Acute Mesenteric Ischemia Differential Diagnoses

  • Author: Chat V Dang, MD; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: May 19, 2011
 
 

Diagnostic Considerations

Because acute mesenteric ischemia (AMI) is a condition with an unclear initial presentation, serious morbidity, and a high mortality rate without proper treatment, clinical suspicion should remain high. Obtain early angiography if any suspicion of AMI exists. Subsequent treatment should be initiated as rapidly as possible. No patient in whom AMI is suspected should be discharged unless AMI can be ruled out.

Consider a diagnosis of AMI in all elderly patients with abdominal pain, especially if the pain is disproportionate to physical examination findings. Patients with atrial fibrillation, cardiovascular disease, or peripheral vascular disease, especially those with recent myocardial infarction, are at higher risk.

Other conditions to consider include the following:

  • Ovarian torsion
  • Small bowel obstruction
  • Volvulus of midgut
  • Splenic vein thrombosis

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Chat V Dang, MD  Clinical Professor of Emergency Medicine, Charles Drew University of Medicine and Science; Clinical Professor, Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Burt Cagir, MD, FACS  Assistant Professor of Surgery, State University of New York Upstate Medical University; Consulting Staff, Director of Surgical Research, Robert Packer Hospital; Associate Program Director, Department of Surgery, Guthrie Clinic

Burt Cagir, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, and Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

David L Morris, MD, PhD, FRACS  Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia

David L Morris, MD, PhD, FRACS is a member of the following medical societies: British Society of Gastroenterology

Disclosure: RFA Medical None Director; MRC Biotec None Director

Chief Editor

John Geibel, MD, DSc, MA  Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; ARdelyx Ownership interest Board membership

References

  1. Cokkinis AJ. Observations on the mesenteric circulation. J Anat. Jan 1930;64:200-205. [Medline].

  2. Kozuch PL, Brandt LJ. Review article: diagnosis and management of mesenteric ischaemia with an emphasis on pharmacotherapy. Aliment Pharmacol Ther. Feb 1 2005;21(3):201-15. [Medline].

  3. Rosenblum JD, Boyle CM, Schwartz LB. The mesenteric circulation. Anatomy and physiology. Surg Clin North Am. Apr 1997;77(2):289-306. [Medline].

  4. Leung DA, Schneider E, Kubik-Huch R, Marincek B, Pfammatter T. Acute mesenteric ischemia caused by spontaneous isolated dissection of the superior mesenteric artery: treatment by percutaneous stent placement. Eur Radiol. 2000;10(12):1916-9. [Medline].

  5. Miyamoto N, Sakurai Y, Hirokami M, Takahashi K, Nishimori H, Tsuji K, et al. Endovascular stent placement for isolated spontaneous dissection of the superior mesenteric artery: report of a case. Radiat Med. Nov 2005;23(7):520-4. [Medline].

  6. Ko GJ, Han KJ, Han SG, Hwang SY, Choi CH, Gham CW, et al. [A case of spontaneous dissection of the superior mesenteric artery treated by percutaneous stent placement]. Korean J Gastroenterol. Feb 2006;47(2):168-72. [Medline].

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  9. Acosta S, Nilsson TK, Bjorck M. Preliminary study of D-dimer as a possible marker of acute bowel ischaemia. Br J Surg. Mar 2001;88(3):385-8. [Medline].

  10. Altinyollar H, Boyabatli M, Berberoglu U. D-dimer as a marker for early diagnosis of acute mesenteric ischemia. Thromb Res. 2006;117(4):463-7. [Medline].

  11. Herbert GS, Steele SR. Acute and chronic mesenteric ischemia. Surg Clin North Am. Oct 2007;87(5):1115-34, ix. [Medline].

  12. Hladík P, Raupach J, Lojík M, Krajina A, Voboril Z, Jon B, et al. Treatment of acute mesenteric thrombosis/ischemia by transcatheter thromboaspiration. Surgery. Jan 2005;137(1):122-3. [Medline].

  13. Hansen KJ, Deitch JS. Transaortic mesenteric endarterectomy. Surg Clin North Am. Apr 1997;77(2):397-407. [Medline].

 
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Pneumatosis intestinalis (black stripes of air) in advanced acute mesenteric ischemia (AMI) with gangrenous bowel.
CT scan (with contrast) of nonocclusive mesenteric ischemia with resulting bowel wall edema (arrows).
 
 
 
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