| 8.) What is the management of the patient with acute mesenteric ischemia?
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Management:
Infarcted bowel must be resected. A second look operation at 24
hours is often required to determine viability of remaining bowel. In
addition, specific etiologies may be treated as follows:
- Nonocclusive ischemia may be treated with improvement of cardiac output and selective intraarterial vasodilator therapy. A Swan-Ganz catheter should be inserted to assess the cardiac paramenters to guide the improvement in cardiac output.
- Mesenteric venous thrombosis requires systemic anticoagulation with heparin preop, intraop, and postop.
- Occlusion due to embolus is treated with embolectomy and
long-term anticoagulation to prevent recurrent embolus.
- Occlusion due to thrombus is treated with revascularization by bypass procedure.
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