideline2022

    Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World journal of emergency surgery : WJES. 2022. doi:10.1186/s13017-022-00443-x.

    PubMedDOI
  27. 27.
    Radiological predictive factors of transmural intestinal necrosis in acute mesenteric ischemia: systematic review and meta-analysis. European radiology. 2023.
    PubMed-indexed articleMeta-analysis / systematic review2023

    Radiological predictive factors of transmural intestinal necrosis in acute mesenteric ischemia: systematic review and meta-analysis. European radiology. 2023. doi:10.1007/s00330-022-09258-5.

    PubMedDOI
  28. 28.
    Basic demographic characteristics and prevalence of comorbidities in acute mesenteric ischemia: a systematic review and proportional meta-analysis. Scandinavian journal of gastroenterology. 2023.
    PubMed-indexed articleMeta-analysis / systematic review2023

    Basic demographic characteristics and prevalence of comorbidities in acute mesenteric ischemia: a systematic review and proportional meta-analysis. Scandinavian journal of gastroenterology. 2023. doi:10.1080/00365521.2022.2152289.

    PubMedDOI
  29. 29.
    Advances in the diagnosis of non-occlusive mesenteric ischemia and challenges in intra-abdominal sepsis patients: a narrative review. PeerJ. 2023.
    PubMed-indexed articleReview2023

    Advances in the diagnosis of non-occlusive mesenteric ischemia and challenges in intra-abdominal sepsis patients: a narrative review. PeerJ. 2023. doi:10.7717/peerj.15307.

    PubMedDOI
  30. 30.
    Outcomes of Acute Mesenteric Ischemia in Patients With COVID-19: A Nationwide Database Study. Cureus. 2023.
    PubMed-indexed articleRegistry / cohort2023

    Outcomes of Acute Mesenteric Ischemia in Patients With COVID-19: A Nationwide Database Study. Cureus. 2023. doi:10.7759/cureus.41444.

    PubMedDOI
  31. 31.
    Results after intraoperative open and endovascular revascularization of acute mesenteric ischemia requiring a laparotomy. Langenbeck's archives of surgery. 2023.
    PubMed-indexed articleRegistry / cohort2023

    Results after intraoperative open and endovascular revascularization of acute mesenteric ischemia requiring a laparotomy. Langenbeck's archives of surgery. 2023. doi:10.1007/s00423-023-03035-8.

    PubMedDOI
  32. 32.
    Diagnostic Role of Multi-Detector Computed Tomography in Acute Mesenteric Ischemia. Diagnostics (Basel, Switzerland). 2024.
    PubMed-indexed article2024

    Diagnostic Role of Multi-Detector Computed Tomography in Acute Mesenteric Ischemia. Diagnostics (Basel, Switzerland). 2024. doi:10.3390/diagnostics14121214.

    PubMedDOI
  33. 33.
    Endovascular revascularization vs open surgical revascularization as the first strategy for arterial acute mesenteric ischemia: A systematic review and meta-analysis. Journal of vascular surgery. 2024.
    PubMed-indexed articleMeta-analysis / systematic review2024

    Endovascular revascularization vs open surgical revascularization as the first strategy for arterial acute mesenteric ischemia: A systematic review and meta-analysis. Journal of vascular surgery. 2024. doi:10.1016/j.jvs.2024.07.084.

    PubMedDOI
  34. 34.
    Retrograde open mesenteric stenting and outcomes for acute mesenteric ischemia. Vascular. 2025.
    PubMed-indexed articleRegistry / cohort2025

    Retrograde open mesenteric stenting and outcomes for acute mesenteric ischemia. Vascular. 2025. doi:10.1177/17085381241273265.

    PubMedDOI
  35. 35.
    Diagnosis and management of acute mesenteric ischemia: What you need to know. The journal of trauma and acute care surgery. 2025.
    PubMed-indexed articleReview2025

    Diagnosis and management of acute mesenteric ischemia: What you need to know. The journal of trauma and acute care surgery. 2025. doi:10.1097/ta.0000000000004585.

    PubMedDOI
  36. 36.
    Radiological diagnosis of acute mesenteric ischemia in adult patients: a systematic review and meta-analysis. Scientific reports. 2025.
    PubMed-indexed articleMeta-analysis / systematic review2025

    Radiological diagnosis of acute mesenteric ischemia in adult patients: a systematic review and meta-analysis. Scientific reports. 2025. doi:10.1038/s41598-025-94846-w.

    PubMedDOI
  37. 37.
    Endovascular Versus Open Surgical Approaches for Acute Mesenteric Ischemia: A Systematic Review of Outcomes. Cureus. 2025.
    PubMed-indexed articleMeta-analysis / systematic review2025

    Endovascular Versus Open Surgical Approaches for Acute Mesenteric Ischemia: A Systematic Review of Outcomes. Cureus. 2025. doi:10.7759/cureus.85013.

    PubMedDOI
  38. 38.
    Acute Mesenteric Ischemia: Pathophysiology-based Approach to Imaging Findings and Diagnosis. Radiographics : a review publication of the Radiological Society of North America, Inc. 2025.
    PubMed-indexed articleReview2025

    Acute Mesenteric Ischemia: Pathophysiology-based Approach to Imaging Findings and Diagnosis. Radiographics : a review publication of the Radiological Society of North America, Inc. 2025. doi:10.1148/rg.250012.

    PubMedDOI
  39. 39.
    Outcomes of revascularized acute mesenteric ischemia in the American College of Surgeons National Surgical Quality Improvement Program database. The American surgeon. 2011.
    PubMed-indexed articleRegistry / cohort2011

    Outcomes of revascularized acute mesenteric ischemia in the American College of Surgeons National Surgical Quality Improvement Program database. The American surgeon. 2011. doi:10.1177/000313481107700715.

    PubMedDOI
  40. 40.
    Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases. Intensive care medicine. 2015.
    PubMed-indexed articleRegistry / cohort2015

    Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases. Intensive care medicine. 2015. doi:10.1007/s00134-015-3690-8.

    PubMedDOI
  41. 41.
    Mortality of acute mesenteric ischemia remains unchanged despite significant increase in utilization of endovascular techniques. Vascular. 2016.
    PubMed-indexed articleRegistry / cohort2016

    Mortality of acute mesenteric ischemia remains unchanged despite significant increase in utilization of endovascular techniques. Vascular. 2016. doi:10.1177/1708538115577730.

    PubMedDOI
  42. 42.
    Endovascular Therapy for Acute Mesenteric Ischemia: an NSQIP Analysis. The American surgeon. 2015.
    PubMed-indexed articleRegistry / cohort2015

    Endovascular Therapy for Acute Mesenteric Ischemia: an NSQIP Analysis. The American surgeon. 2015. doi:10.1177/000313481508101131.

    PubMedDOI
  43. 43.
    ESTES guidelines: acute mesenteric ischaemia. European journal of trauma and emergency surgery : official publication of the European Trauma Society. 2016.
    PubMed-indexed articleClinical practice guideline2016

    ESTES guidelines: acute mesenteric ischaemia. European journal of trauma and emergency surgery : official publication of the European Trauma Society. 2016. doi:10.1007/s00068-016-0634-0.

    PubMedDOI
  44. 44.
    Duplex ultrasound in the early diagnosis of acute mesenteric ischemia: a longitudinal cohort multicentric study. European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 2017.
    PubMed-indexed articleRegistry / cohort2017

    Duplex ultrasound in the early diagnosis of acute mesenteric ischemia: a longitudinal cohort multicentric study. European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 2017. doi:10.1097/mej.0000000000000378.

    PubMedDOI
  45. 45.
    Predictive Factors of Intestinal Necrosis in Acute Mesenteric Ischemia: Prospective Study from an Intestinal Stroke Center. The American journal of gastroenterology. 2017.
    PubMed-indexed articleRegistry / cohort2017

    Predictive Factors of Intestinal Necrosis in Acute Mesenteric Ischemia: Prospective Study from an Intestinal Stroke Center. The American journal of gastroenterology. 2017. doi:10.1038/ajg.2017.38.

    PubMedDOI
  46. 46.
    Thrombectomy Devices in the Treatment of Acute Mesenteric Ischemia: Initial Single-Center Experience. Annals of vascular surgery. 2018.
    PubMed-indexed article2018

    Thrombectomy Devices in the Treatment of Acute Mesenteric Ischemia: Initial Single-Center Experience. Annals of vascular surgery. 2018. doi:10.1016/j.avsg.2017.11.041.

    PubMedDOI
  47. 47.
    A Retrospective Analysis of Nonocclusive Mesenteric Ischemia in Medical and Surgical ICU Patients: Clinical Data on Demography, Clinical Signs, and Survival. Journal of intensive care medicine. 2020.
    PubMed-indexed articleRegistry / cohort2020

    A Retrospective Analysis of Nonocclusive Mesenteric Ischemia in Medical and Surgical ICU Patients: Clinical Data on Demography, Clinical Signs, and Survival. Journal of intensive care medicine. 2020. doi:10.1177/0885066619837911.

    PubMedDOI
  48. 48.
    Vasodilator Therapy and Mortality in Nonocclusive Mesenteric Ischemia: A Nationwide Observational Study. Critical care medicine. 2020.
    PubMed-indexed articleRegistry / cohort2020

    Vasodilator Therapy and Mortality in Nonocclusive Mesenteric Ischemia: A Nationwide Observational Study. Critical care medicine. 2020. doi:10.1097/ccm.0000000000004255.

    PubMedDOI
  49. 49.
    Normal Lactate and Unenhanced CT-Scan Result in Delayed Diagnosis of Acute Mesenteric Ischemia. The American journal of gastroenterology. 2020.
    PubMed-indexed article2020

    Normal Lactate and Unenhanced CT-Scan Result in Delayed Diagnosis of Acute Mesenteric Ischemia. The American journal of gastroenterology. 2020. doi:10.14309/ajg.0000000000000836.

    PubMedDOI
  50. 50.
    Monitoring the Sequential Organ Failure Assessment score in nonocclusive mesenteric ischemia increases the survival rate: A single-center observational study. Medicine. 2021.
    PubMed-indexed articleRegistry / cohort2021

    Monitoring the Sequential Organ Failure Assessment score in nonocclusive mesenteric ischemia increases the survival rate: A single-center observational study. Medicine. 2021. doi:10.1097/md.0000000000028056.

    PubMedDOI
  51. 51.
    Serum lactate and acute mesenteric ischaemia: An observational, controlled multicentre study. Anaesthesia, critical care & pain medicine. 2022.
    PubMed-indexed articleRegistry / cohort2022

    Serum lactate and acute mesenteric ischaemia: An observational, controlled multicentre study. Anaesthesia, critical care & pain medicine. 2022. doi:10.1016/j.accpm.2022.101141.

    PubMedDOI
  52. 52.
    Preoperative prognostic predictors and treatment strategies for surgical procedure focused on the sequential organ failure assessment score in nonocclusive mesenteric ischemia: a multicenter retrospective cohort study. International journal of surgery (London, England). 2023.
    PubMed-indexed articleRegistry / cohort2023

    Preoperative prognostic predictors and treatment strategies for surgical procedure focused on the sequential organ failure assessment score in nonocclusive mesenteric ischemia: a multicenter retrospective cohort study. International journal of surgery (London, England). 2023. doi:10.1097/js9.0000000000000733.

    PubMedDOI
  53. 53.
    Association between Postoperative Adjuvant Vasodilator Therapy and In-Hospital Mortality for Non-Occlusive Mesenteric Ischemia: A Nationwide Observational Study. Journal of Nippon Medical School = Nippon Ika Daigaku zasshi. 2024.
    PubMed-indexed articleRegistry / cohort2024

    Association between Postoperative Adjuvant Vasodilator Therapy and In-Hospital Mortality for Non-Occlusive Mesenteric Ischemia: A Nationwide Observational Study. Journal of Nippon Medical School = Nippon Ika Daigaku zasshi. 2024. doi:10.1272/jnms.jnms.2024_91-310.

    PubMedDOI
  54. 54.
    Treatment outcomes in non-occlusive mesenteric ischemia and post-treatment return to social activities. Surgery today. 2025.
    PubMed-indexed articleRegistry / cohort2025

    Treatment outcomes in non-occlusive mesenteric ischemia and post-treatment return to social activities. Surgery today. 2025. doi:10.1007/s00595-024-02909-8.

    PubMedDOI
  55. 55.
    Open Revascularization for Acute Mesenteric Ischemia is Associated with Increased Morbidity and Mortality when Compared to Endovascular Intervention. Annals of vascular surgery. 2025.
    PubMed-indexed articleRegistry / cohort2025

    Open Revascularization for Acute Mesenteric Ischemia is Associated with Increased Morbidity and Mortality when Compared to Endovascular Intervention. Annals of vascular surgery. 2025. doi:10.1016/j.avsg.2024.10.013.

    PubMedDOI
  56. 56.
    Acute mesenteric ischaemia in the elderly - results of combined endovascular and surgical treatment. Primary study. Scientific reports. 2025.
    PubMed-indexed articleRegistry / cohort2025

    Acute mesenteric ischaemia in the elderly - results of combined endovascular and surgical treatment. Primary study. Scientific reports. 2025. doi:10.1038/s41598-024-84026-7.

    PubMedDOI
  57. 57.
    Racial and Gender Disparities in the Management and Outcomes of Patients With Acute Mesenteric Ischemia: A Nationwide Retrospective Cohort Analysis. The Journal of surgical research. 2025.
    PubMed-indexed articleRegistry / cohort2025

    Racial and Gender Disparities in the Management and Outcomes of Patients With Acute Mesenteric Ischemia: A Nationwide Retrospective Cohort Analysis. The Journal of surgical research. 2025. doi:10.1016/j.jss.2025.03.014.

    PubMedDOI
  58. 58.
    The significance of possible non-occlusive mesenteric ischemia in relation to neurological outcomes in patients with refractory cardiac arrest - Secondary analysis of the Prague OHCA study. Resuscitation. 2025.
    PubMed-indexed article2025

    The significance of possible non-occlusive mesenteric ischemia in relation to neurological outcomes in patients with refractory cardiac arrest - Secondary analysis of the Prague OHCA study. Resuscitation. 2025. doi:10.1016/j.resuscitation.2025.110642.

    PubMedDOI
  59. 59.
    Acute Mesenteric Ischaemia: Think About It, Don't Think Too Long, and Stick to the Guidelines. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2025.
    PubMed-indexed article2025

    Acute Mesenteric Ischaemia: Think About It, Don't Think Too Long, and Stick to the Guidelines. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2025. doi:10.1016/j.ejvs.2025.06.020.

    PubMedDOI
  60. 60.
    Risk Factors for 30-day Mortality After Emergency Surgery for Non-occlusive Mesenteric Ischemia. In vivo (Athens, Greece). 2025.
    PubMed-indexed articleRegistry / cohort2025

    Risk Factors for 30-day Mortality After Emergency Surgery for Non-occlusive Mesenteric Ischemia. In vivo (Athens, Greece). 2025. doi:10.21873/invivo.14089.

    PubMedDOI
  61. 61.
    Association of Perioperative Vasodilator Therapy and Mortality in Nonocclusive Mesenteric Ischemia. The Journal of surgical research. 2025.
    PubMed-indexed articleRegistry / cohort2025

    Association of Perioperative Vasodilator Therapy and Mortality in Nonocclusive Mesenteric Ischemia. The Journal of surgical research. 2025. doi:10.1016/j.jss.2025.08.017.

    PubMedDOI
  62. 62.
    Endovascular revascularization for treatment of acute mesenteric ischemia: a single-center experience. Postepy w kardiologii interwencyjnej = Advances in interventional cardiology. 2026.
    PubMed-indexed articleRegistry / cohort2026

    Endovascular revascularization for treatment of acute mesenteric ischemia: a single-center experience. Postepy w kardiologii interwencyjnej = Advances in interventional cardiology. 2026. doi:10.5114/aic.2026.160099.

    PubMedDOI
  63. 63.
    Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. 2017.
    PubMed-indexed articleClinical practice guideline2017

    Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. 2017. doi:10.1186/s13017-017-0150-5.

    PubMedDOI

Educational use only

AI assists this editorial workflow. Published updates are human-reviewed before publication.

Not intended to diagnose, monitor, predict, prognose, treat, or alleviate disease.

Verify clinically relevant information against primary sources and current guidelines.

AI DisclosurePrivacyTermsCautions