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Hess B, Cahenzli M, Forbes A, Burgos R, Coccolini F, Corcos O, Holst M, Irtun Ø, Klek S, Pironi L, Rasmussen HH, Serlie MJ, Thibault R, Gabe S, Reintam Blaser A. Management of acute mesenteric ischaemia: Results of a worldwide survey. Clin Nutr ESPEN 2023; 54:194-205. [PMID: 36963863 DOI: 10.1016/j.clnesp.2022.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023]
Abstract
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.
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Affiliation(s)
- Benjamin Hess
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - Martin Cahenzli
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Alastair Forbes
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia
| | - Rosa Burgos
- Nutritional Support Unit, University Hospital Vall D'Hebron, Barcelona, Spain
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Olivier Corcos
- Intestinal Vascular Emergencies Structure (SURVI), Beaujon Hospital/Assistance Publique, Hopitaux de Paris, France
| | - Mette Holst
- Centre for Nutrition and Intestinal Failure, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark
| | - Øivind Irtun
- Department of Gastrointestinal Surgery, University Hospital North Norway, Norway
| | - Stanislaw Klek
- Surgical Oncology Clinic, The Maria Sklodowska-Curie Reseach Institute of Oncology, Krakow, Poland
| | - Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Centre for Chronic Intestinal Failure - Clinical Nutrition and Metabolism Unit, IRCCS AOUBO, Bologna, Italy
| | - Henrik Højgaard Rasmussen
- Centre for Nutrition and Intestinal Failure, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark
| | - Mireille J Serlie
- Department of Endocrinology & Metabolism, Amsterdam University Medical Center, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
| | - Ronan Thibault
- Unité de Nutrition, CHU Rennes, INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer Institute, NuMeCan, Rennes, France
| | - Simon Gabe
- Lennard Jones Intestinal Rehabilitation Unit, St Mark's Hospital, London, England
| | - Annika Reintam Blaser
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland; Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia
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