الفهرس 
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Abstract
Mesenteric ischemia accounts for approximately 1% of acute abdomen hospitalizations. Classically, classified into acute and chronic mesenteric ischemia . (Coco and Leanza, 2018).
Acute mesenteric ischemia (AMI) is associated with a dramatic onset of severe cramp-like abdominal pain disproportionate to physical exam findings, followed after approximately 3 to 6 hours by a deceptive pain-free interval . Development of symptoms within minutes (in embolism) to hours (in athero-thrombosis). (Ierardi et al., 2017)
In patients with chronic mesenteric ischemia, the association of pain and nausea with meals leads to fear of eating and subsequent weight loss. The evolution of symptoms is typically gradual (over months) and progressive. (Guo et al., 2017)
Most of cases with intestinal ischemia is caused by an arterial embolus or thrombosis within the superior mesenteric artery. In cases of embolic occlusion, the absence of a well-developed collateral circulation causes earlier ischemia and transmural necrosis compared to other causes of mesenteric ischemia. Other causes are venous thrombosis, vascular anomalies and non-thrombotic mechanical causes such as strangulated hernia. Vasculitis is a common cause of mesenteric ischemia in younger people with auto-immune disease. . (Olson et al., 2018)
Unfortunately, there are currently no standardized blood tests that could be used widely in patients with acute abdominal pain to screen for AMI.The initial blood gas analysis showed metabolic alkalosis more frequently than metabolic acidosis.Classically, patients with mesenteric ischemia have leukocytosis (may exceed 20×109/L), metabolic acidosis, an elevated D-dimer and elevated serum lactate. (Wasnik et al., 2015)
The diagnosis of AMI is made based on clinical index of suspicion . New diagnostic strategies aim for early identification (e.g. biochemical markers) or seek to optimize accurate diagnosis using existing modalities. (Blauw et al., 2017)
Radiological imaging is essential for the diagnosis of mesenteric vascular disease. U/S has a limited value in diagnosis of acute mesenteric ischemia, but may be helpful in follow up post operative. CTA and MRA are highly accurate vascular imaging modalities with high sensitivity and specificity for evaluation of the mesenteric vasculature and these imaging modalities have virtually replaced reference standard DSA as a diagnostic modality. However, DSA has a leading role in endovascular treatment of CMI and an emerging role in the treatment of AMI. CTA is the first-line approach in diagnosing acute and chronic mesenteric ischemia, because of its high spatial resolution and short acquisition time. (Hauser et al., 2016)
With early diagnosis and treatment, more than half of patients with AMI can be rescued. In AMI patients , the aim of treatment is to early remove the cause , secure the bowel and avoid bowel necrosis and re-perfuse the ischemic viscera. The goals of therapy in treating CMI are to relieve symptoms, restore normal digestion, and prevent bowel infarction. Revascularization is warranted in symptomatic patients. (Coffey et al., 2017)
Treatment widely range from laparotomy and open surgery revascularization (OSR), up to percutaneous mesenteric angiography and stenting (PMAS) , reaching just conservative treatment and medications . Choosing the modality of treatment depends on the general state of the patient , causative agent and the time of patient arrival to the hospital . Post operative surveillance and follow up is extremely helpful in management of the mesenteric ischemia . . (Binda et al., 2016)