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Updated: Jun 22, 2026

Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
[A rare differential diagnosis of acute abdominal pain--case 04/2009]
Michael Haap1, Ferruh Artunc, Christian S Haas
1Medizinische Universitätsklinik Tübingen, Abteilung für Endokrinologie, Diabetes, Nephrologie, Angiologie und Klinische Chemie, Tübingen, Germany.
History And Findings:
A 44-year-old woman was referred to the emergency department for acute paraumbilical abdominal pain with colics. 5 days previously, a tooth extraction had been performed and postoperatively ibuprofen had been prescribed for pain relief. The medical history was empty besides a penicillin allergy and two caesarean sections 20 and 21 years ago.
Investigations:
The physical examination revealed paraumbilical pain on palpation. Abdominal ultrasound could identify some free fluid and an aperistaltic intestinal loop as well as an echo-rich structure in the hypogastric region. An abdominal CT scan showed a hypodense tubular structure of 6.5 x 3.3 cm indicating a possible ischaemic intestinal segment, and a dilated intestinal loop as well as an uterus myomatosis. Due to therapy refractory symptoms and increasing leucocytes on the second day after admission, a diagnostic laparoscopy was performed.
Diagnosis:
Intraoperatively, a volvulus of the ileum as well as an adhesive strangulation of the small intestine could be identified.
Treatment And Course:
Consecutively, surgery with an ileocoecal resection and a side-to-side ileotransversostomy was performed. Within a few days, the patient recovered completely and resumed normal activities of daily living.
Conclusions:
In the evaluation of unclear acute abdominal pain, interdisciplinary cooperation is very important to ensure a fast and appropriate diagnosis and therapy as shown in our case.
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