High risk and low prevalence diseases: Mesenteric ischemia

Kevin Molyneux, Jennifer Beck-Esmay, Alex Koyfman, Brit Long

Research output: Contribution to journalReview articlepeer-review

Abstract

Introduction: Mesenteric ischemia is a rare, frequently misdiagnosed, serious condition that carries with it a high rate of morbidity and mortality. Objective: This review highlights the pearls and pitfalls of mesenteric ischemia, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. Discussion: Mesenteric ischemia is an abdominal vascular emergency that includes superior mesenteric arterial embolism, arterial thrombosis, venous mesenteric ischemia, and non-occlusive mesenteric ischemia. It is associated with a variety of risk factors including older age, cardiovascular disease, hypercoagulable state, and end-stage renal disease. The presentation depends on the underlying pathophysiology. While arterial embolic disease may present with sudden, severe pain, the early stages of the disease and other forms can present with vague symptoms, including generalized abdominal pain, weight loss, vomiting, and diarrhea. Laboratory testing can suggest the disease with leukocytosis and elevated lactate, but normal values should not be used to exclude the diagnosis. The imaging modality of choice is triple phase computed tomography with non-contrast, arterial, and delayed phases. The initial ED management includes fluid resuscitation, symptomatic therapy, broad-spectrum antibiotics, and anticoagulation. Emergent consultation with a multidisciplinary team including diagnostic and interventional radiologists and cardiovascular and general surgeons is necessary for definitive treatment. Conclusions: An understanding of mesenteric ischemia can assist emergency clinicians in diagnosing and managing this disease.

Original languageEnglish (US)
Pages (from-to)154-161
Number of pages8
JournalAmerican Journal of Emergency Medicine
Volume65
DOIs
StatePublished - Mar 2023

Keywords

  • Gastroenterology
  • Gastrointestinal
  • Mesenteric ischemia
  • Vascular

ASJC Scopus subject areas

  • Emergency Medicine

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