Hassan AS, Laor B, Benmassaoud A. Acute mesenteric ischemia in cirrhosis: Diagnostic and management challenges. World J Hepatol 2026; 18(4): 114916 [DOI: 10.4254/wjh.v18.i4.114916]
Corresponding Author of This Article
Amine Benmassaoud, MD, MSc, FRCPC, Division of Gastroenterology and Hepatology, McGill University Health Centre, 1001 Decarie Blvd, Montreal H4A 3J1, Quebec, Canada. amine.benmassaoud@mcgill.ca
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Apr 27, 2026; 18(4): 114916 Published online Apr 27, 2026. doi: 10.4254/wjh.v18.i4.114916
Acute mesenteric ischemia in cirrhosis: Diagnostic and management challenges
Adam Sahl Hassan, Boaz Laor, Amine Benmassaoud
Adam Sahl Hassan, Boaz Laor, Faculty of Medicine and Health Sciences, McGill University, Montreal H4A 3J1, Quebec, Canada
Amine Benmassaoud, Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal H4A 3J1, Quebec, Canada
Co-first authors: Adam Sahl Hassan and Boaz Laor.
Author contributions: Hassan AS and Laor B drafted the manuscript, and they contributed equally to this manuscript and are co-first authors; Benmassaoud A provided clinical input and critical revisions. All authors reviewed and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Amine Benmassaoud, MD, MSc, FRCPC, Division of Gastroenterology and Hepatology, McGill University Health Centre, 1001 Decarie Blvd, Montreal H4A 3J1, Quebec, Canada. amine.benmassaoud@mcgill.ca
Received: October 9, 2025 Revised: November 27, 2025 Accepted: February 9, 2026 Published online: April 27, 2026 Processing time: 202 Days and 8.4 Hours
Abstract
Acute mesenteric ischemia is a rare but often fatal complication in patients with cirrhosis. A combination of circulatory changes, endothelial dysfunction, and unstable coagulation increases the risk of both occlusive and non-occlusive forms. Yet, due to nonspecific symptoms and clinical overlap with other complications of cirrhosis, diagnosis is frequently delayed. In this review, we describe the pathophysiologic mechanisms that underlie acute mesenteric ischemia in cirrhosis and outline current diagnostic and management strategies. Computed tomography angiography remains the first-line imaging modality, while laboratory findings are supportive but not diagnostic. Medical treatment includes fluid resuscitation, early anticoagulation, and infection control, with vasodilator therapy considered in select cases. Surgical intervention may be required in the setting of bowel infarction or confirmed vascular occlusion, but the risks in patients with cirrhosis are significant and require careful assessment. We also review four published case reports, which illustrate a range of clinical presentations, diagnostic challenges, and outcomes. Together, these cases highlight the need for early imaging, attention to thrombotic risk, and thoughtful use of both medical and surgical therapies. Ongoing research is needed to guide management in this high-risk population.
Core Tip: Acute mesenteric ischemia is rare in cirrhosis but often fatal when missed. This review outlines the unique pathophysiology, diagnostic challenges, and therapeutic considerations of acute mesenteric ischemia in cirrhotic patients, who are predisposed to both arterial and portomesenteric venous thrombosis due to portal hypertension and coagulation imbalance. We also highlight lessons from reported cases and propose practical guidance for imaging, medical therapy, and surgical decision-making. Timely recognition and individualized management are essential to improving outcomes in this high-risk group.
