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Multidetector computed tomography of mesenteric ischaemia.

Andreu F Costa1, Vijay Chidambaram, Jonghun J Lee

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Mesenteric ischaemia, a condition of inadequate bowel blood supply, is difficult to diagnose. Multidetector computed tomography (MDCT) angiography is crucial for early detection and management of both acute and chronic mesenteric ischaemia.

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Area of Science:

  • Gastroenterology
  • Vascular Surgery
  • Radiology

Background:

  • Mesenteric ischaemia involves inadequate blood supply to the bowel, presenting variably and often nonspecifically.
  • Acute mesenteric ischaemia is a surgical emergency with high morbidity and mortality.
  • Causes range from embolic/thrombotic superior mesenteric artery occlusion to generalized atherosclerotic disease.

Purpose of the Study:

  • To review clinical features and etiologies of mesenteric ischaemia.
  • To illustrate imaging manifestations of mesenteric ischaemia on MDCT.
  • To emphasize the role of MDCT in diagnosis and management.

Main Methods:

  • Review of clinical features and etiologies.
  • Illustration of imaging findings on multidetector computed tomography (MDCT) angiography.
  • Discussion of MDCT's utility in diagnosis and complication identification.

Main Results:

  • MDCT angiography is the preferred imaging test for acute and chronic mesenteric ischaemia.
  • MDCT aids in prompt, precise diagnosis, cause identification, and complication detection.
  • Key bowel findings on MDCT include wall thickening, abnormal enhancement, pneumatosis, and luminal dilation.

Conclusions:

  • Mesenteric ischaemia is challenging to diagnose, necessitating high clinical and radiologic suspicion.
  • MDCT is the first-line imaging modality for suspected mesenteric ischaemia.
  • MDCT can reveal vascular occlusion, portomesenteric venous gas, mesenteric congestion, and free air, guiding patient management.