Treatment of Acute Mesenteric Arterial Embolism with Peritonitis or Transmural Bowel Necrosis
When acute mesenteric arterial embolism is accompanied by clinical or radiological signs of peritonitis or transmural bowel necrosis (bowel infarction), this defines a distinct and time-critical presentation that determines the management pathway.
Clinical scenario
Acute mesenteric arterial embolism with clinical or radiological signs of peritonitis or transmural bowel necrosis. In this setting, irreversible bowel damage is highly likely — placing this presentation in a specific, urgency-driven management category.
Why peritonitis changes the approach
The presence of peritonitis or confirmed bowel infarction on imaging indicates that conservative management alone is insufficient. Open surgery is indicated once bowel necrosis is confirmed or strongly suspected on clinical or radiological grounds.
Treatment approach — partial overview
First-line management in this scenario centres on immediate surgical intervention. Concurrent systemic critical care measures form an integral part of the approach alongside surgery.
The complete clinical algorithm, full management components, and all sequencing details are available in the structured protocol below.
References
DOI: 10.1007/s00270-025-04080-0
- When signs of intestinal necrosis and peritonitis are present, irreversible bowel damage is highly likely and surgery is the first-line treatment.
- Open surgery is indicated in the presence of bowel necrosis, the diagnosis of which remains challenging.
- In contrast, when signs of peritonitis or bowel necrosis are evident clinically or radiologically, prompt surgical intervention with laparotomy and resection is required.
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