Mesenteric ischemia in the elderly

Mesenteric ischemia is a well-recognized clinical entity among the elderly. Although first described more than 500 years ago, advances in both diagnos tic and treatment regimens only minimally have improved on the bleak morbid ity and mortality rates associated with this disease. Significant progress, however, has been made in understanding the pathophysiology behind a visce ral vascular compromise. Using this knowledge, physicians have been able to rechannel their efforts. Rather than focusing on the development of new tr eatment options for bowel infarction, physicians place more emphasis on the prevention and early detection of bowel ischemia. The goal is to identify accurately individuals at risk and intervene medically before irreversible infarction occurs. After briefly discussing the history, epidemiology, and pathophysiology of mesenteric ischemia, this article reviews the past, curr ent, and future approaches to the diagnosis and treatment of this challengi ng condition.