• Epidemiology
  1. Accounts for 5-15% of Acute Mesenteric Ischemia
  2. Gender: Women are more commonly affected
  • Pathophysiology
  1. Superior Mesenteric Artery is affected in most cases
  • Causes
  1. Prothrombotic state (70% of cases)
    1. Family History of Venous Thromboembolism (50% of cases)
    2. Cancer
    3. Thrombophilia
  • Risk Factors
  1. Tobacco Abuse
  2. Oral Contraceptive use
  3. Hypercoagulable State
  4. Abdominal Trauma (especially significant Trauma such as seen in Motor Vehicle Accident)
  • Symptoms
  1. Presentation is often delayed 48 hours or more after onset
  2. Mid-abdominal, colicky pain
    1. May still eat despite pain
  3. Nausea
  4. Vomiting
  5. Diarrhea
  • Signs
  1. Fecal Occult Blood stool (50%)
  2. Grossly bloody stool (15%)
  • Labs
  1. Lactic Acidosis is a late finding
  • Imaging
  1. Abdominal Xray
    1. Early: Mild bowel dilation
    2. Late: Thumb printing, pneumatosis, portal venous gas
  2. Abdominal CT
    1. Test Sensitivity: 90%
  3. Abdominal Ultrasound with venous doppler
  • Management
  1. See Mesenteric Ischemia
  2. Anticoagulation
    1. Start with Heparin infusion
      1. Associated with improved survival (especially if started early)
    2. Transition to Warfarin (continue for >=6 months)
  3. Surgery
  • Prognosis
  1. Mortality: 20-50%
  • References
  1. Fraboni (2012) Board Review Express, San Jose
  2. Kern and Gilley-Avramis (2022) Crit Dec Emerg Med 36(11) 21-8
  3. Mastoraki (2021) World J Gastrointest Pathophysiol 7(1): 125-30 [PubMed]