Management of acute mesenteric ischaemia: Recommended strategy is  misleading

doi:10.1136/bmj.327.7411.396

BMJ 2003;327:396 (16 August), doi:10.1136/bmj.327.7411.396

Letter

Management of acute mesenteric ischaemia

Recommended strategy is misleading

The first 150 words of the full text of this article appear below.

EDITOR—Sreenarasimhaiah has produced a comprehensive review of the clinical features and diagnosis of intestinal ischaemia.¹ However, the recommended management strategy foracute mesenteric ischaemia is misleading and flawed.

Contrary to Sreenarasimhaiah's report, surgical embolectomyshould be considered the standard of care only in cases ofembolic arterial occlusion. In up to 50% of cases of acutemesenteric ischaemia, arterial occlusion occurs owing to thrombosisat an atherosclerotic stenosis of the superior mesenteric artery.²In these instances superior mesenteric artery reconstructionis indicated either through aortosuperior mesenteric arterybypass grafting or reimplantation of the superior mesentericartery to the aorta.

Furthermore, despite Sreenarasimhaiah's support for interventional radiology, the evidence base for the use of thrombolytic agentsin mesenteric ischaemia remains largely anecdotal. Savassi-Rochaand Veloso's review of the use of lysis in superior mesentericartery embolism identified only 18 other reported cases inthe literature.³ Though thrombolysis may be . . . [Full text of this article]

Andrew L Tambyraja, lecturer

Department of Clinical and Surgical Sciences (Surgery), Royal Infirmary of Edinburgh, Edinburgh EH16 4SA andrew.tambyraja@ed.ac.uk