BACKGROUND

Acute mesenteric ischaemia (AMI) is a disease with high lethality that is often difficult to diagnose due to non-specific symptoms and the absence of diagnostic biomarkers, and it lacks a standardized therapeutic concept. Due to its generallyrare occurrence and difficulties in diagnosis, AMI is insufficiently studied. Most of the available evidence originates from retrospective single-centre studies with a long duration of data collection (ongoing systematic review CRD42021247148). Many different specialties are involved in the diagnosis and management of AMI, making it a multidisciplinary emergency (1-4). Different forms of AMI (occlusive arterial or venous, non-occlusive) may occur, leading to the same severe consequences, but requiring distinct and specific approaches to diagnosis and management (4, 5). These different forms lie within the focus of different specialties and therefore are commonly studied in different cohort studies, precluding ready identification of similarities and differences between these forms. Moreover, the patterns of diagnosis, differentiation between the forms, and management of AMI have not been studied in a prospective multicentre design. AMI has been suggested to cause 1 in 1000 hospital admissions (6, 7), but the true current incidence is not known.

To plan for the current study, we have assessed the incidence of AMI in an on-going systematic review and retrospective analysis. We have identified the pooled proportion of AMI to be 0. 05% of hospital admissions on systematic review (CRD42021247148) and 0. 07% in a retrospective population-based study in Estonia (NCT04867499).

As AMI is rare and at the same time multifaceted, and because diagnostic and management strategies are expectedly highly variable, we consider a large multicentre observational study aiming to capture all consecutive hospitalized cases of AMI as the best (and probably the only realistic) study design to identify the proportion of AMI in hospitalized patients and to describe the phenotype, diagnostics, management and outcomes of AMI.

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