If peritoneal signs develop, perform surgical exploration.
Perform CT or MR angiography to identify nature of the vascular obstruction.
If the patient has chronic mesenteric ischemia and a focal lesion is identified on angiography, perform one of the following:
(1) surgical revascularization
(2) percutaneous transluminal mesenteric angioplasty with or without stent
The management of a patient with chronic mesenteric ischemia and diffuse vascular disease was not shown in the diagram. If the disease is limited to a few vessels, surgical resection of the bowel segment may be feasible. Alternatively the patient could receive anticoagulation.
If the patient has acute mesenteric ischemia and an arterial thrombus is found, consider:
(1) surgical exploration
(2) thrombolytic agents if surgical risk is high
If the patient has a venous thrombosis:
(1) search for a hypercoagulable state
(2) anticoagulate (immediate heparin followed by warfarin) if symptomatic
(3) observe with or without anticoagulation if asymptomatic
If no vascular occlusive lesion can be identified on angiography, attempt vasodilation with papaverine.
(1) observe the patient if there is improvement
(2) perform surgical exploration if there is no clinical improvement
