Is Acute Mesenteric Ischemia Common in Adolescents?
No, acute mesenteric ischemia (AMI) is extremely rare in adolescents and is predominantly a disease of older adults, with incidence increasing exponentially with age. 1, 2
Epidemiology and Age Distribution
AMI has an extremely low overall incidence of 0.09–0.2% of all acute surgical admissions in the general population, and this already rare condition becomes even more uncommon in younger age groups. 1
The disease burden increases dramatically with advancing age:
- The incidence in an 80-year-old patient is approximately tenfold that of a 60-year-old patient 1, 2
- In patients aged 75 years or older, AMI is actually a more prevalent cause of acute abdomen than appendicitis 1, 2
- The general population incidence is only 1 per 100,000 per year 2
Why AMI is Rare in Adolescents
Adolescents typically lack the predisposing risk factors that drive AMI in older adults:
Arterial Embolism Risk Factors (50% of AMI cases):
- Atrial fibrillation (present in nearly 50% of embolic AMI cases) 1, 2
- Cardiac thrombi, mitral valve disease, left ventricular aneurysm 2
- Recent myocardial infarction 2
Arterial Thrombosis Risk Factors (40% of cases, increasing):
- Diffuse atherosclerotic disease 1, 2
- History of chronic postprandial abdominal pain and progressive weight loss 1, 2
Non-Occlusive Mesenteric Ischemia (NOMI) Risk Factors (25% of cases):
- Heart failure with poor cardiac output 1, 3
- Critically ill ICU patients requiring vasopressor support 3
- Cardiac surgery using cardiopulmonary bypass 1, 3
- Renal failure and hemodialysis 1, 3
Mesenteric Venous Thrombosis Risk Factors (5-15% of cases):
- In young patients, 36% of MVT occurs without an obvious cause, but this still represents a small fraction of an already rare disease 1
- Inherited thrombophilias (Factor V Leiden, prothrombin mutation, protein deficiencies) 1
- Oral contraceptives, malignancies, inflammatory bowel disease 1, 2
Clinical Caveat for Adolescents
While AMI is exceedingly rare in adolescents, it should not be completely dismissed if specific high-risk conditions are present:
- Inherited hypercoagulable states 1
- Recent abdominal surgery (splenectomy, bariatric surgery) 1
- Severe trauma or critical illness requiring vasopressor support 3
- Oral contraceptive use in young women 1, 2
- Inflammatory bowel disease 1
The key pitfall is that the rarity of AMI in this age group can lead to delayed diagnosis if it does occur, which is catastrophic given the 50-80% mortality rate if untreated. 4 However, the pretest probability remains extremely low in adolescents without these specific risk factors. 2