Consensus statement on the surgical management of acute mesenteric ischemia in China (2025 edition)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHOU Zongguang ,  YU Peiwu ,  ZHAO Jichun ,  HU Jiankun ,  YANG Lie ,  HUANG Bin ,  ZHANG Shu

Laparoscopic Surgery Committee of the Endoscopist Branch in the Chinese Medical Doctor Association, Robotic and Laparoscopic Surgery Committee of Chinese Research Hospital Association, Peripheral Vascular Disease Management Branch of the Chinese Geriatrics Society, Emergency Medicine Branch of Chinese Geriatric Society, Multidisciplinary Committee for Gastrointestinal Diseases of Sichuan Medical Association;

Corresponding author：

ZHOU Zongguang, Email: zhou767@163.com; YU Peiwu, Email: yupeiwu01@sina.com; ZHAO Jichun, Email: zhaojc3@126.com; HU Jiankun, Email: hujkwch@126.com; YANG Lie, Email: lie_222@163.com; HUANG Bin, Email: dochuangbin@163.com; ZHANG Shu, Email: dr.zhangshu@qq.com

Keywords：

acute mesenteric ischemia; occlusive mesenteric ischemia; non-occlusive mesenteric ischemia; expert consensus

DOI：

10.7507/1007-9424.202509090

Video：

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Abstract Full text Figures/Tables Video References Cited by

Acute mesenteric ischemia (AMI) refers to a group of acute abdominal conditions resulting from impaired mesenteric blood supply, characterized by low incidence but high mortality. Early diagnosis and prompt intervention are crucial for reducing AMI-related fatalities and improving patients’ outcomes, with surgical treatment playing a key role. To address challenges in the surgical management of AMI, the Laparoscopic Surgery Committee of the Endoscopist Branch of the Chinese Medical Doctor Association, the Robotic and Laparoscopic Surgery Committee of Chinese Research Hospital Association, the Peripheral Vascular Disease Management Branch of the Chinese Geriatrics Society, the Emergency Medicine Branch of Chinese Geriatrics Society, and the Multidisciplinary Committee for Gastrointestinal Diseases of Sichuan Medical Association have jointly organized experts in the field to develop this consensus. The document aims to enhance clinical awareness of AMI, standardize surgical diagnosis and treatment protocols, and ultimately improve the prognosis of AMI patients.

Citation： ZHOU Zongguang, YU Peiwu, ZHAO Jichun, HU Jiankun, YANG Lie, HUANG Bin, ZHANG Shu. Consensus statement on the surgical management of acute mesenteric ischemia in China (2025 edition). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(10): 1189-1203. doi: 10.7507/1007-9424.202509090 Copy

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2.	Leone M, Bechis C, Baumstarck K, et al. Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases. Intensive Care Med, 2015, 41(4): 667-676.
3.	Estler A, Estler E, Feng YS, et al. Treatment of acute mesenteric ischemia: individual challenges for interventional radiologists and abdominal surgeons. J Pers Med, 2022, 13(1): 55. doi: 10.3390/jpm13010055.
4.	Kundan M, Chebrolu H, Muniswamppa C, et al. Outcomes of management of patients with acute mesenteric ischemia: a prospective study. Niger J Surg, 2021, 27(1): 16-21.
5.	Cudnik MT, Darbha S, Jones J, et al. The diagnosis of acute mesenteric ischemia: a systematic review and meta-analysis. Acad Emerg Med, 2013, 20(11): 1087-1100.
6.	Bette S, Habeeballah O, Luitjens JH, et al. Treatment of acute mesenteric ischemia between 2010 and 2020 - a German nation-wide study. BMC Gastroenterol, 2023, 23(1): 300. doi: 10.1186/s12876-023-02926-w.
7.	Wu W, Yang L, Zhou Z. Clinical features and factors affecting postoperative mortality for obstructive acute mesenteric ischemia in China: a hospital- based survey. Vasc Health Risk Manag, 2020, 16: 479-487.
8.	Wu W, Zhou Z. A comprehensive way to access hospital death prediction model for acute mesenteric ischemia: a combination of traditional statistics and machine learning. Int J Gen Med, 2021, 14: 591-602.
9.	Wu W, Liu J, Zhou Z. Preoperative risk factors for short-term postoperative mortality of acute mesenteric ischemia after laparotomy: a systematic review and meta-analysis. Emerg Med Int, 2020, 2020: 1382475. doi: 10.1155/2020/1382475.
10.	撖毓敏, 姜笑梅, 张贵祥, 等. 急性闭塞性肠系膜缺血临床特征分析及肠坏死风险预测模型构建. 中国实用外科杂志, 2025, 45(4): 443-449.
11.	朱明杰, 王自强. 应重视培养急腹症诊断中急性肠缺血的病理生理与CT影像相关联的系统性思维模式. 中国普外基础与临床杂志, 2020, 27(12): 1473-1479.
12.	Zhang Q, Ma T, Zhao H, et al. Factors that may affect the outcome of acute occlusive mesenteric ischemia. A single-center study. BMC Surg, 2024, 24(1): 21. doi: 10.1186/s12893-024-02310-9.
13.	Clair DG, Beach JM. Mesenteric ischemia. N Engl J Med, 2016, 374(10): 959-968.
14.	Huerta C, Rivero E, Montoro MA, et al. Risk factors for intestinal ischaemia among patients registered in a UK primary care database: a nested case-control study. Aliment Pharmacol Ther, 2011, 33(8): 969-978.
15.	Acosta S. Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg, 2010, 23(1): 4-8.
16.	Kärkkäinen JM, Lehtimäki TT, Manninen H, et al. Acute mesenteric ischemia is a more common cause than expected of acute abdomen in the elderly. J Gastrointest Surg, 2015, 19(8): 1407-1414.
17.	Kärkkäinen JM, Acosta S. Acute mesenteric ischemia (part Ⅰ) - incidence, etiologies, and how to improve early diagnosis. Best Pract Res Clin Gastroenterol, 2017, 31(1): 15-25.
18.	徐亮, 李明, 谭诗云, 等. 影响急性肠系膜缺血患者院内死亡的危险因素分析. 中华消化杂志, 2023, 43(6): 401-405.
19.	纪忠, 王星, 梁朋真, 等. 急性肠系膜缺血疾病诊治及预后影响因素研究. 蚌埠医学院学报, 2023, 48(10): 1361-1365.
20.	冯江毅, 王丽萍, 郭轶, 等. 急性肠系膜缺血预后的影响因素. 血管与腔内血管外科杂志, 2021, 7(2): 179-182, 199.
21.	Acosta S, Ogren M, Sternby NH, et al. Clinical implications for the management of acute thromboembolic occlusion of the superior mesenteric artery: autopsy findings in 213 patients. Ann Surg, 2005, 241(3): 516-522.
22.	Yu H, Kirkpatrick IDC. An update on acute mesenteric ischemia. Can Assoc Radiol J, 2023, 74(1): 160-171.
23.	Franca E, Shaydakov ME, Kosove J. Mesenteric artery thrombosis. StatPearls. Treasure Island (FL), 2025.
24.	Gore RM, Thakrar KH, Mehta UK, et al. Imaging in intestinal ischemic disorders. Clin Gastroenterol Hepatol, 2008, 6(8): 849-858.
25.	Reddy KT, Syeda H, Stenberg D, et al. Spontaneous isolated superior mesenteric artery dissection with thrombosis: a case report of a rare presentation of acute abdominal pain. CJC Open, 2022, 4(12): 1090-1092.
26.	Wang B, Pan J, Xu Y, et al. Long-term outcomes of endovascular versus medical treatment for isolated superior mesenteric artery dissection: a 10-year retrospective study. Cardiovasc Intervent Radiol, 2025, 48(5): 593-602.
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29.	Juvonen T, Jormalainen M, Mustonen C, et al. Direct aortic versus supra-aortic arterial cannulation during surgery for acute type a aortic dissection. World J Surg, 2023, 47(11): 2899-2908.
30.	Klar E, Rahmanian PB, Bücker A, et al. Acute mesenteric ischemia: a vascular emergency. Dtsch Arztebl Int, 2012, 109(14): 249-256.
31.	al-Hilaly MA, Abu-Zidan FM. Mesenteric vein thrombosis: is it one disease? Eur J Vasc Endovasc Surg, 1995, 9(1): 103-106.
32.	Aschoff AJ, Stuber G, Becker BW, et al. Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging, 2009, 34(3): 345-357.
33.	Zeier M, Wiesel M, Rambausek M, et al. Non-occlusive mesenteric infarction in dialysis patients: the importance of prevention and early intervention. Nephrol Dial Transplant, 1995, 10(6): 771-773.
34.	Kärkkäinen JM. Acute mesenteric ischemia: a challenge for the acute care surgeon. Scand J Surg, 2021, 110(2): 150-158.
35.	Tilsed JV, Casamassima A, Kurihara H, et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg, 2016, 42(2): 253-270.
36.	Nuzzo A, Maggiori L, Ronot M, et al. Predictive factors of intestinal necrosis in acute mesenteric ischemia: prospective study from an intestinal stroke center. Am J Gastroenterol, 2017, 112(4): 597-605.
37.	Treskes N, Persoon AM, van Zanten ARH. Diagnostic accuracy of novel serological biomarkers to detect acute mesenteric ischemia: a systematic review and meta-analysis. Intern Emerg Med, 2017, 12(6): 821-836.
38.	Powell A, Armstrong P. Plasma biomarkers for early diagnosis of acute intestinal ischemia. Semin Vasc Surg, 2014, 27(3-4): 170-175.
39.	Block T, Nilsson TK, Björck M, et al. Diagnostic accuracy of plasma biomarkers for intestinal ischaemia. Scand J Clin Lab Invest, 2008, 68(3): 242-248.
40.	Bala M, Kashuk J, Moore EE, et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg, 2017, 12: 38. doi: 10.1186/s13017-017-0150-5.
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42.	Matsumoto S, Sekine K, Funaoka H, et al. Diagnostic performance of plasma biomarkers in patients with acute intestinal ischaemia. Br J Surg, 2014, 101(3): 232-238.
43.	Olson MC, Fletcher JG, Nagpal P, et al. Mesenteric ischemia: what the radiologist needs to know. Cardiovasc Diagn Ther, 2019, 9(Suppl 1): S74-S87.
44.	Garzelli L, Nuzzo A, Copin P, et al. Contrast-enhanced CT for the diagnosis of acute mesenteric ischemia. AJR Am J Roentgenol, 2020, 215(1): 29-38.
45.	Fitzpatrick LA, Rivers-Bowerman MD, Thipphavong S, et al. Pearls, pitfalls, and conditions that mimic mesenteric ischemia at CT. Radiographics, 2020, 40(2): 545-561.
46.	Lehtimäki TT, Kärkkäinen JM, Saari P, et al. Detecting acute mesenteric ischemia in CT of the acute abdomen is dependent on clinical suspicion: review of 95 consecutive patients. Eur J Radiol, 2015, 84(12): 2444-2453.
47.	Weber DG, Bendinelli C, Balogh ZJ. Damage control surgery for abdominal emergencies. Br J Surg, 2014, 101(1): e109-e118.
48.	Oldenburg WA, Lau LL, Rodenberg TJ, et al. Acute mesenteric ischemia: a clinical review. Arch Intern Med, 2004, 164(10): 1054-1062.
49.	Sartelli M, Coccolini F, Kluger Y, et al. WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections. World J Emerg Surg, 2021, 16(1): 49. doi: 10.1186/s13017-021-00387-8.
50.	A global declaration on appropriate use of antimicrobial agents across the surgical pathway. Surg Infect (Larchmt), 2017, 18(8): 846-853.
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1. Bala M, Catena F, Kashuk J, et al. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World J Emerg Surg, 2022, 17(1): 54. doi: 10.1186/s13017-022-00443-x.
2. Leone M, Bechis C, Baumstarck K, et al. Outcome of acute mesenteric ischemia in the intensive care unit: a retrospective, multicenter study of 780 cases. Intensive Care Med, 2015, 41(4): 667-676.
3. Estler A, Estler E, Feng YS, et al. Treatment of acute mesenteric ischemia: individual challenges for interventional radiologists and abdominal surgeons. J Pers Med, 2022, 13(1): 55. doi: 10.3390/jpm13010055.
4. Kundan M, Chebrolu H, Muniswamppa C, et al. Outcomes of management of patients with acute mesenteric ischemia: a prospective study. Niger J Surg, 2021, 27(1): 16-21.
5. Cudnik MT, Darbha S, Jones J, et al. The diagnosis of acute mesenteric ischemia: a systematic review and meta-analysis. Acad Emerg Med, 2013, 20(11): 1087-1100.
6. Bette S, Habeeballah O, Luitjens JH, et al. Treatment of acute mesenteric ischemia between 2010 and 2020 - a German nation-wide study. BMC Gastroenterol, 2023, 23(1): 300. doi: 10.1186/s12876-023-02926-w.
7. Wu W, Yang L, Zhou Z. Clinical features and factors affecting postoperative mortality for obstructive acute mesenteric ischemia in China: a hospital- based survey. Vasc Health Risk Manag, 2020, 16: 479-487.
8. Wu W, Zhou Z. A comprehensive way to access hospital death prediction model for acute mesenteric ischemia: a combination of traditional statistics and machine learning. Int J Gen Med, 2021, 14: 591-602.
9. Wu W, Liu J, Zhou Z. Preoperative risk factors for short-term postoperative mortality of acute mesenteric ischemia after laparotomy: a systematic review and meta-analysis. Emerg Med Int, 2020, 2020: 1382475. doi: 10.1155/2020/1382475.
10. 撖毓敏, 姜笑梅, 张贵祥, 等. 急性闭塞性肠系膜缺血临床特征分析及肠坏死风险预测模型构建. 中国实用外科杂志, 2025, 45(4): 443-449.
11. 朱明杰, 王自强. 应重视培养急腹症诊断中急性肠缺血的病理生理与CT影像相关联的系统性思维模式. 中国普外基础与临床杂志, 2020, 27(12): 1473-1479.
12. Zhang Q, Ma T, Zhao H, et al. Factors that may affect the outcome of acute occlusive mesenteric ischemia. A single-center study. BMC Surg, 2024, 24(1): 21. doi: 10.1186/s12893-024-02310-9.
13. Clair DG, Beach JM. Mesenteric ischemia. N Engl J Med, 2016, 374(10): 959-968.
14. Huerta C, Rivero E, Montoro MA, et al. Risk factors for intestinal ischaemia among patients registered in a UK primary care database: a nested case-control study. Aliment Pharmacol Ther, 2011, 33(8): 969-978.
15. Acosta S. Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg, 2010, 23(1): 4-8.
16. Kärkkäinen JM, Lehtimäki TT, Manninen H, et al. Acute mesenteric ischemia is a more common cause than expected of acute abdomen in the elderly. J Gastrointest Surg, 2015, 19(8): 1407-1414.
17. Kärkkäinen JM, Acosta S. Acute mesenteric ischemia (part Ⅰ) - incidence, etiologies, and how to improve early diagnosis. Best Pract Res Clin Gastroenterol, 2017, 31(1): 15-25.
18. 徐亮, 李明, 谭诗云, 等. 影响急性肠系膜缺血患者院内死亡的危险因素分析. 中华消化杂志, 2023, 43(6): 401-405.
19. 纪忠, 王星, 梁朋真, 等. 急性肠系膜缺血疾病诊治及预后影响因素研究. 蚌埠医学院学报, 2023, 48(10): 1361-1365.
20. 冯江毅, 王丽萍, 郭轶, 等. 急性肠系膜缺血预后的影响因素. 血管与腔内血管外科杂志, 2021, 7(2): 179-182, 199.
21. Acosta S, Ogren M, Sternby NH, et al. Clinical implications for the management of acute thromboembolic occlusion of the superior mesenteric artery: autopsy findings in 213 patients. Ann Surg, 2005, 241(3): 516-522.
22. Yu H, Kirkpatrick IDC. An update on acute mesenteric ischemia. Can Assoc Radiol J, 2023, 74(1): 160-171.
23. Franca E, Shaydakov ME, Kosove J. Mesenteric artery thrombosis. StatPearls. Treasure Island (FL), 2025.
24. Gore RM, Thakrar KH, Mehta UK, et al. Imaging in intestinal ischemic disorders. Clin Gastroenterol Hepatol, 2008, 6(8): 849-858.
25. Reddy KT, Syeda H, Stenberg D, et al. Spontaneous isolated superior mesenteric artery dissection with thrombosis: a case report of a rare presentation of acute abdominal pain. CJC Open, 2022, 4(12): 1090-1092.
26. Wang B, Pan J, Xu Y, et al. Long-term outcomes of endovascular versus medical treatment for isolated superior mesenteric artery dissection: a 10-year retrospective study. Cardiovasc Intervent Radiol, 2025, 48(5): 593-602.
27. Jia Z, Mei J, Ding W, et al. The pathogenesis of superior mesenteric artery dissection: an in-depth study based on fluid-structure interaction and histology analysis. Comput Methods Programs Biomed, 2022, 226: 107187. doi: 10.1016/j.cmpb.2022.107187.
28. Shi Y, Zhou Y, Yuan Y, et al. Association between aortomesenteric angle and symptomatic spontaneous isolated superior mesenteric artery dissection. Sci Rep, 2025, 15(1): 8605. doi: 10.1038/s41598-024-81103-9.
29. Juvonen T, Jormalainen M, Mustonen C, et al. Direct aortic versus supra-aortic arterial cannulation during surgery for acute type a aortic dissection. World J Surg, 2023, 47(11): 2899-2908.
30. Klar E, Rahmanian PB, Bücker A, et al. Acute mesenteric ischemia: a vascular emergency. Dtsch Arztebl Int, 2012, 109(14): 249-256.
31. al-Hilaly MA, Abu-Zidan FM. Mesenteric vein thrombosis: is it one disease? Eur J Vasc Endovasc Surg, 1995, 9(1): 103-106.
32. Aschoff AJ, Stuber G, Becker BW, et al. Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging, 2009, 34(3): 345-357.
33. Zeier M, Wiesel M, Rambausek M, et al. Non-occlusive mesenteric infarction in dialysis patients: the importance of prevention and early intervention. Nephrol Dial Transplant, 1995, 10(6): 771-773.
34. Kärkkäinen JM. Acute mesenteric ischemia: a challenge for the acute care surgeon. Scand J Surg, 2021, 110(2): 150-158.
35. Tilsed JV, Casamassima A, Kurihara H, et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg, 2016, 42(2): 253-270.
36. Nuzzo A, Maggiori L, Ronot M, et al. Predictive factors of intestinal necrosis in acute mesenteric ischemia: prospective study from an intestinal stroke center. Am J Gastroenterol, 2017, 112(4): 597-605.
37. Treskes N, Persoon AM, van Zanten ARH. Diagnostic accuracy of novel serological biomarkers to detect acute mesenteric ischemia: a systematic review and meta-analysis. Intern Emerg Med, 2017, 12(6): 821-836.
38. Powell A, Armstrong P. Plasma biomarkers for early diagnosis of acute intestinal ischemia. Semin Vasc Surg, 2014, 27(3-4): 170-175.
39. Block T, Nilsson TK, Björck M, et al. Diagnostic accuracy of plasma biomarkers for intestinal ischaemia. Scand J Clin Lab Invest, 2008, 68(3): 242-248.
40. Bala M, Kashuk J, Moore EE, et al. Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg, 2017, 12: 38. doi: 10.1186/s13017-017-0150-5.
41. Reintam Blaser A, Starkopf J, Björck M, et al. Diagnostic accuracy of biomarkers to detect acute mesenteric ischaemia in adult patients: a systematic review and meta-analysis. World J Emerg Surg, 2023, 18(1): 44. doi: 10.1186/s13017-023-00512-9.
42. Matsumoto S, Sekine K, Funaoka H, et al. Diagnostic performance of plasma biomarkers in patients with acute intestinal ischaemia. Br J Surg, 2014, 101(3): 232-238.
43. Olson MC, Fletcher JG, Nagpal P, et al. Mesenteric ischemia: what the radiologist needs to know. Cardiovasc Diagn Ther, 2019, 9(Suppl 1): S74-S87.
44. Garzelli L, Nuzzo A, Copin P, et al. Contrast-enhanced CT for the diagnosis of acute mesenteric ischemia. AJR Am J Roentgenol, 2020, 215(1): 29-38.
45. Fitzpatrick LA, Rivers-Bowerman MD, Thipphavong S, et al. Pearls, pitfalls, and conditions that mimic mesenteric ischemia at CT. Radiographics, 2020, 40(2): 545-561.
46. Lehtimäki TT, Kärkkäinen JM, Saari P, et al. Detecting acute mesenteric ischemia in CT of the acute abdomen is dependent on clinical suspicion: review of 95 consecutive patients. Eur J Radiol, 2015, 84(12): 2444-2453.
47. Weber DG, Bendinelli C, Balogh ZJ. Damage control surgery for abdominal emergencies. Br J Surg, 2014, 101(1): e109-e118.
48. Oldenburg WA, Lau LL, Rodenberg TJ, et al. Acute mesenteric ischemia: a clinical review. Arch Intern Med, 2004, 164(10): 1054-1062.
49. Sartelli M, Coccolini F, Kluger Y, et al. WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections. World J Emerg Surg, 2021, 16(1): 49. doi: 10.1186/s13017-021-00387-8.
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Consensus statement on the surgical management of acute mesenteric ischemia in China (2025 edition)

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