Mesenteric Ischemia

Question 1

Presentation

Definitive diagnosis

Answer 1

Minimal clinical signs

• Distended abdo
• Diffuse tenderness
• No guarding => no peritonitis
• Tympanic abdo

Abdo pain out of proportion to clinical findings

High LACTATE!

CT angiogram

Question 2

Management

Answer 2

Quick restoration of blood flow
-keep laparotomy open for 2nd look
Remove necrotic bowel
Manage ends of healthy bowel with stoma
Short gut syndrome management

Question 3

Types of mesenteric ischemia

Answer 3

Chronic
-often due to hypercoagulable states
Acute
-non occlusive
-majority are occlusive
  -majority are arterial => embolus, can be thrombus
  - some are venous => thrombus