Related Experiment Video
Updated: Aug 14, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
High risk and low prevalence diseases: Mesenteric ischemia
Kevin Molyneux1, Jennifer Beck-Esmay2, Alex Koyfman3
1Department of Emergency Medicine, Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032, USA.
Introduction:
Mesenteric ischemia is a rare, frequently misdiagnosed, serious condition that carries with it a high rate of morbidity and mortality.
Objective:
This review highlights the pearls and pitfalls of mesenteric ischemia, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.
Discussion:
Mesenteric ischemia is an abdominal vascular emergency that includes superior mesenteric arterial embolism, arterial thrombosis, venous mesenteric ischemia, and non-occlusive mesenteric ischemia. It is associated with a variety of risk factors including older age, cardiovascular disease, hypercoagulable state, and end-stage renal disease. The presentation depends on the underlying pathophysiology. While arterial embolic disease may present with sudden, severe pain, the early stages of the disease and other forms can present with vague symptoms, including generalized abdominal pain, weight loss, vomiting, and diarrhea. Laboratory testing can suggest the disease with leukocytosis and elevated lactate, but normal values should not be used to exclude the diagnosis. The imaging modality of choice is triple phase computed tomography with non-contrast, arterial, and delayed phases. The initial ED management includes fluid resuscitation, symptomatic therapy, broad-spectrum antibiotics, and anticoagulation. Emergent consultation with a multidisciplinary team including diagnostic and interventional radiologists and cardiovascular and general surgeons is necessary for definitive treatment.
Conclusions:
An understanding of mesenteric ischemia can assist emergency clinicians in diagnosing and managing this disease.
Insights
Mesenteric ischemia is a serious vascular emergency often misdiagnosed. Early recognition of symptoms and prompt management in the emergency department are crucial for improving patient outcomes and reducing mortality.
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.
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