Color Duplex evaluation of the mesenteric artery()

Area of Science:

• Vascular Imaging
• Gastroenterology
• Medical Diagnostics

Background:

• Ischemic colitis, the most common intestinal ischemia, is often diagnosed via clinical examination, endoscopy, and vascular imaging.
• Color Doppler ultrasound (CDUS) shows promise as a primary imaging modality for mesenteric circulation assessment.

Purpose of the Study:

• To highlight the utility of CDUS in diagnosing ischemic colitis.
• To present a case demonstrating CDUS effectiveness in identifying mesenteric artery stenosis missed by other imaging.

Main Methods:

• Case report of an 80-year-old woman with recurrent ischemic colitis.
• Initial diagnosis aided by CDUS showing inferior mesenteric artery (IMA) stenosis, later contradicted by CT angiography.
• Diagnosis confirmed by rectosigmoidoscopy and angiography, followed by percutaneous transluminal angioplasty (PTA) of the IMA.

Main Results:

• CDUS initially detected significant IMA stenosis, which was crucial for subsequent diagnosis and treatment.
• CT angiography initially missed the stenosis, leading to a misdiagnosis.
• Post-PTA, IMA patency was restored, and endoscopic evaluation confirmed resolution of colonic ischemia.

Conclusions:

• CDUS is a reliable first-line technique for evaluating mesenteric arterial circulation in ischemic intestinal lesions.
• CDUS can detect hemodynamic stenosis missed by CT or MR angiography.
• Arteriography remains essential for discrepancies and potential endovascular revascularization.