Acute mesenteric ischaemia and unexpected death

Area of Science:

• Vascular Surgery
• Gastroenterology
• Pathology

Background:

• Acute mesenteric ischemia (AMI) is a critical vascular emergency characterized by compromised intestinal blood flow, leading to tissue necrosis.
• It disproportionately affects the elderly, presenting significant morbidity and mortality.
• Causes include arterial thromboembolism, venous thrombosis, and nonocclusive mesenteric ischemia due to splanchnic vasoconstriction.

Purpose of the Study:

• To review the clinical and pathological features of acute mesenteric ischemia.
• To discuss predisposing conditions and diagnostic challenges.
• To highlight autopsy findings and considerations for inherited thrombophilias and toxicology.

Main Methods:

• Review of clinical and pathological features of acute mesenteric ischemia.
• Discussion of predisposing conditions.
• Emphasis on autopsy protocols, including mesenteric vasculature dissection, histologic sampling, and examination of other organs for thrombi.
• Consideration of inherited thrombophilia testing and toxicological evaluation.

Main Results:

• Acute mesenteric ischemia leads to reperfusion injury, intestinal mucosal barrier breakdown, metabolic derangements, sepsis, and multiorgan failure.
• Diagnosis can be clinically challenging, with increasing incidence due to an aging population.
• Autopsy findings require careful mesenteric vasculature dissection and histologic sampling; nonocclusive mesenteric ischemia may be difficult to diagnose due to post-mortem changes.

Conclusions:

• Acute mesenteric ischemia is a complex vascular emergency with high mortality, often challenging to diagnose clinically and pathologically.
• Comprehensive autopsy evaluation, including specific sampling and consideration of thrombophilias and toxicology, is crucial.
• Increased awareness and diagnostic vigilance are necessary given the rising incidence in an aging demographic.