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      Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery

      review-article
      1 , , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 8 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 25 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 34 , 38 , 39 , 40 , 41 , 34 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58
      World Journal of Emergency Surgery : WJES
      BioMed Central
      Mesenteric ischemia, Mesenteric arterial occlusion, Mesenteric artery stenting, Bowel ischemia, Guidelines, Recommendations, World Society of Emergency Surgery

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          Abstract

          Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process may progress to life-threatening intestinal necrosis. The incidence is low, estimated at 0.09–0.2% of all acute surgical admissions, but increases with age. Although the entity is an uncommon cause of abdominal pain, diligence is required because if untreated, mortality remains in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques is evolving and provides new treatment options. Lastly, a focused multidisciplinary approach based on early diagnosis and individualized treatment is essential. Thus, we believe that updated guidelines from World Society of Emergency Surgery are warranted, in order to provide the most recent and practical recommendations for diagnosis and treatment of AMI.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s13017-022-00443-x.

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          Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.

          To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012".
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            Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy

            Background Few data are available on the rate and characteristics of thromboembolic complications in hospitalized patients with COVID-19. Methods We studied consecutive symptomatic patients with laboratory-proven COVID-19 admitted to a university hospital in Milan, Italy (13.02.2020–10.04.2020). The primary outcome was any thromboembolic complication, including venous thromboembolism (VTE), ischemic stroke, and acute coronary syndrome (ACS)/myocardial infarction (MI). Secondary outcome was overt disseminated intravascular coagulation (DIC). Results We included 388 patients (median age 66 years, 68% men, 16% requiring intensive care [ICU]). Thromboprophylaxis was used in 100% of ICU patients and 75% of those on the general ward. Thromboembolic events occurred in 28 (7.7% of closed cases; 95%CI 5.4%–11.0%), corresponding to a cumulative rate of 21% (27.6% ICU, 6.6% general ward). Half of the thromboembolic events were diagnosed within 24 h of hospital admission. Forty-four patients underwent VTE imaging tests and VTE was confirmed in 16 (36%). Computed tomography pulmonary angiography (CTPA) was performed in 30 patients, corresponding to 7.7% of total, and pulmonary embolism was confirmed in 10 (33% of CTPA). The rate of ischemic stroke and ACS/MI was 2.5% and 1.1%, respectively. Overt DIC was present in 8 (2.2%) patients. Conclusions The high number of arterial and, in particular, venous thromboembolic events diagnosed within 24 h of admission and the high rate of positive VTE imaging tests among the few COVID-19 patients tested suggest that there is an urgent need to improve specific VTE diagnostic strategies and investigate the efficacy and safety of thromboprophylaxis in ambulatory COVID-19 patients.
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              Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery

              Acute mesenteric ischemia (AMI) is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process will eventuate in life threatening intestinal necrosis. The incidence is low, estimated at 0.09–0.2% of all acute surgical admissions. Therefore, although the entity is an uncommon cause of abdominal pain, diligence is always required because if untreated, mortality has consistently been reported in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment and are essential to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques may provide new options. Thus, we believe that a current position paper from World Society of Emergency Surgery (WSES) is warranted, in order to put forth the most recent and practical recommendations for diagnosis and treatment of AMI. This review will address the concepts of AMI with the aim of focusing on specific areas where early diagnosis and management hold the strongest potential for improving outcomes in this disease process. Some of the key points include the prompt use of CT angiography to establish the diagnosis, evaluation of the potential for revascularization to re-establish blood flow to ischemic bowel, resection of necrotic intestine, and use of damage control techniques when appropriate to allow for re-assessment of bowel viability prior to definitive anastomosis and abdominal closure.
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                Author and article information

                Contributors
                rbalam@hadassah.org.il
                Journal
                World J Emerg Surg
                World J Emerg Surg
                World Journal of Emergency Surgery : WJES
                BioMed Central (London )
                1749-7922
                19 October 2022
                19 October 2022
                2022
                : 17
                : 54
                Affiliations
                [1 ]GRID grid.9619.7, ISNI 0000 0004 1937 0538, Director of Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, , Hebrew University of Jerusalem Kiriat Hadassah, ; POB 12000, 91120 Jerusalem, Israel
                [2 ]GRID grid.414682.d, ISNI 0000 0004 1758 8744, General and Emergency Surgery Department, , Bufalini Hospital, ; Cesena, Italy
                [3 ]GRID grid.12136.37, ISNI 0000 0004 1937 0546, Tel Aviv Sackler School of Medicine, ; Tel Aviv, Israel
                [4 ]GRID grid.418056.e, ISNI 0000 0004 1765 2558, Department of General, Digestive and Metabolic Minimally Invasive Surgery, , Centre Hospitalier Intercommunal De Poissy/St Germain en Laye, ; Poissy, France
                [5 ]Department of Surgery, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Hospital Universitário Terezinha de Jesus, Juiz de Fora, Brazil
                [6 ]GRID grid.1012.2, ISNI 0000 0004 1936 7910, Department of General Surgery, Royal Perth Hospital, , The University of Western Australia, ; Perth, Australia
                [7 ]Department of Surgery, Macerata Hospital, Macerata, Italy
                [8 ]GRID grid.144189.1, ISNI 0000 0004 1756 8209, Department of General, Emergency and Trauma Surgery, , Pisa University Hospital, ; Pisa, Italy
                [9 ]GRID grid.413731.3, ISNI 0000 0000 9950 8111, Department of General Surgery, , Rambam Health Care Campus, ; Haifa, Israel
                [10 ]GRID grid.43519.3a, ISNI 0000 0001 2193 6666, Department of Surgery, College of Medicine and Health Sciences, , United Arab Emirates University, ; Al-Ain, United Arab Emirates
                [11 ]GRID grid.411482.a, Department of Anesthesia and Intensive Care, , Azienda Ospedaliero-Universitaria Parma, ; Parma, Italy
                [12 ]GRID grid.8982.b, ISNI 0000 0004 1762 5736, Department of Surgery, Fondazione IRCCS Policlinico San Matteo, , University of Pavia, ; Pavia, Italy
                [13 ]GRID grid.412688.1, ISNI 0000 0004 0397 9648, Department of Surgery, , University Hospital Centre Zagreb, ; Zagreb, Croatia
                [14 ]GRID grid.415401.5, Division of Trauma/Acute Care Surgery, , Scripps Clinic Medical Group, ; La Jolla, CA USA
                [15 ]GRID grid.7563.7, ISNI 0000 0001 2174 1754, Emergency and General Surgery Department, School of Medicine and Surgery, , University of Milano-Bicocca, ; Monza, Italy
                [16 ]GRID grid.416200.1, Emergency Department, , Niguarda Ca’Granda Hospital, ; Milan, Italy
                [17 ]GRID grid.43582.38, ISNI 0000 0000 9852 649X, CECORC Research Center, Riverside University Health System, , Loma Linda University, ; Loma Linda, USA
                [18 ]GRID grid.265021.2, ISNI 0000 0000 9792 1228, Department of Surgery, Nankai Clinical School of Medicine, Tianjin Nankai Hospital, , Tianjin Medical University, ; Tianjin, China
                [19 ]GRID grid.418716.d, ISNI 0000 0001 0709 1919, Department of Surgery, , Royal Infirmary of Edinburgh, ; Edinburgh, UK
                [20 ]General Surgery Department Hospital of San Benedetto del Tronto, Marche region, Italy
                [21 ]GRID grid.27860.3b, ISNI 0000 0004 1936 9684, Division of Trauma and Acute Care Surgery, Department of Surgery, , University of California Davis, ; Sacramento, CA USA
                [22 ]Department of Emergency Surgery, City Hospital, Mozyr, Belarus
                [23 ]GRID grid.414959.4, ISNI 0000 0004 0469 2139, General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, , Foothills Medical Centre, ; Calgary, AB Canada
                [24 ]GRID grid.42505.36, ISNI 0000 0001 2156 6853, Division of Trauma and Surgical Critical Care, Department of Surgery, , University of Southern California, ; Los Angeles, CA USA
                [25 ]GRID grid.15485.3d, ISNI 0000 0000 9950 5666, Abdominal Center, , Helsinki University Hospital and University of Helsinki, ; Helsinki, Finland
                [26 ]GRID grid.410686.d, ISNI 0000 0001 1018 9204, Department of Surgical Disciplines, Regional Clinical Hospital, , Immanuel Kant Baltic Federal University, ; Kaliningrad, Russia
                [27 ]GRID grid.21925.3d, ISNI 0000 0004 1936 9000, Department of Surgery, , University of Pittsburgh School of Medicine, UPMC-Presbyterian, ; Pittsburgh, USA
                [28 ]GRID grid.240988.f, ISNI 0000 0001 0298 8161, Department of General Surgery, , Tan Tock Seng Hospital, ; Novena, Singapore
                [29 ]GRID grid.415900.9, ISNI 0000 0004 0617 6488, Donegal Clinical Research Academy Emergency Surgery Outcome Project, , Letterkenny University Hospital, ; Donegal, Ireland
                [30 ]GRID grid.413542.5, ISNI 0000 0004 0637 437X, Surgery Department, Section of Trauma Surgery, , Hamad General Hospital (HGH), ; Doha, Qatar
                [31 ]General Surgery Department, Military Teaching Hospital, Dakar, Senegal
                [32 ]Ethiopian Air Force Hospital, Bishoftu, Ethiopia
                [33 ]GRID grid.8158.4, ISNI 0000 0004 1757 1969, Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, , University of Catania, ; Catania, Italy
                [34 ]GRID grid.10417.33, ISNI 0000 0004 0444 9382, Department of Surgery, , Radboud University Medical Center, ; Nijmegen, The Netherlands
                [35 ]GRID grid.410529.b, ISNI 0000 0001 0792 4829, Centre Hospitalier Universitaire Grenoble Alpes, ; Grenoble, France
                [36 ]GRID grid.416377.0, ISNI 0000 0004 1760 672X, Department of Digestive and Emergency Surgery, , S.Maria Hospital Trust, ; Terni, Italy
                [37 ]GRID grid.460094.f, ISNI 0000 0004 1757 8431, General and Emergency Surgery, , ASST Papa Giovanni XXIII, ; Bergamo, Italy
                [38 ]GRID grid.34477.33, ISNI 0000000122986657, Harborview Medical Center, , University of Washington School of Medicine, ; Seattle, WA USA
                [39 ]GRID grid.5645.2, ISNI 000000040459992X, Department of Surgery, , Erasmus University Medical Centre, ; Rotterdam, The Netherlands
                [40 ]GRID grid.9654.e, ISNI 0000 0004 0372 3343, Faculty of Medical and Health Sciences, , University of Auckland, ; Auckland, New Zealand
                [41 ]GRID grid.411067.5, ISNI 0000 0000 8584 9230, Emergency Medicine Department of General and Thoracic Surgery, , University Hospital of Giessen, ; Giessen, Germany
                [42 ]GRID grid.412835.9, ISNI 0000 0004 0627 2891, HPB Unit, Department of Gastrointestinal Surgery, , Stavanger University Hospital, ; Stavanger, Norway
                [43 ]GRID grid.11835.3e, ISNI 0000 0004 1936 9262, Department of Oncology and Metabolism, , University of Sheffield, ; Sheffield, UK
                [44 ]Government Gousia Hospital, Srinagar, India
                [45 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, Department of Surgery, IRCCS Policlinico San Donato, , University of Milano, ; Milano, Italy
                [46 ]GRID grid.67105.35, ISNI 0000 0001 2164 3847, Case Western Reserve University School of Medicine, ; Cleveland, USA
                [47 ]GRID grid.410835.b, Kyoto Medical Center, ; Kyoto, Japan
                [48 ]GRID grid.32224.35, ISNI 0000 0004 0386 9924, Division of Trauma, Emergency Surgery and Surgical Critical Care, , Massachusetts General Hospital, ; Boston, PA USA
                [49 ]GRID grid.411087.b, ISNI 0000 0001 0723 2494, Division of Trauma Surgery, School of Medical Sciences, , University of Campinas (Unicamp), ; Campinas, Brazil
                [50 ]Pediatric Surgery, Children’s Care Center, SRH Klinikum Suhl, Suhl, Thueringen Germany
                [51 ]GRID grid.508487.6, ISNI 0000 0004 7885 7602, Unit of Digestive and HPB Surgery, Faculty of Medicine, , University of Paris, ; Paris, France
                [52 ]GRID grid.414724.0, ISNI 0000 0004 0577 6676, John Hunter Hospital and University of Newcastle, ; Newcastle, NSW Australia
                [53 ]GRID grid.411024.2, ISNI 0000 0001 2175 4264, Cowley Shock Trauma Center at the University of Maryland, ; Baltimore, MD USA
                [54 ]GRID grid.8142.f, ISNI 0000 0001 0941 3192, Emergency Surgery and Trauma, Fondazione Policlinico Universitario A. Gemelli IRCCS, , Università Cattolica del Sacro Cuore, ; Rome, Italy
                [55 ]Department of General Surgery, Albury Hospital, Albury, Australia
                [56 ]GRID grid.4701.2, ISNI 0000 0001 0728 6636, University of Portsmouth, Portsmouth Hospitals University NHS Trust, ; Portsmouth, UK
                [57 ]GRID grid.461417.1, ISNI 0000 0004 0445 646X, College of Osteopathic Medicine, , Rocky Vista University, ; Parker, CO USA
                [58 ]GRID grid.241116.1, ISNI 0000000107903411, Ernest E Moore Shock Trauma Center at Denver Health, , University of Colorado, ; Denver, CO USA
                Article
                443
                10.1186/s13017-022-00443-x
                9580452
                36261857
                54cf943a-dfb7-4132-a2bf-ef17922a0d14
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 14 May 2022
                : 17 June 2022
                Categories
                Review
                Custom metadata
                © The Author(s) 2022

                Surgery
                mesenteric ischemia,mesenteric arterial occlusion,mesenteric artery stenting,bowel ischemia,guidelines,recommendations,world society of emergency surgery

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