Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Acute Mesenteric Ischemia Workup

  • Author: Chat V Dang, MD; Chief Editor: John Geibel, MD, DSc, MSc, MA  more...
 
Updated: Dec 16, 2015
 

Approach Considerations

Various laboratory studies may be performed for suspected acute mesenteric ischemia (AMI), but in general, such studies will not establish the diagnosis. At most, they suggest the diagnosis; they do not exclude it. If serious suspicion of AMI exists, the clinician should order diagnostic imaging studies (eg, plain radiography, classic angiography, computed tomography [CT] angiography [CTA], magnetic resonance angiography [MRA], or ultrasonography) without waiting for laboratory results. Electrocardiography (ECG) and diagnostic peritoneal lavage may also be considered.

A review of 180 consecutive malpractice claims at a Veterans Affairs Medical Center over a 12-year period ending in 1998 revealed seven cases involving AMI. Failure to make a timely diagnosis was alleged in five cases, and failure to administer anticoagulation was alleged in one. The remaining allegation was failure to prevent nonocclusive mesenteric ischemia (NOMI). Legal risk is reduced with early surgical consultation and the ordering of CT contrast (CTA) as soon as AMI is noted in the differential diagnosis. (See also Mesenteric Ischemia Imaging.)

Next

Laboratory Studies

Laboratory findings in AMI are nonspecific and generally unreliable. No serum marker is sensitive or specific enough to establish or exclude the diagnosis of AMI. However, the following laboratory examinations should be ordered:

  • Prothrombin time (PT)
  • Activated partial thromboplastin time (aPTT)
  • International normalized ratio (INR)
  • Complete blood count (CBC), which may reveal leukocytosis (bandemia) or hemoconcentration
  • Chemistry studies that may show metabolic acidosis, increased amylase levels, or increased lactate dehydrogenase levels

The CBC may be within the reference range initially, but the white blood cell (WBC) count eventually rises as the disease progresses. Leukocytosis, a leftward shift, or both are observed in more than 50% of cases. The hematocrit is elevated initially from hemoconcentration due to third-spacing, but it decreases with gastrointestinal (GI) bleeding.

Metabolic acidosis is observed late in the disease course, but this is a nonspecific finding. Amylase levels are moderately elevated in more than 50% of patients, but this is also nonspecific. Lactate is elevated late in the clinical course. levels that are persistently within the reference normal range strongly indicate a diagnosis other than AMI (sensitivity 90-96%, specificity 60-87%).[57, 58, 59] Phosphate levels were initially thought to be sensitive, but later studies showed a sensitivity of only 25-33%.

If a hypercoagulable state is suggested, additional laboratory studies, such as tests for protein C and S deficiencies and antithrombin III deficiency, may be ordered. Testing for abnormalities in lupus anticoagulant, anticardiolipin antibody, and platelet aggregation may be considered.

Several studies have found that serum D-dimer may be used as an early marker for AMI, though it appears to be insensitive.[60, 61, 62, 63] Additional clinical experience will be required to validate the role of D-dimer in the screening and diagnosis of AMI.

Previous
Next

Plain Abdominal Radiography

Although plain abdominal films can yield a presumptive diagnosis in 20-30% of patients with AMI, they often appear normal in this setting and therefore should not be used to rule out AMI. However, plain abdominal films are warranted for excluding identifiable causes of abdominal pain, such as perforated viscus with free intraperitoneal air.

Positive findings on plain abdominal radiography are usually late and nonspecific and include ileus, small bowel obstruction, edematous or thickened bowel walls, and paucity of gas in the intestines. More specific signs, such as pneumatosis intestinalis (ie, submucosal gas), thumbprinting of the bowel wall, and portal vein gas are late findings (see the images below). In a study of 23 cases of bowel infarction, 30% of the patients demonstrated focally edematous bowel wall (thumbprinting) or pneumatosis intestinalis.

Pneumatosis intestinalis (black stripes of air) in Pneumatosis intestinalis (black stripes of air) in advanced acute mesenteric ischemia (AMI) with gangrenous bowel.
Pneumatosis intestinalis, one of few radiographic Pneumatosis intestinalis, one of few radiographic findings in patients with mesenteric ischemia.
Gas in colon wall (typical of advanced ischemia). Gas in colon wall (typical of advanced ischemia).
Thumbprinting of bowel, characteristic of mesenter Thumbprinting of bowel, characteristic of mesenteric artery ischemia.
Ischemia stricture. Ischemia stricture.
Previous
Next

Angiography

Angiography (see the image below) has been the criterion standard for diagnosis and preoperative planning in AMI. Various studies have reported sensitivities of 74-100% and a specificity of 100% for acute arterial occlusion.[53, 64, 65, 66, 67, 68, 69] Anteroposterior views demonstrate collateral pathways, whereas lateral projections show the origins of visceral branches. Currently, however, angiography is less and less resorted to in clinical practice.

Aortogram showing narrowing of superior mesenteric Aortogram showing narrowing of superior mesenteric artery.

Patients with embolization to the superior mesenteric artery (SMA)—that is, acute mesenteric arterial embolism (AMAE)—have an aortogram that demonstrates filling of the proximal SMA vessels to a sharp cutoff with no visualization of the distal vessels. Such an abrupt cutoff with the absence of collateral circulation is diagnostic, with nearly 100% sensitivity in acute embolic occlusion.[70]

Unlike patients with AMAE, those with acute mesenteric arterial thrombosis (AMAT) have well-developed collateral circulation as a consequence of long-standing, chronic ischemia. Thrombosis of the SMA generally appears as a more tapered occlusion near to or flush with the aortic origin of the vessel, resulting in an aortogram that fails to demonstrate any visualization of the SMA.

NOMI is characterized by narrowing of the origins of multiple SMA branches, alternating dilation and narrowing of the intestinal branches (ie, the “string of sausages” sign), spasm of the mesenteric arcades, and impaired filling of the intramural vessels.

Angiography has the added advantage of offering therapeutic as well as diagnostic options, including administration of intra-arterial thrombolytic agents for acute arterial thrombosis[71] and intra-arterial infusion of papaverine for all types of arterial ischemia.

The disadvantages of angiography are that it is highly invasive and unsuitable for critically ill patients; that it often is not readily available and may delay surgical management; and that nephrotoxicity may occur because of the effects of intravenous (IV) contrast on the kidneys. Angiography also has a relatively high false-negative rate in patients presenting early in the course of AMI.[72] Finally, arteriography can precipitate acute ischemia; thus, it is important to make sure that the patient is well hydrated.

Despite the disadvantages, if suspicion for AMI is high in an emergency setting, the treating physician should aggressively pursue conventional angiography if it is easily accessible. Prompt laparotomy is indicated if AMI is suspected but expeditious angiography is not available. If the case is not an emergency, it may be worthwhile to perform a dipyridamole-thallium scan to evaluate for coronary artery disease (CAD).

If mesenteric venous thrombosis (MVT) is strongly suspected, as in a patient with a history of hypercoagulability, angiography is considered a second-line study because of the high false-negative rate; abdominal CTA is preferable. Findings with angiography in MVT include thrombus in the superior mesenteric vein (SMV), reflux of contrast into the aorta, prolonged arterial phase with accumulation of contrast and thickened bowel walls, extravasation of contrast into bowel lumen, and filling defect in the portal vein or complete lack of venous phase.

Previous
Next

Computed Tomography and CT Angiography

Contrast CT has proved very valuable for the assessment of mesenteric ischemia; current multiarray spiral scanners allow detailed examination of both the small bowel and the mesenteric vessels.[73, 74, 75] Multiple studies have cited sensitivities of 96-100% and specificities of 89-94%.

CT findings with a specificity greater than 95% for AMI include SMA or SMV thrombosis, intestinal pneumatosis, portal venous gas, lack of bowel-wall enhancement, and ischemia of other organs[76] ; less specific findings include distended bowel, absence of intestinal gas, thickened bowel wall, mesenteric or perienteric fat stranding, ascites, pneumoperitoneum, and air-fluid levels.[77, 78]

Bowel wall edema (see the image below) is the most common finding, representing submucosal infiltration of fluid or hemorrhage into ischemic bowel. Arterial occlusion may show nonenhancement of the vessels. MVT usually shows a thrombus in the SMV or the portal vein.

CT scan (with contrast) of nonocclusive mesenteric CT scan (with contrast) of nonocclusive mesenteric ischemia with resulting bowel wall edema (arrows).

CTA has a sensitivity of 71-96% and a specificity of 92-94% for AMI. In current clinical practice, CTA is ordered much more frequently than classic angiography. CTA is noninvasive and readily available, and serial CT angiograms can be used to monitor patients treated nonsurgically with anticoagulation.

Abdominal CTA is considered by many to be the diagnostic test of choice if the index of suspicion for MVT is high and the patient is stable enough to undergo the procedure; sensitivities are greater than 90%.[79, 33, 80] CT findings include enlargement of the SMV or portal vein, a sharply defined vein wall with a rim of increased density, and low density (representing thrombus) within the vein (see the images below).[35]

CT scan demonstrating cavernous change of superior CT scan demonstrating cavernous change of superior mesenteric vein as consequence of venous thrombosis.
CT scan demonstrating thrombosis of superior mesen CT scan demonstrating thrombosis of superior mesenteric vein.
CT scan demonstrating thrombosis of portal vein. CT scan demonstrating thrombosis of portal vein.
Previous
Next

Magnetic Resonance Imaging and Magnetic Resonance Angiography

Magnetic resonance imaging (MRI) and MRA yield findings similar to those of CT in AMI. MRA has a sensitivity of 100% and a specificity of 91%. It is particularly effective for evaluating MVT.

Despite its high sensitivity, MRI is not yet as practical as CT in the setting of suspected AMI, because of the cost and the time required for the examination. If these drawbacks can be eliminated or mitigated, rapid MRA may eventually supplant CTA.

Previous
Next

Ultrasonography

Duplex ultrasonography is highly specific (92-100%), but its sensitivity (70-89%) does not match that of angiography. It cannot detect clots beyond the proximal main vessels, nor can it be used to diagnose NOMI. Ultrasonography is considered a second-line study for AMI. It is often less useful in the presence of dilated loops of bowel.

In some studies, ultrasonography appears to be as useful as CT if duplex scanning is performed for MVT at an early stage. It may show a thrombus or absent flow in the involved arteries or veins. Other possible findings include portal vein gas, biliary disease, free peritoneal fluid, thickened bowel wall, and intramural gas. Some researchers believe that duplex scans should be used as a first-line diagnostic tool in any patient thought to have MVT.

Echocardiography may confirm the source of embolization or show valvular pathology.

Previous
Next

Other Studies

ECG may show myocardial infarction or atrial fibrillation.

Nasogastric tube decompression is diagnostically useful, both for helping to relieve distention and for facilitating evaluation for upper gastrointestinal bleeding.

Diagnostic peritoneal lavage (DPL) may recover the serosanguineous fluid associated with bowel infarction; with the availability of CTA or MRA, DPL is now very rarely (if ever) used when AMI is suspected.

Foley catheterization allows monitoring of urinary output as an indicator for minimal fluid resuscitation. Placement of a central line may be useful in hemodynamically unstable patients.

Previous
 
 
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.

Coauthor(s)

Mark Su, MD, MPH, FACEP, FACMT Consulting Staff and Director of Fellowship in Medical Toxicology, Department of Emergency Medicine, North Shore University Hospital

Mark Su, MD, MPH, FACEP, FACMT is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Daniel K Nishijima, MD, MAS Assistant Professor of Emergency Medicine, Associate Research Director, Department of Emergency Medicine, University of California, Davis, School of Medicine

Daniel K Nishijima, MD, MAS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MSc, 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; American Gastroenterological Association Fellow

John Geibel, MD, DSc, MSc, 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, Society for Surgery of the Alimentary Tract

Disclosure: Received royalty from AMGEN for consulting; Received ownership interest from Ardelyx for consulting.

Acknowledgements

David FM Brown, MD Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: lippincott Royalty textbook royalty; wiley Royalty textbook royalty

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, Association of Program Directors in Surgery, and Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Brian James Daley, MD, MBA, FACS, FCCP, CNSC Professor and Program Director, Department of Surgery, Chief, Division of Trauma and Critical Care, University of Tennessee Health Science Center College of Medicine

Brian James Daley, MD, MBA, FACS, FCCP, CNSC is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Eastern Association for the Surgery of Trauma, Shock Society, Society of Critical Care Medicine, Southeastern Surgical Congress, Southern Surgical Association, andTennessee Medical Association

Disclosure: Nothing to disclose.

Michael A Grosso, MD Consulting Staff, Department of Cardiothoracic Surgery, St Francis Hospital

Michael A Grosso, MD is a member of the following medical societies: American College of Surgeons, Society of Thoracic Surgeons, and Society of University Surgeons

Disclosure: Nothing to disclose.

Chandler Long, MD Resident Physician, Department of Surgery, University of Tennessee Medical Center-Knoxville

Disclosure: Nothing to disclose.

Ashis Mandal, MD Professor, Department of Surgery, Drew University of Medicine and Science and UCLA College of Medicine

Disclosure: Nothing to disclose.

Robert M McNamara, MD, FAAEM Chair and Professor, Department of Emergency Medicine, Temple University School of Medicine

Robert M McNamara, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, Pennsylvania Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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

Yale D Podnos, MD, MPH Consulting Surgeon, Department of Surgery, City of Hope National Medical Center

Disclosure: Nothing to disclose.

Gary Setnik, MD Chair, Department of Emergency Medicine, Mount Auburn Hospital; Assistant Professor, Division of Emergency Medicine, Harvard Medical School

Gary Setnik, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: SironaHealth Salary Management position; South Middlesex EMS Consortium Salary Management position; ProceduresConsult.com Royalty Other

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

Disclosure: Medscape Salary Employment

Deron J Tessier, MD Staff Surgeon, Kaiser Permanente Medical Center, Fontana, CA

Deron J Tessier, MD is a member of the following medical societies: American College of Surgeons and American Medical Association

Disclosure: Nothing to disclose.

Jeff Wade, MD Resident Physician, Department of Emergency Medicine, Long Beach Community Hospital, Greater El Monte Medical Center

Disclosure: Nothing to disclose.

Russell A Williams, MBBS Program Director, Professor, Department of Surgery, University of California Medical Center at Irvine

Disclosure: Nothing to disclose.

References
  1. Sachs SM, Morton JH, Schwartz SI. Acute mesenteric ischemia. Surgery. 1982 Oct. 92(4):646-53. [Medline].

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

  3. Mamode N, Pickford I, Leiberman P. Failure to improve outcome in acute mesenteric ischaemia: seven-year review. Eur J Surg. 1999 Mar. 165(3):203-8. [Medline].

  4. Alpern MB, Glazer GM, Francis IR. Ischemic or infarcted bowel: CT findings. Radiology. 1988 Jan. 166(1 Pt 1):149-52. [Medline].

  5. Kim MY, Suh CH, Kim ST, Lee JH, Kong K, Lim TH, et al. Magnetic resonance imaging of bowel ischemia induced by ligation of superior mesenteric artery and vein in a cat model. J Comput Assist Tomogr. 2004 Mar-Apr. 28(2):187-92. [Medline].

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

  7. Aksu C, Demirpolat G, Oran I, Demirpolat G, Parildar M, Memis A. Stent implantation in chronic mesenteric ischemia. Acta Radiol. 2009 Jul. 50(6):610-6. [Medline].

  8. Loffroy R, Steinmetz E, Guiu B, Molin V, Kretz B, Gagnaire A, et al. Role for endovascular therapy in chronic mesenteric ischemia. Can J Gastroenterol. 2009 May. 23(5):365-73. [Medline]. [Full Text].

  9. Penugonda N, Gardi D, Schreiber T. Percutaneous intervention of superior mesenteric artery stenosis in elderly patients. Clin Cardiol. 2009 May. 32(5):232-5. [Medline].

  10. Mitchell EL, Chang EY, Landry GJ, Liem TK, Keller FS, Moneta GL. Duplex criteria for native superior mesenteric artery stenosis overestimate stenosis in stented superior mesenteric arteries. J Vasc Surg. 2009 Aug. 50(2):335-40. [Medline].

  11. Sivamurthy N, Rhodes JM, Lee D. Endovascular versus open mesenteric revascularization: immediate benefits do not equate with short-term functional outcomes. J Am Coll Surg. 2006. 202(6):859-67.

  12. Bertrán X, Muchart J, Planas R, Real MI, Ribera JM, Cabré E, et al. Occlusion of the superior mesenteric artery in a patient with polycythemia vera: resolution with percutaneous transluminal angioplasty. Ann Hematol. 1996 Feb. 72(2):89-91. [Medline].

  13. Schoots IG, Levi MM, Reekers JA, Lameris JS, van Gulik TM. Thrombolytic therapy for acute superior mesenteric artery occlusion. J Vasc Interv Radiol. 2005 Mar. 16(3):317-29. [Medline].

  14. Fink S, Chaudhuri TK, Davis HH. Acute mesenteric ischemia and malpractice claims. South Med J. 2000 Feb. 93(2):210-4. [Medline].

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

  16. Boley SJ. Circulatory responses to acute reduction of superior mesenteric arterial flow. Physiologist. 1969. 12:180.

  17. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the... Circulation. 2006 Mar 21. 113(11):e463-654. [Medline].

  18. Chang RW, Chang JB, Longo WE. Update in management of mesenteric ischemia. World J Gastroenterol. 2006 May 28. 12(20):3243-7. [Medline].

  19. 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].

  20. 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. 2005 Nov. 23(7):520-4. [Medline].

  21. 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. 2006 Feb. 47(2):168-72. [Medline].

  22. Casella IB, Bosch MA, Sousa WO Jr. Isolated spontaneous dissection of the superior mesenteric artery treated by percutaneous stent placement: case report. J Vasc Surg. 2008 Jan. 47(1):197-200. [Medline].

  23. Cappell MS. Intestinal (mesenteric) vasculopathy. I. Acute superior mesenteric arteriopathy and venopathy. Gastroenterol Clin North Am. 1998 Dec. 27(4):783-825, vi. [Medline].

  24. Boley SJ, Brandt LJ, Sammartano RJ. History of mesenteric ischemia. The evolution of a diagnosis and management. Surg Clin North Am. 1997 Apr. 77(2):275-88. [Medline].

  25. Liu JJ, Ardolf JC. Sumatriptan-associated mesenteric ischemia. Ann Intern Med. 2000 Apr 4. 132(7):597. [Medline].

  26. Abu-Daff S, Abu-Daff N, Al-Shahed M. Mesenteric venous thrombosis and factors associated with mortality: a statistical analysis with five-year follow-up. J Gastrointest Surg. 2009 Jul. 13(7):1245-50. [Medline].

  27. Endress C, Gray DG, Wollschlaeger G. Bowel ischemia and perforation after cocaine use. AJR Am J Roentgenol. 1992 Jul. 159(1):73-5. [Medline].

  28. Sudhakar CB, Al-Hakeem M, MacArthur JD, Sumpio BE. Mesenteric ischemia secondary to cocaine abuse: case reports and literature review. Am J Gastroenterol. 1997 Jun. 92(6):1053-4. [Medline].

  29. Bech FR. Celiac artery compression syndromes. Surg Clin North Am. 1997 Apr. 77(2):409-24. [Medline].

  30. Tseng YC, Tseng CK, Chou JW, Lai HC, Hsu CH, Cheng KS, et al. A rare cause of mesenteric ischemia: celiac axis compression syndrome. Intern Med. 2007. 46(15):1187-90. [Medline].

  31. Sanchez LD, Tracy JA, Berkoff D, Pedrosa I. Ischemic colitis in marathon runners: a case-based review. J Emerg Med. 2006 Apr. 30(3):321-6. [Medline].

  32. Agaoglu N, Türkyilmaz S, Ovali E, Uçar F, Agaoglu C. Prevalence of prothrombotic abnormalities in patients with acute mesenteric ischemia. World J Surg. 2005 Sep. 29(9):1135-8. [Medline].

  33. Alvi AR, Khan S, Niazi SK, Ghulam M, Bibi S. Acute mesenteric venous thrombosis: improved outcome with early diagnosis and prompt anticoagulation therapy. Int J Surg. 2009 Jun. 7(3):210-3. [Medline].

  34. Ji M, Yoon SN, Lee W, Jang S, Park SH, Kim DY, et al. Protein S deficiency with a PROS1 gene mutation in a patient presenting with mesenteric venous thrombosis following total colectomy. Blood Coagul Fibrinolysis. 2011 Oct. 22(7):619-21. [Medline].

  35. Kumar S, Sarr MG, Kamath PS. Mesenteric venous thrombosis. N Engl J Med. 2001 Dec 6. 345(23):1683-8. [Medline].

  36. Abdu RA, Zakhour BJ, Dallis DJ. Mesenteric venous thrombosis--1911 to 1984. Surgery. 1987 Apr. 101(4):383-8. [Medline].

  37. Harward TR, Green D, Bergan JJ, Rizzo RJ, Yao JS. Mesenteric venous thrombosis. J Vasc Surg. 1989 Feb. 9(2):328-33. [Medline].

  38. James AW, Rabl C, Westphalen AC, Fogarty PF, Posselt AM, Campos GM. Portomesenteric venous thrombosis after laparoscopic surgery: a systematic literature review. Arch Surg. 2009 Jun. 144(6):520-6. [Medline].

  39. Wang MQ, Lin HY, Guo LP, Liu FY, Duan F, Wang ZJ. Acute extensive portal and mesenteric venous thrombosis after splenectomy: treated by interventional thrombolysis with transjugular approach. World J Gastroenterol. 2009 Jun 28. 15(24):3038-45. [Medline]. [Full Text].

  40. Stamou KM, Toutouzas KG, Kekis PB, Nakos S, Gafou A, Manouras A, et al. Prospective study of the incidence and risk factors of postsplenectomy thrombosis of the portal, mesenteric, and splenic veins. Arch Surg. 2006 Jul. 141(7):663-9. [Medline].

  41. Wang MQ, Liu FY, Duan F, Wang ZJ, Song P, Fan QS. Acute symptomatic mesenteric venous thrombosis: treatment by catheter-directed thrombolysis with transjugular intrahepatic route. Abdom Imaging. 2011 Aug. 36(4):390-8. [Medline]. [Full Text].

  42. Swartz DE, Felix EL. Acute mesenteric venous thrombosis following laparoscopic Roux-en-Y gastric bypass. JSLS. 2004 Apr-Jun. 8(2):165-9. [Medline]. [Full Text].

  43. Cappell MS. Intestinal (mesenteric) vasculopathy. II. Ischemic colitis and chronic mesenteric ischemia. Gastroenterol Clin North Am. 1998 Dec. 27(4):827-60, vi. [Medline].

  44. Ha C, Magowan S, Accortt NA, Chen J, Stone CD. Risk of arterial thrombotic events in inflammatory bowel disease. Am J Gastroenterol. 2009 Jun. 104(6):1445-51. [Medline].

  45. Vokurka J, Olejnik J, Jedlicka V, Vesely M, Ciernik J, Paseka T. Acute mesenteric ischemia. Hepatogastroenterology. 2008 Jul-Aug. 55(85):1349-52. [Medline].

  46. Tallarita T, Oderich GS, Macedo TA, Gloviczki P, Misra S, Duncan AA, et al. Reinterventions for stent restenosis in patients treated for atherosclerotic mesenteric artery disease. J Vasc Surg. 2011 Nov. 54(5):1422-1429.e1. [Medline].

  47. Cardin F, Fratta S, Perissinotto E, Casarrubea G, Inelmen EM, Terranova C, et al. Clinical correlation of mesenteric vascular disease in older patients. Aging Clin Exp Res. 2012 Jun. 24(3 Suppl):43-6. [Medline].

  48. Di Fabio F, Obrand D, Satin R, Gordon PH. Intra-abdominal venous and arterial thromboembolism in inflammatory bowel disease. Dis Colon Rectum. 2009 Feb. 52(2):336-42. [Medline].

  49. Cardin F, Fratta S, Perissinotto E, Casarrubea G, Inelmen EM, Terranova C. Clinical correlation of mesenteric vascular disease in older patients. Aging Clin Exp Res. 2012 Jun. 24(3 Suppl):43-6. [Medline].

  50. Huang HH, Chang YC, Yen DH, Kao WF, Chen JD, Wang LM, et al. Clinical factors and outcomes in patients with acute mesenteric ischemia in the emergency department. J Chin Med Assoc. 2005 Jul. 68(7):299-306. [Medline].

  51. Safioleas MC, Moulakakis KG, Papavassiliou VG, Kontzoglou K, Kostakis A. Acute mesenteric ischaemia, a highly lethal disease with a devastating outcome. Vasa. 2006 May. 35(2):106-11. [Medline].

  52. Schoots IG, Koffeman GI, Legemate DA, Levi M, van Gulik TM. Systematic review of survival after acute mesenteric ischaemia according to disease aetiology. Br J Surg. 2004 Jan. 91(1):17-27. [Medline].

  53. Boley SJ, Sprayregen S, Veith FJ, Siegelman SS. An aggressive roentgenologic and surgical approach to acute mesenteric ischemia. Surg Annu. 1973. 5:355-78. [Medline].

  54. Klempnauer J, Grothues F, Bektas H, Pichlmayr R. Long-term results after surgery for acute mesenteric ischemia. Surgery. 1997 Mar. 121(3):239-43. [Medline].

  55. Boley SJ, Sprayregan S, Siegelman SS, Veith FJ. Initial results from an agressive roentgenological and surgical approach to acute mesenteric ischemia. Surgery. 1977 Dec. 82(6):848-55. [Medline].

  56. Nonthasoot B, Tullavardhana T, Sirichindakul B, Suphapol J, Nivatvongs S. Acute mesenteric ischemia: still high mortality rate in the era of 24-hour availability of angiography. J Med Assoc Thai. 2005 Sep. 88 Suppl 4:S46-50. [Medline].

  57. Murray MJ, Gonze MD, Nowak LR, Cobb CF. Serum D(-)-lactate levels as an aid to diagnosing acute intestinal ischemia. Am J Surg. 1994 Jun. 167(6):575-8. [Medline].

  58. Lange H, Jäckel R. Usefulness of plasma lactate concentration in the diagnosis of acute abdominal disease. Eur J Surg. 1994 Jun-Jul. 160(6-7):381-4. [Medline].

  59. Lange H, Toivola A. [Warning signals in acute abdominal disorders. Lactate is the best marker of mesenteric ischemia]. Lakartidningen. 1997 May 14. 94(20):1893-6. [Medline].

  60. Kurt Y, Akin ML, Demirbas S, Uluutku AH, Gulderen M, Avsar K, et al. D-dimer in the early diagnosis of acute mesenteric ischemia secondary to arterial occlusion in rats. Eur Surg Res. 2005 Jul-Aug. 37(4):216-9. [Medline].

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

  62. 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].

  63. Acosta S, Nilsson TK, Björck M. D-dimer testing in patients with suspected acute thromboembolic occlusion of the superior mesenteric artery. Br J Surg. 2004 Aug. 91(8):991-4. [Medline].

  64. Clark RA, Gallant TE. Acute mesenteric ischemia: angiographic spectrum. AJR Am J Roentgenol. 1984 Mar. 142(3):555-62. [Medline].

  65. NAITOVE A, WEISMANN RE. PRIMARY MESENTERIC VENOUS THROMBOSIS. Ann Surg. 1965 Apr. 161:516-23. [Medline]. [Full Text].

  66. Kaufman SL, Harrington DP, Siegelman SS. Superior mesenteric artery embolization: an angiographic emergency. Radiology. 1977 Sep. 124(3):625-30. [Medline].

  67. Böttger T, Schäfer W, Weber W, Junginger T. [Value of preoperative diagnosis in mesenteric vascular occlusion. A prospective study]. Langenbecks Arch Chir. 1990. 375(5):278-82. [Medline].

  68. Boos S. [Angiography of the mesenteric artery 1976 to 1991. A change in the indications during mesenteric circulatory disorders?]. Radiologe. 1992 Apr. 32(4):154-7. [Medline].

  69. Czerny M, Trubel W, Claeys L, Scheuba C, Huk I, Prager M, et al. [Acute mesenteric ischemia]. Zentralbl Chir. 1997. 122(7):538-44. [Medline].

  70. Brandt LJ, Boley SJ. AGA technical review on intestinal ischemia. American Gastrointestinal Association. Gastroenterology. 2000 May. 118(5):954-68. [Medline].

  71. Savassi-Rocha PR, Veloso LF. Treatment of superior mesenteric artery embolism with a fibrinolytic agent: case report and literature review. Hepatogastroenterology. 2002 Sep-Oct. 49(47):1307-10. [Medline].

  72. American Gastroenterological Association Medical Position Statement: guidelines on intestinal ischemia. Gastroenterology. 2000 May. 118(5):951-3. [Medline].

  73. Horton KM, Fishman EK. Multi-detector row CT of mesenteric ischemia: can it be done?. Radiographics. 2001 Nov-Dec. 21(6):1463-73. [Medline].

  74. Cikrit DF, Harris VJ, Hemmer CG, Kopecky KK, Dalsing MC, Hyre CE, et al. Comparison of spiral CT scan and arteriography for evaluation of renal and visceral arteries. Ann Vasc Surg. 1996 Mar. 10(2):109-16. [Medline].

  75. Zeman RK, Silverman PM, Vieco PT, Costello P. CT angiography. AJR Am J Roentgenol. 1995 Nov. 165(5):1079-88. [Medline].

  76. Aschoff AJ, Stuber G, Becker BW, Hoffmann MH, Schmitz BL, Schelzig H, et al. Evaluation of acute mesenteric ischemia: accuracy of biphasic mesenteric multi-detector CT angiography. Abdom Imaging. 2009 May-Jun. 34(3):345-57. [Medline].

  77. Kirkpatrick ID, Kroeker MA, Greenberg HM. Biphasic CT with mesenteric CT angiography in the evaluation of acute mesenteric ischemia: initial experience. Radiology. 2003 Oct. 229(1):91-8. [Medline].

  78. Wiesner W. [Is multidetector computerized tomography currently the primary diagnostic method of choice in diagnostic imaging of acute intestinal ischemia?]. Praxis (Bern 1994). 2003 Jul 30. 92(31-32):1315-7. [Medline].

  79. Vogelzang RL, Gore RM, Anschuetz SL, Blei AT. Thrombosis of the splanchnic veins: CT diagnosis. AJR Am J Roentgenol. 1988 Jan. 150(1):93-6. [Medline].

  80. Barmase M, Kang M, Wig J, Kochhar R, Gupta R, Khandelwal N. Role of multidetector CT angiography in the evaluation of suspected mesenteric ischemia. Eur J Radiol. 2011 Dec. 80(3):e582-7. [Medline].

  81. Tambyraja AL. Management of acute mesenteric ischaemia: recommended strategy is misleading. BMJ. 2003 Aug 16. 327(7411):396; author reply 396. [Medline]. [Full Text].

  82. Ward D, Vernava AM, Kaminski DL, Ure T, Peterson G, Garvin P, et al. Improved outcome by identification of high-risk nonocclusive mesenteric ischemia, aggressive reexploration, and delayed anastomosis. Am J Surg. 1995 Dec. 170(6):577-80; discussion 580-1. [Medline].

  83. Grieshop RJ, Dalsing MC, Cikrit DF, Lalka SG, Sawchuk AP. Acute mesenteric venous thrombosis. Revisited in a time of diagnostic clarity. Am Surg. 1991 Sep. 57(9):573-7; discussion 578. [Medline].

  84. Jona J, Cummins GM Jr, Head HB, Govostis MC. Recurrent primary mesenteric venous thrombosis. JAMA. 1974 Mar 4. 227(9):1033-5. [Medline].

  85. Acosta S, Ogren M, Sternby NH, Bergqvist D, Björck M. Mesenteric venous thrombosis with transmural intestinal infarction: a population-based study. J Vasc Surg. 2005 Jan. 41(1):59-63. [Medline].

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

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

  88. Marudanayagam R, Syed S, Nasr H, Fox A. Outcome following mesenteric artery revascularisation for chronic mesenteric ischemia. Minerva Chir. 2011 Apr. 66(2):101-6. [Medline].

  89. Gagnière J, Favrolt G, Alfidja A, Kastler A, Chabrot P, Cassagnes L, et al. Acute thrombotic mesenteric ischemia: primary endovascular treatment in eight patients. Cardiovasc Intervent Radiol. 2011 Oct. 34(5):942-8. [Medline].

  90. Harnik IG, Brandt LJ. Mesenteric venous thrombosis. Vasc Med. 2010 Oct. 15(5):407-18. [Medline].

  91. Takahashi N, Kuroki K, Yanaga K. Percutaneous transhepatic mechanical thrombectomy for acute mesenteric venous thrombosis. J Endovasc Ther. 2005 Aug. 12(4):508-11. [Medline].

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

  93. Thomas RM, Ahmad SA. Management of acute post-operative portal venous thrombosis. J Gastrointest Surg. 2010 Mar. 14(3):570-7. [Medline].

 
Previous
Next
 
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).
Aortogram showing narrowing of superior mesenteric artery.
Radiograph showing bowel spasm (early sign of ischemia).
Gas in colon wall (typical of advanced ischemia).
Ischemia stricture.
Thumbprinting of bowel, characteristic of mesenteric artery ischemia.
Pathologic findings 2 hours after bowel ischemia starts.
Microscopic findings 24 hours after ischemia starts.
Gross specimen showing hemorrhagic dead bowel after resection from patient with acute mesenteric ischemia.
Pneumatosis intestinalis, one of few radiographic findings in patients with mesenteric ischemia.
Diagnosis and treatment of intestinal ischemia (mesenteric venous thrombosis and major nonembolic arterial occlusion). Solid lines indicate accepted management plan; dashed lines indicate alternate management plan. DVT=deep vein thrombosis; SMA=superior mesenteric artery. Adapted from Gastroenterology. 2000 May;118(5):954-68.
Diagnosis and treatment of intestinal ischemia (minor arterial occlusion or embolus, major embolus, and splanchnic vasoconstriction without occlusion). Solid lines indicate accepted management plan; dashed lines indicate alternate management plan. DVT=deep vein thrombosis; SMA=superior mesenteric artery. Adapted from Gastroenterology. 2000 May;118(5):954-68.
Management of colon ischemia. Solid lines indicate accepted management plan; dashed lines indicate alternative management plan. BE=barium enema; NPO—nil per os (nothing by mouth); PLC=protein-losing colopathy; IBD=inflammatory bowel disease. Adapted from Gastroenterology. 2000 May;118(5):954-68.
Complete aortic occlusion (Leriche syndrome) with acute embolism of superior mesenteric artery.
Gross specimen of dead bowel.
Meandering artery (radiographic sign of preexisting bowel ischemia).
CT scan demonstrating thrombosis of superior mesenteric vein.
CT scan demonstrating thrombosis of portal vein.
CT scan demonstrating cavernous change of superior mesenteric vein as consequence of venous thrombosis.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.