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Updated: Aug 17, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Diagnosis and outcome from suspected mesenteric ischaemia following cardiac surgery
M Edwards1, D Sidebotham, M Smith
1Green Lane Hospital, Green Lane West, Epsom, Auckland, New Zealand.
Insights
Mesenteric ischemia in cardiothoracic ICU patients has a 76% mortality rate. Clinical tests and X-rays are unreliable for diagnosis, making early laparotomy crucial for suspected cases.
Area of Science:
- Cardiology
- Gastroenterology
- Critical Care Medicine
Background:
- Mesenteric ischemia is a critical condition often presenting in post-cardiothoracic intensive care unit (ICU) patients.
- Accurate and timely diagnosis of mesenteric ischemia is challenging in this complex patient population.
Purpose of the Study:
- To compare clinical and diagnostic features of suspected mesenteric ischemia in cardiothoracic ICU patients.
- To evaluate the diagnostic utility of clinical, biochemical, hematological tests, and plain abdominal radiography.
Main Methods:
- Retrospective chart review of 3024 cardiothoracic ICU admissions over three years.
- Analysis of 26 laparotomies for suspected mesenteric ischemia, with 15 confirmed cases.
- Comparison of diagnostic test performance for mesenteric ischemia.
Main Results:
- Overall incidence of mesenteric ischemia was 0.6% (17/3024), with a high mortality rate of 76% (13/17).
- No single clinical, biochemical, or hematological test reliably differentiated mesenteric ischemia.
- Plain abdominal radiography showed limited diagnostic value (sensitivity 54%, specificity 100%).
Conclusions:
- Routine investigations and radiography are insufficient for diagnosing mesenteric ischemia in suspected cases.
- Early surgical intervention (laparotomy) is recommended, as further diagnostic delays can be detrimental.
- Mesenteric ischemia represents a high-mortality condition in cardiothoracic ICU patients, necessitating prompt management.
Abstract:
A three-year retrospective chart review was undertaken of all post-cardiothoracic ICU patients who underwent laparotomy for suspected mesenteric ischaemia, or who had the diagnosis confirmed at post mortem. The aim was to compare the clinical and diagnostic characteristics of cardiothoracic patients with suspected mesenteric ischaemia with patients who had a confirmed diagnosis. There were 3024 admissions to the cardiothoracic ICU over the three-year period. Twenty-six laparotomies were performed for suspected mesenteric ischaemia and 15 were positive for mesenteric ischaemia. The overall incidence of mesenteric ischaemia was 17/3024 (0.6%). Mortality for patients with mesenteric ischaemia was 13/17 (76%). Ischaemia was limited to a single segment of bowel in the four survivors. Mortality in patients who had a negative laparotomy for suspected mesenteric ischaemia was 7/11 (64%), attributable to cardiovascular failure (2/11) and multi-organ dysfunction syndrome (5/11). No clinical, biochemical or haematological test was discriminatory for mesenteric ischaemia. In patients with proven ischaemia, 7/13 plain abdominal radiographs were positive for ischaemia and 7/7 radiographs were negative for ischaemia in patients with no ischaemia (P = 0.05, PPV 1.0, NPV 0.5, sensitivity 54%, specificity 100%). Neither routine clinical investigations nor plain abdominal radiography reliably diagnose mesenteric ischaemia when the diagnosis is suspected clinically. Early laparotomy is recommended in these patients and further investigation may delay this procedure unnecessarily. The presence of mesenteric ischaemia identifies a cohort of patients with high mortality.
