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Potentially life-threatening emergency
Acute mesenteric ischemia
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Potentially life-threatening emergency

Acute mesenteric ischemia

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Contributors: Michael W. Winter MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

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Synopsis

Acute mesenteric ischemia is the acute insufficiency of small bowel blood supply leading to bowel ischemia. It can progress to bowel perforation, severe sepsis, and death. Acute arterial obstruction is caused either by an embolism or thrombus in the setting of atherosclerosis. Hypoperfusion in the setting of severe hypotension or low flow states may also cause acute mesenteric insufficiency in the absence of occlusive disease.

Symptoms are characterized by acute onset of abdominal pain, often out of proportion to the examination. In critically ill patients who may not be able to communicate, worsening pressor requirements, rising lactates, and abdominal distension or feeding intolerance should raise suspicion for mesenteric ischemia. Risk is increased in patients with risk for thromboembolic cardiac disease: patients with diabetes, peripheral artery disease, history of hypertension, hyperlipidemia, and who smoke.

Acute mesenteric ischemia is a medical emergency. Prompt diagnosis and intervention are necessary to re-establish blood flow to the intestine. Morbidity and mortality increases with delayed revascularization.

Related topic: Chronic mesenteric ischemia

Codes

ICD10CM:
K55.9 – Vascular disorder of intestine, unspecified

SNOMEDCT:
91489000 – Acute vascular insufficiency of intestine

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 12/27/2017
Last Updated: 05/13/2019
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Potentially life-threatening emergency
Acute mesenteric ischemia
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Acute mesenteric ischemia : Nausea/vomiting, Diffuse abdominal pain, Metabolic acidosis, Pain out of proportion to exam findings, Periumbilical pain, WBC elevated
Imaging Studies image of Acute mesenteric ischemia
Enhanced CT scan of the abdomen showing low attenuation wall thickening throughout the small bowel with mesenteric edema and decrease in wall enhancement. These findings are consistent with diffuse extensive ischemia of the small bowel.

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