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Operative intervention

Authoring team

At laparotomy of the patient with acute superior mesenteric ischaemia, the entire midgut should be examined and pulsation sought at the origin of the superior mesenteric artery, its major branches and terminal arcades. Patients will then fall into one of three categories:

  • reversible intestinal ischaemia: viable bowel is treated by a superior mesenteric artery embolectomy or bypass
  • segmental intestinal ischaemia: obviously necrotic segments of bowel require resection. This may be combined with a revascularization procedure.
  • massive intestinal infarction: subtotal resection of the small bowel is performed with the fashioning of a stoma or anastomosis. The elderly, unfit patient may be too frail to survive this procedure.

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