Mesenteric Ischemia
The often quoted “Time is bowel” is a sentiment that speaks to the danger of this disease and need for diagnosis - Brit Long MD & Alex Koyfman
image by: Hesham Wageh
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Mesenteric Ischemia: Pearls and Pitfalls
Pearls and Pitfalls
- Mesenteric ischemia is a time-sensitive diagnosis that, if missed, can lead to bowel necrosis, organ failure, and death.
- The signs and symptoms of mesenteric ischemia are vague with "pain out of proportion to exam" being the classic presentation.
- The mortality rate for mesenteric ischemia remains high despite new diagnostic testing.
- The four causes of mesenteric ischemia are mesenteric artery embolism (commonly due to atrial fibrillation), mesenteric artery thrombosis (commonly due to atherosclerosis), mesenteric vein thrombosis (commonly due to hypercoagulability) and non-occlusive mesenteric ischemia…
Resources
The Dangerous Miss: Recognizing Acute Mesenteric Ischemia
80% of acute mesenteric ischemia cases result in mortality because of missed diagnosis.
Acute Mesenteric Ischemia A Clinical Review
Acute mesenteric ischemia is a life-threatening vascular emergency that requires early diagnosis and intervention to adequately restore mesenteric blood flow and to prevent bowel necrosis and patient death. The underlying cause is varied, and the prognosis depends on the precise pathologic findings.
Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery
Acute mesenteric ischemia (AMI) is typically defined as a group of diseases characterized by an interruption of the blood supply to varying portions of the small intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process will eventuate in life threatening intestinal necrosis. The incidence is low, estimated at 0.09–0.2% of all acute surgical admissions. Therefore, although the entity is an uncommon cause of abdominal pain, diligence is always required./
Mesenteric ischemia: what the radiologist needs to know
Diagnosis is challenging secondary to the rarity of the disease, its nonspecific clinical presentation, and often subtle or non-specific imaging findings. Consequently, a high index of suspicion on the part of the clinician and the radiologist, as well as familiarity with the spectrum of imaging findings associated with mesenteric ischemia, is required to ensure prompt recognition of the disease.
Mesenteric Ischemia: Pearls and Pitfalls
In spite of all our technological advances in medicine, mesenteric ischemia remains a very difficult disease process to identify early. Often patients will present with vague and variable signs and symptoms such as poorly localized abdominal pain, nausea, vomiting, and diarrhea. These non-specific signs and symptoms can be associated with an extremely wide variety of abdominal pathologies including, but not limited to, abdominal aortic aneurysm, volvulus, perforated viscus, incarcerated hernia, appendicitis, biliary colic, and renal colic.
Society for Vascular Surgery
Mesenteric ischemia can come on suddenly or build slowly and become an ongoing health issue. It is part of a systemic disease process known as peripheral vascular disease or peripheral artery disease (PAD).
Acute Mesenteric Ischemia: a Vascular Emergency
This consensus paper was written with the participation of physicians from all of the involved specialties for the purpose of improving outcomes. Mesenteric ischemia must be recognized as a vascular emergency requiring rapid and efficient clinical evaluation and treatment.
Mayo Clinic
Sudden loss of blood flow to the small intestine (acute mesenteric ischemia) from a blood clot requires immediate surgery. Mesenteric ischemia that develops over time (chronic) is treated with angioplasty or open surgery.
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