Ischemia mezenterica acuta (IMA) reprezinta o problema chirurgicala severa cu abordare urgenta privind masurile diagnostico-curative. Tabloul clinic incert in IMA creste rata letalitatii (50-100%). Scopul: Analiza rezultatelor diagnosticului clinic si instrumental in IMA. Material si metoda: S-a studiat eficacitatea metodelor diagnostice la 85 de pacienti cu IMA, tratati in perioada 20172021. Varsta pacientilor a variat intre 30-91 ani, raportul barbati/ femei-43/42 ani. Rezultate: Diagnosticul IMA este dificil, fiind stabilit corect in 32,5% cazuri in baza tabloului clinic, pacientii prezentand dureri ischemice abdomenale, meteorism si mai rar scaun sanguinolent. La 53 pacienti diagnosticul prezumtiv a fost ileusul intestinal acut (IIA), colecistita acuta, apendicita acuta si peritonita. Diagnosticul diferential a necesitat efectuarea investigatiilor instrumentale, de rutina fiind Rx abdomenal efectuat la toti pacientii cu evidentierea patologiei chirurgicale in 81,7% cazuri: 52 pacienti cu date de IIA, 3- pneumoperitoneum, 2-asocierea pneumoperitoneului cu IIA, 12- pneumatoza intestinala. La 16 pacienti patologie confirmata radiologic nu s-a depistat. EUS efectuat la 64 de pacienti, patologie chirurgicala stabilindu-se in 73,4 % cazuri: semne de colecistita acuta, suspectie la apendicita si pancreatita acuta. In 82,4 % cazuri diagnosticul a fost confirmat prin angio CT. Laparoscopia si laparotomia exploratorie efectuata in 24,6% si 3,1% cazuri a confirmat diagnosticul. Concluzie: Diagnosticul IMA in 32,5% cazuri poate fi confirmat la prezenta semnelor clinice. Rx abdomenal si EUS prezinta informativitate redusa, necesitand investigatii suplimentare diagnostice, de electie fiind angio CT si laparoscopia.

Acute mesenteric ischemia (AMI) is a severe surgical problem with an urgent approach on diagnostic-curative measures. The uncertain clinical picture of the AMI increases the rate of fatality (50-100%). Purpose: Analysis of clinical and instrumental diagnostic outcomes in AMI. Materials and methods: The effectiveness of diagnostic methods has been studied in 85 patients with AMI during 2017-2021. The age of patients ranged from 30-91 years, the male/female ratio 43/42 years. Results: The diagnosis of AMI is difficult, being correctly established in 32,5% cases based on the clinical picture, patients experienced ischemic abdominal pain, distension of the abdomen and rarely bloody stool. In 53 patients the presumptive diagnosis was acute intestinal ileus (AII), acute cholecystitis, acute appendicitis and peritonitis. Differential diagnosis required instrumental investigations, per usual being used abdominal Xray in all patients with evidence of surgical pathology in 81,7% cases: 52 patients with evidence of AII, 3 - pneumoperitoneum, 2 - asociation of pneumoperitoneum with AII, 12 – intestinal pneumatosis. In 16 patients, radiologically confirmed pathology was not detected. Endoscopic ultrasound was performed in 64 patients, surgical pathology being detected in 73,4% cases: signs of acute cholecystitis, suspection of acute appendicitis and acute pancreatitis. In 82,4% of cases, the diagnosis was confirmed by CTA. Laparoscopy and exploratory laparotomy performed in 24,6% and 3,1% cases confirmed the diagnosis. Conclusion: The diagnosis of AMI in 32,5% cases can be confirmed at the presence of clinical signs. Abdominal Xray and endoscopic ultrasound displays low evidence of AMI, requiring additional diagnostic investigations, of choice being CTA and laparoscopy.