Take Home Points
- Be sure to consider mesenteric ischemia in any elderly patient with abdominal pain or lower gastrointestinal (GI) complaints. Remember, the presentation can be tricky to find and they may have a reassuring abdominal exam.
- Ask about artherosclerotic risk factors, history of cardiovascular disease including atrial fibrillation and prior embolic events, and a history of intestinal angina to help clue you in to the diagnosis.
- Lab abnormalities could include leukocytosis, lactemia or elevated d-dimer. But normal labs cannot exclude this disease.
- The money is in the CTA. Get it as fast as possible because time is bowel.
- Consult your surgeons and interventional radiologists eary, because again TIME IS BOWEL
REBEL Core Cast 45.0 – Mesenteric Ischemia
For More on This Topic Checkout:
References:
- Cudnik MT et al. The diagnosis of acute mesenteric ischemia: A systematic review and meta-analysis. Acad Emerg Med. 2013. PMID: 24238311.
- Kärkkäinen JM et al. Acute mesenteric ischemia (part I) – Incidence, etiologies, and how to improve early diagnosis. Best Pract Res Clin Gastroenterol 2017. PMID: 28395784.
- Kärkkäinen JM et al. Acute Mesenteric Ischemia Is a More Common Cause than Expected of Acute Abdomen in the Elderly. J Gastrointest Surg 2015. PMID: 25917534.
- Martinez J. Mesenteric Ischemia. In: Mattu A and Swadron S, ed. CorePendium. Burbank, CA: CorePendium, LLC. Updated August 7, 2020. Accessed October 11, 2020.
- Tilsed JV et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg 2016. PMID: 26820988.
- Wadman M et al. Survival after operations for ischaemic bowel disease. Eur J Surg 2000. PMID: 11097154.
Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)
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