Laparoscopic Approach to Acute Mesenteric Ischemia in Elderly Patients

Acute mesenteric ischemia is a rare but life-threatening disease that can cause mesenteric infarction, intestinal necrosis, and systemic inflammatory response. The etiologies of acute mesenteric ischemia are classified into obstructive and nonobstructive visceral ischemia. The obstructive origin includes an acute arterial occlusion due to vascular embolism or to thrombosis and an acute venous occlusion due to thrombosis. Early diagnosis and timely treatment are the key determinants for improving prognosis. Early diagnostic laparoscopy can be lifesaving, with a 50% reduction in mortality compared with delayed intervention or conservative management. Diagnostic laparoscopy is also feasible as a bedside approach in the intensive care unit, avoiding time delay for awaiting operating room availability and preventing adverse events in patients with critical medical condition, including those on mechanical ventilation or unstable vital sign. First-look diagnostic laparoscopy can improve prognosis, allowing early recognition of acute mesenteric ischemia. Some authors have described the use of indocyanine green fluorescence imaging in early diagnosis of acute mesenteric ischemia. Acute mesenteric ischemia, either occlusive or nonocclusive, is frequently a progressive entity with repeated attacks of emboli or low-flow state which could cause ischemic challenge in the bowel even after surgical or medical management. Within this context, laparoscopy has evolved as an alternative to laparotomy also for the second-look in the management of ischemic bowel, to keep patients away from the effects of a progressive ischemia.