WSES Mesenteric Ischemia 2022 — Guidelines for the Management of Acute Mesenteric Ischemia

Biphasic contrast-enhanced multidetector CT angiography (CTA) is the primary diagnostic imaging of choice. Immediate systemic unfractionated heparin anticoagulation should be initiated upon suspicion. Hemodynamic resuscitation must avoid splanchnic vasoconstrictors (vasopressin and high-dose epinephrine). Emergent revascularization (endovascular thrombectomy/stenting or surgical embolectomy) must precede or accompany laparotomy. Mandatory planned second-look laparotomy at 24-48 hours to assess bowel viability.