Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
World J Hepatol. Apr 27, 2026; 18(4): 114916
Published online Apr 27, 2026. doi: 10.4254/wjh.v18.i4.114916
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, 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
Revised: November 27, 2025
Accepted: February 9, 2026
Published online: April 27, 2026
Processing time: 202 Days and 8.4 Hours
Core Tip
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.