REBEL Core Cast 45.0 – Mesenteric Ischemia

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:

• Mesenteric Ischemia: A Power Review – emDOCs.net – Emergency Medicine Education

References:

1. Cudnik MT et al. The diagnosis of acute mesenteric ischemia: A systematic review and meta-analysis. Acad Emerg Med. 2013. PMID: 24238311.
2. 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.
3. 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.
4. Martinez J. Mesenteric Ischemia. In: Mattu A and Swadron S, ed. CorePendium. Burbank, CA: CorePendium, LLC. Updated August 7, 2020. Accessed October 11, 2020.
5. Tilsed JV et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg 2016. PMID: 26820988.
6. 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)