Minimally invasive modalities in the management of acute mesenteric ischemia: a prospective case-series study

Introduction
Acute arterial mesenteric ischemia (AMI) represents a challenging disease regarding diagnosis and treatment; usually the patient is diagnosed at a late stage of the disease that imposes a high risk of mortality, and usually the diagnosis is reached intraoperatively with the full-blown picture of intestinal gangrene.
Aim
The aim was to assess the feasibility and effectiveness of minimally invasive modalities (laparoscopy and endovascular techniques) in the diagnosis and treatment of patients having acute AMI.
Patients and methods
This is a prospective case-series study that was conducted over 11 patients who were diagnosed to have an acute abdomen with suspected acute mesenteric ischemia. They were subjected to an intervention in the form of diagnostic laparoscopy with simultaneous direct mesenteric angiography through a transfemoral approach, this was done for diagnosis and possibly treatment of this condition.
Results
About 18.2% presented within 24 hours from the onset of symptoms, 81.8% presented after 1 day from the onset of symptoms. About 36.4% of patients had a white blood cell count of greater than 15 000/ml, 45.4% had a white blood cell count of greater than 12 000–15 000/ml, while 18.2% of patients had a white blood cell count of less than 12 000/ml. As for D-dimer, it was greater than 2.0 mg/l in 9.1%, greater than 1.0–0.2 mg/l in 63.7%, and 0.5–1.0 mg/l in 27.3%. About 81.8% of patients had thrombosed superior mesenteric artery (SMA), together with intestinal gangrene or devitalized segments of the intestine, they were treated by laparotomy and bowel resection with no intervention regarding the SMA. Two patients (18.2%) had dusky bowel loops with a critical stenosis at the origin of SMA for which stenting was done, with no need for laparotomy.
Conclusion
The use of minimally invasive modalities is an efficient method in definitive diagnosis of patients having AMI, as well as it can be used for treatment. Those minimally invasive techniques offer a low-risk intervention with reduced morbidity, reducing the time needed for diagnosis and treatment, but in order to reach this goal, the patient must present as early as possible in order to intervene while the intestine is still viable.