International multidisciplinary consensus on the definition and nomenclature of acute mesenteric ischaemia: a modified Delphi study

Acute mesenteric ischaemia (AMI) is a life-threatening emergency with in-hospital mortality of 49–64% across recent cohort studies. Terminology and nomenclature for acute ischaemia of the gastrointestinal tract remain inconsistent across disciplines and geographies, hindering clinical communication, registry design, and research comparability. This project aimed to develop consensus definitions and clinical algorithms for AMI; the present paper addresses definitions and nomenclature, and the companion paper the algorithms. A seven-member steering committee representing intensive care, vascular surgery, general surgery, interventional radiology, and gastroenterology conducted a literature review (2020–2025) and drafted candidate definition statements. An international panel of 50 experts from 15 countries underwent a modified Delphi process comprising two electronic voting rounds (9-point GRADE scale; predefined consensus threshold: ≥75% rated 7–9 and ≤ 15% rated 1–3) via REDCap, followed by two virtual consensus meetings with live polling. Where clinical equipoise existed, competing statements were presented for independent rating. Fifty panellists completed Round 1 (22 statements) and 44 completed Round 2 (27 statements; retention 88%). Ten statements reached the predefined electronic consensus threshold, including a core AMI definition (100%), mechanism classification (100%), and subtype definitions for arterial occlusive AMI (91%), venous AMI (84%), and non-occlusive mesenteric ischaemia (NOMI; 86%). The consensus meetings adopted a novel two-tier nomenclature: Acute GastroIntestinal Ischaemia (AGII) as the umbrella term for acute ischaemia of the gastrointestinal tract, and AMI as the subset to which the clinical algorithms apply. ‘Ischaemic colitis’ was declared a misnomer (92%). The arterial territory question (superior mesenteric artery (SMA) only versus a broader mesenteric territory) was not resolved and is presented as a dual-interpretation framework. Subgroup analysis revealed a specialty-driven divergence: general (73%, n = 11) and vascular surgeons (67%, n = 9) favoured restricting AMI to the SMA distribution, whereas intensivists favoured the whole gastrointestinal tract (80%, n = 10). This international, multidisciplinary Delphi study provides consensus definitions of AMI and its subtypes and proposes AGII/AMI as a two-tier nomenclature to resolve longstanding territorial and terminological ambiguities. These definitions lay the foundation for the companion clinical algorithms and aim to provide a standardised framework for future research, clinical communication, and registry design.

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Journal
World Journal of Emergency Surgery
Published
2026-11-06
DOI
https://doi.org/10.1186/s13017-026-00740-9
Primary Topic
Abdominal vascular conditions and treatments
Type
article
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0.00

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article

International multidisciplinary consensus on the definition and nomenclature of acute mesenteric ischaemia: a modified Delphi study

Christopher P. Twine, Vladislav Mihnovitš, Todd R. Vogel, Simone Piva et al.
2 links
World Journal of Emergency Surgery
Abdominal vascular conditions and treatments
article

International multidisciplinary consensus on the definition and nomenclature of acute mesenteric ischaemia: a modified Delphi study

Christopher P. Twine, Vladislav Mihnovitš, Todd R. Vogel, Simone Piva, Tommaso D’Angelo, Marko Murruste, Stefan Acosta, Mark J.W. Koelemay, Matti Tolonen, Alastair Forbes, Kadri Tamme, Romaric Loffroy, Inès Lakbar, Alan Biloslavo, Juan Antonio Celi de la Torre, Dimitrios Damaskos, Sara L. Zettervall, Sameh Hany Emile, Kaspar Felix Bachmann, Dumitru Casian, Lorenzo Garzelli, Diego Visconti, Martin Björck, Klaus Stahl, Beat Schnüriger, Paul Calame, Tim Vanuytsel, Francesca Rigiroli, Annika Reintam Blaser, Diane Mège, Maxime Ronot, Ville J. Sallinen, Loris Pironi, Alexandre Nuzzo, Joel Starkopf, Martin Padar, Toru Takiguchi, Jussi M. Kärkkäinen, Miklosh Bala, Walter L. Biffl, Wenhan Wu, Benjamin R. Hess
article en

Abstract

Acute mesenteric ischaemia (AMI) is a life-threatening emergency with in-hospital mortality of 49–64% across recent cohort studies. Terminology and nomenclature for acute ischaemia of the gastrointestinal tract remain inconsistent across disciplines and geographies, hindering clinical communication, registry design, and research comparability. This project aimed to develop consensus definitions and clinical algorithms for AMI; the present paper addresses definitions and nomenclature, and the companion paper the algorithms. A seven-member steering committee representing intensive care, vascular surgery, general surgery, interventional radiology, and gastroenterology conducted a literature review (2020–2025) and drafted candidate definition statements. An international panel of 50 experts from 15 countries underwent a modified Delphi process comprising two electronic voting rounds (9-point GRADE scale; predefined consensus threshold: ≥75% rated 7–9 and ≤ 15% rated 1–3) via REDCap, followed by two virtual consensus meetings with live polling. Where clinical equipoise existed, competing statements were presented for independent rating. Fifty panellists completed Round 1 (22 statements) and 44 completed Round 2 (27 statements; retention 88%). Ten statements reached the predefined electronic consensus threshold, including a core AMI definition (100%), mechanism classification (100%), and subtype definitions for arterial occlusive AMI (91%), venous AMI (84%), and non-occlusive mesenteric ischaemia (NOMI; 86%). The consensus meetings adopted a novel two-tier nomenclature: Acute GastroIntestinal Ischaemia (AGII) as the umbrella term for acute ischaemia of the gastrointestinal tract, and AMI as the subset to which the clinical algorithms apply. ‘Ischaemic colitis’ was declared a misnomer (92%). The arterial territory question (superior mesenteric artery (SMA) only versus a broader mesenteric territory) was not resolved and is presented as a dual-interpretation framework. Subgroup analysis revealed a specialty-driven divergence: general (73%, n = 11) and vascular surgeons (67%, n = 9) favoured restricting AMI to the SMA distribution, whereas intensivists favoured the whole gastrointestinal tract (80%, n = 10). This international, multidisciplinary Delphi study provides consensus definitions of AMI and its subtypes and proposes AGII/AMI as a two-tier nomenclature to resolve longstanding territorial and terminological ambiguities. These definitions lay the foundation for the companion clinical algorithms and aim to provide a standardised framework for future research, clinical communication, and registry design.

World Journal of Emergency Surgery
University of Messina (IT), Uppsala University (SE), Lahey Hospital and Medical Center (US), University of Helsinki (FI), Inserm (FR), Mansoura University (EG), University of Massachusetts Chan Medical School (US), Lund University (SE), Hebrew University of Jerusalem (IL), University of Washington (US), Université Paris Cité (FR), Aix-Marseille Université (FR), Hôpital Beaujon (FR), Universitair Ziekenhuis Leuven (BE), Helsinki University Hospital (FI), University Hospital of Bern (CH), Turku University Hospital (FI), Tartu University Hospital (EE), University Hospital of Basel (CH), Edinburgh Royal Infirmary (GB), Medizinische Hochschule Hannover (DE), University of Bristol (GB), Sorbonne Université (FR), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Centre Hospitalier Universitaire de Besançon (FR), Mansoura University Hospital (EG), Centre Hospitalier Universitaire de Montpellier (FR), Ospedale di Cattinara (IT), Assistance Publique – Hôpitaux de Paris (FR), Hôpital Saint-Antoine (FR), Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT), Scripps Memorial Hospital (US), Cleveland Clinic Florida (US), University of Tokyo Hospital (JP), Institutul Medicina de Urgenta (MD), CHU Dijon Bourgogne (FR), Luzerner Kantonsspital (CH), Nicolae Testemițanu State University of Medicine and Pharmacy (MD), The Affiliated Yongchuan Hospital of Chongqing Medical University (CN), Centre de Recherche sur l'Inflammation (FR), Laboratoire de Recherche Vasculaire Translationnelle (FR), Hôpital Bichat-Claude-Bernard (FR), Amsterdam University Medical Centers (NL), Nippon Medical School Hospital (JP), Hôpital de la Timone (FR), Soins intégrés, Nanomédecine, IA & Ingénierie pour la Santé (FR), Université Bourgogne Europe (FR), Université Marie et Louis Pasteur (FR), Bristol NHS Foundation Trust (GB), University of Tartu (EE), University of Missouri (US), University of Brescia (IT), Nippon Medical School (JP), University of Bologna (IT)
Eesti Teadusagentuur
Good health and well-being
Openalex Percentile: Top 12%
Abdominal vascular conditions and treatments
DOIOpen Access PDFOpenAlex
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