Acute mesenteric ischaemia

Question 1

Acute mesenteric ischaemia

Answer 1

Sudden decrease in the blood supply to the bowel, resulting in bowel ischaemia

Question 2

Aetiology

Answer 2

Thrombus-in-situ - atherosclerosis

Embolism:

• AF
• MI
• Prosthetic valve
• thoraco-abdominal aneurysm

Non-occlusive cause:

• Hypovolaemic shock
• Cardiogenic shock

Venous occlusion and congestion:

• Coagulopathy
• malignancy
• autoimmune disorders

Question 3

Clinical Features

Answer 3

Generalised abdominal pain

Out of proportion to the clinical findings

Diffuse and constant pain

Nausea and vomiting

Abdominal examination:

• tenderness
• later stages - perotinisim - especially if perforated

Question 4

Investigations

Answer 4

Abdo examination
Obs

Bloods - FBC, U+Es, LFTs, Clotting, G+S, amylase

ABG - Lactate and acidosis

CT angiography

CT scan with contrast

Question 5

CT scan with contrast results

Answer 5

Early - Oedematous bowel

Intermediate - loss of bowel wall enhancement

Late - pneumatosis

Question 6

Initial Mx

Answer 6

A-E

• IV fluids
• Catheter
• abx
• ITU admission

Question 7

Why are abx given?

Answer 7

Due to the risk of faecal contamination in case of perforation of the ischaemic bowel and bacterial translocation

Question 8

Definitive Management

Answer 8

Revascularisation of the bowel - removal of any thrombus or embolism via radiological intervention

Excision of necrotic or non-viable bowel
- potential relook laparotomy in 24-48 hours

Question 9

Complications of exision

Answer 9

Short bowel syndrome

Question 10

Complications of mesenteric ischaemia

Answer 10

Bowel necrosis and perforation