Authors
Otdelnov L.A.1, 2, Veselova V.P.1
1 Privolzhsky Research Medical University, Nizhny Novgorod
2 City Clinical Hospital № 13 of the Avtozavodsky District of Nizhny Novgorod, Nizhny Novgorod
Abstract
Background: Non-occlusive mesenteric ischemia (NOMI) accounts for up to 30% of all cases of acute mesenteric ischemia and is associated with the highest mortality, ranging from 50% to 93%. Despite the clinical significance of this condition, early diagnosis remains challenging, and effective algorithms for treatment and prevention have not yet been fully established.
Aim: The aim of this review was to systematize current data on the diagnosis and treatment of NOMI, to evaluate existing clinical approaches, and to identify the most promising strategies for reducing mortality.
Materials and Methods: Publications over the past decade addressing NOMI were analyzed. Particular attention was given to data on the diagnostic accuracy of contrast-enhanced computed tomography, angiography, and biomarkers (notably I-FABP), as well as to the reported effectiveness of conservative and surgical treatment strategies.
Results: Contrast-enhanced CT demonstrated high sensitivity in detecting early ischemic changes, angiography confirmed its role as the diagnostic gold standard, and I-FABP showed sensitivity up to 90% and specificity up to 80.3%. The use of vasodilators (papaverine, prostaglandin E1, nitroglycerin) reduced mortality from 34.2% to 22.6% and decreased the rate of surgical interventions from 15.3% to 5.0%.
Discussion: The findings suggest that an integrated approach combining advanced imaging techniques, biomarker-based diagnostics, and vasodilator therapy, together with minimally invasive surgical interventions, may contribute to reduced mortality in NOMI. However, the current evidence base remains limited, highlighting the need for further multicenter studies to refine diagnostic criteria and to develop standardized treatment algorithms.
Keywords: acute mesenteric ischemia, mesenteric circulation, mesenteric ischemia.
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