Document Type

Poster

Version Deposited

None (link only)

Publication Date

3-2025

Conference Name

2025 Camden Scholar's Forum

DOI

10.31986/issn.2689-0690_rdw.cmsru_fac_pub.1064

Abstract

Introduction: Acute mesenteric ischemia (AMI) is a life-threatening condition caused by inadequate blood flow to the intestines. Although it is uncommon, AMI has a high mortality rate of 60-80%, emphasizing the need for early diagnosis and treatment. Computed tomography angiography (CTA) is the preferred imaging modality for assessing vascular occlusion and bowel abnormalities. However, many CT findings associated with bowel ischemia lack specificity, making it crucial for clinicians to recognize key radiologic signs for timely diagnosis and optimal outcomes.

Case Description: A 71-year-old male with a history of alcohol use and gastroesophageal reflux disease presented to critical care with acute onset of progressive nausea, vomiting, and severe abdominal pain. CTA revealed an occlusive thrombus in the superior mesenteric artery (SMA) with complete loss of distal arterial flow. Bowel loops supplied by the SMA were mildly edematous, mottled, and hypo- enhancing, consistent with ischemia. The patient underwent open SMA thrombectomy with primary repair of SMA. Bowel resection was unnecessary as vascular supply was restored and bowel function returned to normal. Postoperative course has been complicated by recurrent fevers, retroperitoneal hematoma, and worsening lactic acidosis.

Discussion: AMI classically presents with nausea, vomiting, bloating, diarrhea, and pain disproportionate to exam findings, warranting urgent imaging. Persistent vascular occlusion leads to bowel ischemia, infarction, and progressive bowel wall changes, including pneumatosis, perforation, portal venous gas, mesenteric edema, and ascites. Absence of focal bowel wall enhancement and presence of pneumatosis intestinalis have a sensitivity of 42% and specificity of 97-100%, while bowel wall thickening and mesenteric stranding show 85-88% sensitivity and 61-72% specificity. CTs are crucial for diagnosing AMI, but imaging features can vary depending on the time course and etiology. Treatment is generally surgical, with bowel viability assessed and necrotic tissue resected. Endovascular thrombolysis/thrombectomy may also be performed, as in this case. Physicians should maintain a high index of suspicion for the diagnosis given the high mortality rates.

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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