What is the inpatient treatment for mesenteric edema?

From the Guidelines

Inpatient treatment for mesenteric edema involves a multidisciplinary approach with the goal of rapid reperfusion to prevent bowel infarction and multiorgan failure.

Key Components of Treatment

• Rapid diagnosis and intervention: Utilizing CT angiography (CTA) to diagnose mesenteric ischemia and initiate treatment promptly 1
• Multidisciplinary team: Involving a general surgeon, vascular surgeon, interventional radiologist, and intensivist to provide comprehensive care 1
• Revascularization: Using endovascular interventions such as aspiration embolectomy, transcatheter thrombolysis, and angioplasty with or without stenting to restore blood flow to the affected bowel 1
• Surgical intervention: Performing bowel resection and/or diversion as needed to remove non-viable tissue and prevent further complications 1
• Anticoagulation and antiplatelet therapy: Administering anticoagulants and antiplatelet agents to prevent recurrent thromboembolism and promote blood flow 1
• Surveillance imaging: Monitoring patients with regular imaging studies, such as CTA or duplex ultrasound, to detect potential restenosis or recurrence of mesenteric ischemia 1

Additional Considerations

• Palliative care: Discussing treatment options and goals of care with patients and their families, particularly in cases of extensive bowel infarction or poor prognosis 1
• Nutritional support: Providing nutritional therapy, including total parenteral nutrition (TPN) and hormonal therapy, to support patients with short bowel syndrome or intestinal failure 1

From the Research

Inpatient Treatment for Mesenteric Edema

The inpatient treatment for mesenteric edema is often dependent on the underlying cause, such as small bowel obstruction (SBO) or mesenteric ischemia.

• For SBO, the treatment approach can be either surgical or non-surgical, with the decision guided by clinical and imaging findings 2, 3, 4.
• Key CT findings that may suggest a need for surgical treatment include mesenteric edema, lack of the small-bowel feces, bowel wall thickening, fat stranding in the mesentery, and intraperitoneal fluid 2, 3, 4.
• In cases of mesenteric ischemia, the management relies on a combination of medical protocol, revascularization of viable bowel, and surgical resection of necrotic tissue 5, 6.
• Endovascular therapy has become an important alternative for treating acute mesenteric ischemia, especially in patients with acute thrombotic superior mesenteric artery occlusion 6.
• Laparotomy is often needed to evaluate the extent and severity of visceral organ ischemia, which is treated according to the principles of damage control surgery 5, 6.

Treatment Approaches

• Surgical approach:
  • Indicated in cases with signs of ischemia, peritonitis, or other complications 2, 3, 4.
  • May involve resection of necrotic tissue and revascularization of viable bowel 5, 6.
• Non-surgical approach:
  • May be considered in patients without severe clinical or imaging findings 3, 4.
  • Typically involves conservative management with oral/enteral antibiotics and supportive care 5.
• Endovascular therapy:
  • May be an option for patients with acute thrombotic superior mesenteric artery occlusion 6.
  • Can be used to recanalize the occlusive lesion and stent the affected area 6.