Overview
Embolic mesenteric infarction involves obstruction of mesenteric vessels by emboli, leading to ischemia and potentially necrosis of bowel tissue, often requiring urgent intervention to prevent bowel perforation and sepsis 1.Diagnosis
Imaging: Serial T2*-weighted single-shot echo-planar gradient-echo (GRE-EPI) MRI and 3D time-of-flight MRA are crucial for assessing changes in susceptibility signs and vascular status 1.
Monitoring: Follow-up imaging within 1 month post-onset helps in evaluating recanalization or migration of emboli 1.Management
Endovascular Intervention: Early endovascular procedures such as thrombolysis or mechanical thrombectomy may be necessary to restore blood flow 1.
Surgical Intervention: In cases of failed endovascular treatment or bowel necrosis, surgical resection of the affected bowel segment may be required 1.Special Populations
No Specific Data: The provided abstracts do not offer specific guidance or evidence regarding management in pregnancy, pediatrics, elderly patients, or those with comorbidities 1.Key Recommendations
Utilize serial GRE-EPI MRI to monitor changes in susceptibility signs reflecting vascular status and response to treatment in acute embolic mesenteric infarction (Evidence: Moderate) 1.
Consider endovascular interventions such as thrombolysis or thrombectomy early in the course of the disease to facilitate recanalization (Evidence: Moderate) 1.
Plan for surgical resection if endovascular approaches fail or if there is evidence of bowel necrosis (Evidence: Expert opinion) 1.References
1 Shinohara Y, Kinoshita T, Kinoshita F. Changes in susceptibility signs on serial T2-weighted single-shot echo-planar gradient-echo images in acute embolic infarction: comparison with recanalization status on 3D time-of-flight magnetic resonance angiography. Neuroradiology* 2012. link