Learning objectives
To review the pathogenesis of acute mesenteric ischemia.
To discuss the role of CT in the diagnosis and management of acute mesenteric ischemia.
Background
Acute mesenteric ischemia (AMI) is caused by an abrupt reduction in blood flow through the mesenteric vessels,
that can threaten the viability of the bowel.
Acute bowel ischemia represents one of the most threatening abdominal conditions,
particularly in elderly patients,
with a reported mortality of 50-90%.
It may involve the bowel in a segmental or diffuse extension,
and be partial mural or transmural.
It is estimated that nearly 1% of patients presenting with acute abdomen have ischemic intestinal disease involving the small bowel or colon....
Findings and procedure details
Acute mesenteric ischemia can be differentiated in primary or secondary ischemia.
The primary type has a vascular origin,
being related to mesenteric arterial embolism or thrombosis,
mesenteric venous thrombosis and non-occlusive ischemia.
Secondary mesenteric ischemia is caused by non-vascular diseases,
such as small bowel strangulation.
Mesenteric Arterial Embolism
- Embolization to the SMA is the most frequent cause of AMI (50%),
due to its wide caliber and narrow takeoff angle from the aorta.
- Location: 85 % - emboli in thesuperior mesenteric artery (SMA) lodge...
Conclusion
Acute mesenteric ischemia is a life-threatening condition,
with a variable clinical and radiologic manifestations.
CT is the first-line imaging examination,
especially for the demonstration of the cause and complications of ischemia.
The radiologists must be familiar with the spectrum of diagnostic CT signs to achieve an accurate and early diagnosis,
as well as determine the appropriate treatment.
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