Acute Mesenteric Ischemia Differential Diagnoses

Updated: Jul 05, 2018
  • Author: Chat V Dang, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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DDx

Diagnostic Considerations

Because acute mesenteric ischemia (AMI) is a condition with an unclear initial presentation, a substantial morbidity, and a high mortality if not properly treated, a high index of clinical suspicion should be maintained. Computed tomography (CT) angiography (CTA) should be performed at an early stage if any suspicion of AMI exists, and 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.

A diagnosis of AMI should be considered 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.

A diagnosis of mesenteric venous thrombosis (MVT) is usually confirmed during laparotomy or autopsy. Only after other causes of a hypercoagulable state have been excluded can a patient be considered to have idiopathic venous thrombosis.

In addition to the conditions listed in the differential diagnosis, other problems to consider include the following:

  • Ovarian torsion
  • Volvulus of midgut
  • Splenic vein thrombosis
  • Crohn disease colitis
  • Ulcerative colitis
  • Perforated viscus
  • Hepatic disease

Differential Diagnoses