From the Guidelines
Mesenteric ischemia typically presents with severe abdominal pain that is out of proportion to physical examination findings, often accompanied by nausea, vomiting, and urgent bowel movements. The condition can be acute or chronic, with acute mesenteric ischemia being a vascular emergency that requires prompt medical attention to prevent high mortality rates 1. Key signs and symptoms of mesenteric ischemia include:
- Severe abdominal pain that is sudden and intense
- Nausea and vomiting
- Urgent bowel movements
- Abdominal distension
- Decreased bowel sounds
- Tenderness without significant guarding initially
- Later signs of peritonitis with rebound tenderness and guarding as intestinal infarction occurs
- Systemic manifestations such as fever, tachycardia, hypotension, and metabolic acidosis, particularly in advanced cases 1. Risk factors for mesenteric ischemia include advanced age, cardiovascular disease, atrial fibrillation, and recent cardiac surgery 1. It is essential to recognize these signs and symptoms promptly, as delayed treatment can lead to life-threatening bowel infarction with associated mortality rates that approach 60% 1. Imaging evaluation, such as CT of the abdomen and pelvis, is crucial in diagnosing mesenteric ischemia and identifying the underlying cause of ischemia 1.
From the Research
Signs and Symptoms of Mesenteric Ischemia
The signs and symptoms of mesenteric ischemia can be varied and non-specific, making diagnosis challenging. Some common signs and symptoms include:
- Pain out of proportion to physical examination findings 2
- Gut emptying 2
- Minimal tenderness early in the course of the disease, with peritoneal findings and tenderness to palpation occurring later 2
- Weight loss, particularly in chronic mesenteric ischemia 3
- Nausea, vomiting, diarrhea, and/or constipation 3
- Postprandial pain, which is classically present in the majority of cases of chronic mesenteric ischemia 3
- Signs of malnutrition on physical examination 3
Diagnostic Challenges
No single history or physical examination finding can definitively diagnose mesenteric ischemia 2. The condition often presents with vague or variable symptoms, and there is no pathognomonic laboratory screening test 4. Computed tomography angiography (CTA) is the best imaging modality for diagnosing mesenteric ischemia 2, 4.
Laboratory and Imaging Findings
Some laboratory and imaging findings that may be associated with mesenteric ischemia include:
- Elevated l-lactate levels, with a pooled sensitivity of 86% and a pooled specificity of 44% 4
- Elevated D-dimer levels, with a pooled sensitivity of 96% and a pooled specificity of 40% 4
- Computed tomography (CT) with a pooled sensitivity of 94% and specificity of 95% 4
- CT angiography, which can establish the diagnosis of acute mesenteric ischemia in lieu of laparotomy 4