Surgical Management of Mesenteric Ischemia

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Successful management of acute mesenteric ischemia is predicated on prompt diagnosis, which still remains clinical in nature. No single radiographic test has a sensitivity or specificity reliable enough to supplant frequent and thorough physical examination and clinical judgment. Operative management requires adequate excision of clearly necrotic bowel and a high index of suspicion of borderline segments. Arterial reconstruction is best done with autogenous tissue when possible in the setting of gangrene or spillage. While diagnosis of chronic mesenteric ischemia is far more straightforward, significant controversy still remains regarding operative management with regards to the number of vessels reconstructed, direction of the graft, and choice of conduit.

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Chronic mesenteric ischemia

The nutritional consequences of food fear and malnutrition make CMI a debilitating disease process. The diagnosis can be difficult to make, and patients often lose extreme amounts of weight before the entity is recognized. Patients can suffer bowel infarction and death when the diagnosis goes unrecognized or untreated.

While atherosclerotic disease involvement of the celiac artery, superior mesenteric artery, and inferior mesenteric artery is common in the elderly, CMI remains an uncommon

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