Management of Acute Mesenteric Ischemia
Acute mesenteric ischemia is an uncommon diagnosis; however, this condition is associated with a high mortality rate because of a delay in diagnosis and treatment. Therefore the diagnosis should be in the differential when evaluating a patient with acute-onset abdominal pain. Patients are typically elderly with a sudden onset of abdominal pain out of proportion to the physical exam. Additional findings may include bloody diarrhea, fever, nausea, vomiting, and abdominal distention. The etiology of acute mesenteric ischemia is either embolic, thrombotic, non-occlusive mesenteric ischemia (NOMI) or mesenteric venous thrombosis. Embolization to the superior mesenteric artery (SMA) is the most common cause of acute mesenteric ischemia. Thrombosis of the SMA typically occurs at the origin of the vessel where dense atherosclerotic disease is present. NOMI typically presents during a low flow state that is secondary to shock or vasoconstrictors. Effective treatment for this condition includes early diagnosis with operative intervention using both open and endovascular techniques.
KeywordsAbdominal pain Embolic etiology Thrombotic etiology Non-occlusive mesenteric ischemia Second-look laparotomy
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