Update in laparoscopic approach to acute mesenteric ischemia

Abstract

AMI is an uncommon but serious disease often associated with a bad prognosis, associated with occlusion of Superior Mesenteric Artery (SMA) for embolism or thrombosis (67.2%), mesenteric venous thrombosis (15.7%), and non-occlusive mesenteric ischemia (15.4%). Clinical markers are often aspecific and symptoms low suggestive. The gold standard for the diagnosis is multidetector CT Angiography (CTA) with sensibility of 93.3% and specificity of 95.9%. Abdominal exploration could be useful to confirm cases of AMI without signs of SMA occlusion at CTA. Few reports have been found on the diagnostic role of Exploratory Laparoscopy. To increase the sensibility of laparoscopy in the diagnosis of AMI in the last ten years, some studies had shown the possibility of using fluorescein to underline the bowel areas of interest by ischemia. The best of laparoscopy in AMI diagnosis remains the second look and bedside use (directly in ICU when possible) overall in patients with Aortic dissection type B (preferable chronic type). In a limited number of cases, it is possible to evaluate bowel perfusion laparoscopically and at the same time perform a laparoscopical bowel resection of residual ischemic segments. However, laparoscopic primary access overall in AoD is an important tool for leading therapeutic decision and timing. Finally, laparoscopy may be a feasible alternative to CTA in patients with kidney failure that contraindicates injection of iodate CT contrast medium.