Objective:

The article describes the clinical need for a time-critical pathway for acute mesenteric ischaemia, linking prompt CTA and mechanism-specific multidisciplinary management with assessment of bowel viability.

Approach:

• Imaging: Obtain urgent CTA with arterial and portal venous phases. Report vascular patency and occlusion features alongside bowel findings, and communicate critical results directly to the treating team.
• Treatment coordination: Coordinate radiology, interventional radiology, surgery, anaesthesia, and intensive care in parallel. Select endovascular, surgical, or combined treatment according to the suspected mechanism and bowel viability.
• Reassessment: Continue evaluating bowel viability after revascularisation; technical success does not exclude necrosis. Use operative assessment when indicated and consider a second look if viability is uncertain.

Key Findings:

• Delayed diagnosis or treatment can allow reversible ischaemia to progress to bowel infarction, sepsis, and death.
• CTA can identify vascular and bowel abnormalities but cannot reliably exclude transmural bowel necrosis.
• Peritonitis, perforation, or persuasive evidence of advanced infarction requires urgent surgical evaluation.
• Endovascular treatment may restore flow in selected patients, but should not delay surgery when advanced bowel injury is suspected.
• Initial management of mesenteric venous thrombosis is anticoagulation; worsening despite treatment may prompt consideration of thrombectomy or catheter-directed thrombolysis.
• NOMI management prioritises correction of shock and vasoconstrictive triggers; catheter-directed vasodilators may be considered, although evidence is limited.

Interpretation:

The article presents prompt CTA, direct communication, mechanism-specific treatment, and ongoing assessment of bowel viability as components of a coordinated multidisciplinary pathway.

Limitations:

• CTA cannot reliably rule out transmural bowel necrosis.
• Imaging may not establish whether bowel injury is reversible or whether surgery is required, particularly in NOMI.
• Evidence for catheter-directed vasodilators in NOMI is described as limited.

Conclusion:

Acute mesenteric ischaemia requires prompt CTA, coordinated multidisciplinary decisions, and ongoing assessment of bowel viability. Imaging and technical revascularisation cannot reliably exclude bowel necrosis; suspected advanced injury requires urgent surgical evaluation.

Sources:

• Article context provided