Diagnosis

Acute mesenteric ischemia

Etiology

Cause [1tg]

• Hypotension

• Arterial occlusion (emboli, thrombosis, vasospasm)

• Venous obstruction (trombosis, segmental strangulation)

Pathophysiology [fnm]

1. Intestinal atherosclerosis, cardiac arrhythmia, congestive heart failure, myocardial infarction, cardiomyopathy, ventricular aneurysm

2. Thrombus formation

3. Localized thrombosis or cardiogenic emboli to the superior mesenteric artery (SMA)

4. Intestinal hypoxemia --> irreversible injury (necrosis)

Risk factors

• Age

• Atherosclerosis

• Heart failure, arrhythmia, valvular disease, myocardial infarction

• Intra-abdominal cancer

• Thrombophilia

Complications [fnm]

• Gastrointestinal necrosis

• Sepsis

• Death (mortality 60%)

Epidemiology

Incidence per 100.000 [biy][pmi]

Approach

• Blood test

• Blood gas

• CT abdomen

• Mesentric angiography

Treatment

1. If no suspicion of bowel necrosis: [1tg]

   • Emboli -> endovascular aspiration

   • Atheroslerotic thrombosis -> endovascular stenting

2. If suspicion of bowel necrosis:

   • Laparotomy

   • Emboli -> Endovascular or open embolectomy

   • Atheroslerotic thrombosis -> endovascular stenting or open bypass

   • Damage control bowel resection

   • Surveillance and second look

Differential diagnoses

Abdominal abscess, Acute intermittent porphyria, Acute pancreatitis, Aortic dissection, Appendicitis, Biliary obstruction, Boerhaave syndrome, Cholangitis, Cholecystitis, Choledocholithiasis, Cholelithiasis, Chronic mesenteric ischemia, Colorectal cancer, Diverticulitis, Esophageal perforation, Gastric volvulus, Gastrointestinal obstruction, Myocardial infarction, Ovarian torsion, Perforated ulcer, Pneumonia, Pneumothorax, Pyelonephritis, Ruptured aortic aneurysm, Ruptured ectopic pregnancy, Sepsis, Splenic vein thrombosis, Testicular torsion, Volvulus