What treatment is recommended for acute mesenteric ischemia if peritonitis or bowel necrosis is present?

In cases of acute mesenteric ischemia where peritonitis or bowel necrosis is present, the recommended treatment is surgical intervention. When these serious complications arise, they indicate that there is a critical and often irreversible state of bowel injury or ongoing inflammation requiring immediate action.

Surgical intervention may involve resection of necrotic bowel segments and addressing the underlying cause of the ischemia, which may include addressing vascular occlusions or lesions. The urgency of the situation means that interventions need to be more invasive and definitive rather than relying on less immediate treatments like angioplasty or thrombolytics, which are typically employed in earlier stages of ischemia without significant bowel compromise. Medications alone would not suffice in the presence of necrosis or peritonitis, as these conditions can quickly lead to systemic complications and require direct surgical management to prevent further deterioration.