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A worldwide survey to assess the management of patients with mesenteric ischaemia & infarction

Introduction

We are conducting a survey to assess the different approaches to the management of patients with mesenteric ischaemia and intestinal infarction.

Patients with mesenteric ischaemia often have a significant delay until a diagnosis is made and some then present with a mesenteric infarction. There may be differences in the availability of appropriate investigations and treatments as well as differences in teaching and awareness in different settings.

We wish to assess the importance of some of these factors prior to conducting a more formal observational study.

We value your input to this survey - thank you very much!

Definitions

Ischaemia refers to intestinal injury related to impaired or disrupted perfusion that can potentially be reversed. This mesenteric vascular insufficiency may be occlusive or non-occlusive in origin.

Infarction refers to irreversible transmural necrosis of the intestine due to ischaemia.

Occlusive intestinal ischaemia: Decreased mesenteric blood flow due to high-grade stenosis or occlusion of mesenteric vessels (arterial or venous).

Non-occlusive intestinal ischaemia : Decreased mesenteric blood flow without high-grade stenosis or occlusion of specifically identifiable (larger) mesenteric vessels. The mechanisms include severe vasoconstriction (especially if accompanied by hypovolaemia), very low cardiac output and compression of mesenteric vessels due to increased intra-abdominal pressure.

Intestinal infarction: Intestinal ischaemia leading to irreversible transmural necrosis of part of the gastrointestinal tract with or without an irreversible loss of blood flow

	never	rarely	often	always	unable to comment
4.) For patients presenting with acute abdominal pain, how often do you feel that the diagnosis of mesenteric ischaemia is delayed?
5.) For patients presenting with acute abdominal pain, how often do you feel that the diagnosis of mesenteric ischaemia is missed?
6.) *In your practice, do patients presenting with acute abdominal pain due to mesenteric ischaemia* undergo urgent or emergency revascularisation procedures?**
7.) *In your practice, do patients presenting with acute abdominal pain due to mesenteric infarction* undergo urgent or emergency revascularisation procedures?**

History of postprandial abdominal pain	History of unintentional weight loss
Decreased dietary intake	Presence of cardiovascular risk factors
Abdominal pain with tenderness	Raised inflammatory markers (CRP/ESR)
Presence of acidosis	Raised serum lactate
Other abnormal blood tests	CT abdomen & pelvis without IV contrast
CT abdomen & pelvis with IV contrast	Diagnostic laparoscopy/laparotomy

History of postprandial abdominal pain	History of unintentional weight loss
Decreased dietary intake	Presence of cardiovascular risk factors
Abdominal pain with tenderness	Raised inflammatory markers (CRP/ESR)
Presence of acidosis	Raised serum lactate
Other abnormal blood tests	CT abdomen & pelvis without IV contrast
CT abdomen & pelvis with IV contrast	Diagnostic laparoscopy/laparotomy

	YES	NO	unable to comment
17.) In the postoperative management of a patient after small bowel resection, do you consider arterial revascularization if not performed before?
18.) In the postoperative management of a patient after extensive small bowel resection, would you give parenteral nutrition support?
19.) Would you send the patient to another centre for parenteral nutrition support?

A worldwide survey to assess the management of patients with mesenteric ischaemia & infarction

Questionnaire