High risk and low prevalence diseases: Mesenteric ischemia

Area of Science:

• Vascular Surgery
• Emergency Medicine
• Radiology

Background:

• Mesenteric ischemia is a rare but critical condition with high morbidity and mortality.
• It encompasses arterial embolism, thrombosis, venous, and non-occlusive forms, often affecting older individuals with comorbidities.

Purpose of the Study:

• To review the key aspects of mesenteric ischemia, focusing on emergency department presentation, diagnosis, and management.
• To highlight diagnostic and therapeutic challenges and evidence-based strategies for clinicians.

Main Methods:

• This review synthesizes current evidence on mesenteric ischemia.
• It covers clinical presentation, risk factors, diagnostic imaging, and initial emergency department interventions.

Main Results:

• Mesenteric ischemia presents variably, from sudden severe pain to vague symptoms like abdominal pain and weight loss.
• Laboratory tests (leukocytosis, elevated lactate) can be suggestive but not diagnostic; triple-phase CT is the imaging modality of choice.
• Initial management involves resuscitation, symptomatic care, antibiotics, and anticoagulation, necessitating multidisciplinary consultation.

Conclusions:

• Accurate diagnosis and timely management of mesenteric ischemia in the emergency department are vital.
• Understanding the nuances of this condition improves clinician ability to diagnose and manage effectively, potentially reducing mortality.