Vishal Garg, MS

 Key points  1. Mesenteric ischemia requires a high index of suspicion, and prompt surgical intervention is indicated to improve mortality.  2. Revascularization should be performed early, with only frankly necrotic or perforated bowel resected.  3. Open revascularization approaches remain the gold standard for the treatment of acute mesenteric ischemia, while endovascular approaches have gained favor for chronic disease. Retrograde open mesenteric stenting (ROMS) Ref: Advances in Surgery 55 (2021) 75–87

  Most important metabolic consequences of short bowel syndrome: Sodium and fluid depletion Hypocalcemia Hypomagnesemia Normal anion gap metabolic acidosis (GI bicarbonate losses) Elevated anion gap metabolic acidosis (D-lactic acidosis -- see below) Hyperoxaluria Take-home point: D lactic acidosis remains an underdiagnosed complication of short bowel syndrome. It presents as brain fogs and bloating after a carb meal. Keep D lactic acidosis in mind when dealing with HAGMA and normal "routine" lactic acid levels in those pts.