Acute mesenteric ischaemia: a pictorial review

Area of Science:

• Radiology
• Gastroenterology
• Vascular Surgery

Background:

• Acute mesenteric ischaemia (AMI) is a critical condition with high mortality, particularly in the elderly.
• Delayed diagnosis of AMI often results in irreversible intestinal necrosis and increased mortality rates.
• AMI requires prompt recognition and intervention to prevent catastrophic outcomes.

Purpose of the Study:

• To provide a comprehensive overview of mesenteric perfusion anatomy and physiology.
• To discuss the causes, pathogenesis, and CT imaging findings of various acute bowel ischaemia types.
• To emphasize the importance of recognizing imaging features for timely AMI diagnosis and improved patient outcomes.

Main Methods:

• Review of literature on mesenteric ischaemia.
• Discussion of anatomical and physiological aspects of mesenteric blood flow.
• Analysis of CT findings associated with different forms of acute bowel ischaemia.

Main Results:

• Arterial inflow occlusion (thrombosis or embolisation) is the most frequent cause of AMI.
• Four etiological types of AMI (EAMI, TAMI, VAMI, NOMI) present with distinct characteristics and risk factors.
• Clinical and laboratory findings lack sensitivity and specificity for AMI diagnosis, making MDCT the primary imaging modality.

Conclusions:

• Early recognition, accurate diagnosis, and timely intervention are paramount for improving patient prognosis in AMI.
• Multidetector CT (MDCT) is the first-line imaging method for suspected AMI, despite nonspecific findings.
• While prognostic scoring systems exist, they require further validation in large-scale studies.