Mesenteric Artery Ischemia Workup

  • Author: Deron J Tessier, MD; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Jun 28, 2011
 

Laboratory Studies

  • The following laboratory examinations should be ordered:
    • Prothrombin time
    • Activated partial thromboplastin time
    • Complete blood cell count, which may reveal a leukocytosis and/or hemoconcentration
    • Chemistry studies that may show acidosis, increased amylase levels, or increased lactate dehydrogenase levels
  • If a hypercoagulable state is suggested, additional laboratory studies such as tests for protein C and S deficiencies and antithrombin III deficiency can be ordered.
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Imaging Studies

  • Obtain a chest radiograph.
  • Plain abdominal films can yield a presumptive diagnosis in 20-30% of patients. Late findings on plain films include intramural air and air in the portal venous system. If bowel perforation occurs, free air may be observed in the abdomen.
  • The computed tomography (CT) findings with specificity greater than 95% include SMA or superior mesenteric vein thrombosis, intestinal pneumatosis, portal venous gas, lack of bowel wall enhancement, and ischemia of other organs. Unlike embolic occlusions, thrombosis of the SMA generally occurs flush with the aortic origin of the vessel. Distended bowel, an absence of intestinal gas, a thickened bowel wall, and air-fluid levels are nonspecific findings.
  • Biplane aortography is the criterion standard for the diagnosis of mesenteric ischemia. It can be used to confirm the presence and extent of occlusive disease. Anteroposterior views demonstrate collateral pathways, while lateral projections show the origins of visceral branches.
  • Because arteriography can precipitate acute ischemia, ensure that the patient is well hydrated. Patients with thrombosis demonstrate complete lack of visualization of the SMA and its branches, while those with embolism to the SMA demonstrate filling of the proximal SMA only with a sharp cutoff of the artery.
  • If the case is not emergent, consider performing a dipyridamole-thallium scan to evaluate for coronary artery disease.
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Other Tests

  • Obtain an ECG.
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Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

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.

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: Medscape Salary Employment

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.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

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

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthors, Yale D Podnos, MD, MPH, and Russell A Williams, MBBS, to the development and writing of this article.

References

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Angiogram of a patient with chronic mesenteric ischemia.
Aortogram showing narrowing of the superior mesenteric artery.
Radiograph showing bowel spasm, an early sign of ischemia.
Gas in the colon wall, typical of advanced ischemia.
Ischemia stricture.
Meandering artery, a sign of chronic mesenteric artery ischemia.
Thumbprinting of the bowel, a characteristic of mesenteric artery ischemia.
Pathologic findings 2 hours after bowel ischemia starts.
Microscopic findings 24 hours after the start of ischemia.
Gross specimen showing hemorrhagic dead bowel.
 
 
 
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