RAPID RESPONSES FROM BMJ.COM

doi:10.1136/bmjusa.03080004

BMJ, doi: 10.1136/bmjusa.03080004, (Published 3 September 2003)

Letter

RAPID RESPONSES FROM BMJ.COM

Following is an edited excerpt from one of the Rapid Responsesgenerated by this article, which can be read in their entiretyat http://bmj.com/cgi/eletters/326/7403/1372 — Editor

From BMJ USA 2003;August:446

Management of acute mesenteric ischemia

Editor — Sreenarasimhaiah has produced a comprehensivereview of the clinical features and diagnosis of intestinalischemia. However, the recommended management strategy foracute mesenteric ischemia is misleading and flawed. Surgicalembolectomy should be considered the standard of care onlyin cases of embolic arterial occlusion. In up to 50% of casesof acute mesenteric ischemia, arterial occlusion occurs dueto thrombosis at a superior mesenteric artery (SMA) atherosclerotic stenosis. In these instances SMA reconstruction is indicated,either through aorto-SMA bypass grafting or reimplantationof the SMA to the aorta.

Furthermore, despite Sreenarasimhaiah's support for interventional radiology, the evidence base for the use of thrombolytic agentsin mesenteric ischemia remains largely anecdotal. Savassi-Rochaand Veloso's review of the use of lysis in SMA embolism identifiedonly 18 other reported cases in the literature ( Hepatogastroenterology2002;49:1307-1310[Medline]). Though thrombolysis may be a viable therapeuticoption in the management of mesenteric ischemia, its efficacyand indications are by no means clear at present.