What Clinical Features Lead to the Diagnosis of Acute Mesenteric Ischemia?

Abstract

The historical and clinical features of acute mesenteric ischemia, though subtle, are best classified by pathophysiologic cause. There are four types: arterial embolism, arterial thrombosis, non-occlusive mesenteric ischemia, and mesenteric venous thrombosis. Arterial embolism is classically characterized by acute onset of severe abdominal pain and results from emboli to the mesenteric arteries, most often of cardiac origin, in regions without collateral supply by the splanchnic vasculature. Arterial thrombosis occurs in patients with pre-existing atherosclerotic disease; these patients often have a long history of intermittent abdominal pain, weight loss, and diarrhea. Non-occlusive mesenteric ischemia is seen in critically ill patients that are exposed to prolonged vasoconstriction, making diagnosis even more challenging. Mesenteric venous thrombosis most often occurs in patients with a predisposition to developing blood clots; these patients tend to be younger with little past medical history and complain of vague abdominal pain, anorexia, and diarrhea. Regardless of etiology, diagnosing acute mesenteric ischemia is challenging, but a careful history can provide clues.