gastrointestinal disorders
Acute Mesenteric Ischemia
Diagnosis of Acute Mesenteric Ischemia
Clinical diagnosis more important than diagnostic tests Mesenteric angiography or CT angiography if diagnosis unclear Early diagnosis of mesenteric ischemia is particularly important because mortality increases significantly once intestinal infarction has occurred ( Diagnosis reference ). Mesenteric ischemia must be considered in any patient Patients with clear peritoneal signs should proceed directly to the operating room for both diagnosis and treatment. For others, selective mesenteric angiography or CT angiography is the diagnostic procedure of choice. Magnetic resonance angiography can be used if there is a contraindication to standard IV contrast. Other imaging studies and serum markers can show abnormalities but lack sensitivity and specificity early in the course of the disease when diagnosis is most critical. Plain abdominal x-rays are useful mainly in ruling out other causes of pain (eg, perforated viscus), although portal venous gas or pneumatosis intestinalis may be seen late in the disease. These findings also appear on CT, which may also directly visualize vascular occlusion—more accurately on the venous side. Doppler ultrasonography can sometimes identify arterial occlusion, but sensitivity is low. MRI is very accurate in proximal vascular occlusion but is less accurate in distal vascular occlusion. Serum markers (eg, creatine kinase, lactate) rise with necrosis but are nonspecific findings that are seen later. 1.Bala M, Catena F, Kashuk J, et al: Acute mesenteric ischemia: Updated guidelines of the World Society of Emergency Surgery.World J Emerg Surg17(1):54, 2022. doi: 10.1186/s13017-022-00443-x 