December 2, 2020

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:

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)

Cite this article as: Anand Swaminathan, "REBEL Core Cast 45.0 – Mesenteric Ischemia", REBEL EM blog, December 2, 2020. Available at: https://rebelem.com/rebel-core-cast-45-0-mesenteric-ischemia/.
The following two tabs change content below.

Anand Swaminathan

Clinical Assistant Professor of Emergency Medicine at St. Joe's Regional Medical Center (Paterson, NJ)
REBEL EM Associate Editor and Author
No Comments

Post A Comment

Time limit is exhausted. Please reload CAPTCHA.

0