When acute mesenteric arterial thrombosis presents with clinical or radiological signs of intestinal or transmural bowel necrosis, bowel infarction, or peritonitis, the situation demands immediate, simultaneous intervention on multiple fronts.
This protocol addresses cases where signs of intestinal necrosis, transmural bowel infarction, or peritonitis are present. In this setting, irreversible bowel damage is highly likely and surgery is the first-line treatment.
The approach involves urgent pre-operative critical care — including aggressive fluid resuscitation, close haemodynamic monitoring, broad-spectrum antibiotic therapy, and intravenous full-dose anticoagulation — combined with immediate surgical intervention. The full sequence, targets, and complete treatment algorithm are in the structured protocol.
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.
Intra-vascular volume expansion with crystalloids and blood products must be started immediately to improve visceral perfusion.
Early, broad-spectrum antibiotic therapy is required due to the high risk of infection secondary to bacterial translocation.
Intravenous full-dose anticoagulation, preferably with unfractionated heparin, should be initiated unless contra-indicated.
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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