Learning objectives
Acute mesenteric ischemia (AMI) is an important abdominal emergency because of its high mortality (50-90%) and therefore requires an early diagnosis and treatment.
The aim of this review is to learn the physiopathology and imaging findings of acute mesenteric ischemia,
in order to be able to make a correct diagnosis early in the course of the disease,
and avoid its serious complications.
Background
ANATOMY
Irrigation of the intestinal tract depends on three branches of the abdominal aorta: the celiac trunk,
the superior mesenteric artery (SMA) and the inferior mesenteric artery (IMA).
The first and second portions of the duodenum are irrigated by the gastroduodenal artery,
which most commonly arises from the common hepatic arteryof the celica trunk.
The third portion of the duodenum receives arterial blood from the inferior pancreaticoduodenal branches of the SMA.
The jejunum,
ileum and caecum are irrigated by the AMS,
as well as the...
Findings and procedure details
Abdominal X-ray and ultrasound can be useful to suspect AMI within the correct clinical context,
but the absence of abnormal findings does not exclude the diagnosis.
Typical X-ray findings include bowel dilatation,
portomesenteric gas,
pneumatosis intestinalis and pneumoperitoneum,
whereas ultrasound findings include parietal thickening of a long segment of intestine with diminished or absent Doppler flow.
Multiphase CT of the abdomen and pelvis is the imaging modality of choice in the assessment of patients with suspected AMI.
An arterial phase is done triggered automatically by...
Conclusion
AMI is an abdominal emergency and it is important for radiologists to be familiar with the image manifestations in order to make a quick diagnosis and treatment because it has a high mortality rate.
It occurs because of an inadequate blood supply to the bowel,
due to many different causes,
that can be divided into occlusive (arterial or venous) or not occlusive (hypo-perfusion,
vasoconstriction,
etc...).
It is important to suspect this pathology after a clinical evaluation and blood test (abdominal pain,
raised lactate,
metabolic acidosis...)...
References
Mastoraki A,
Mastoraki S,
Tziava E,
Touloumi S,
Krinos N,
Danias N,
et al.
Mesenteric ischemia: Pathegenesis and challenging diagnosis and therapeutich modalities.
World J Gastrointest Pathophysiol 2016 February 15; 7(1): 125-130
Harpreet S.
Dhatt,
Spencer C.
Behr,
Aaron Miracle,
Zhen Jane Wang,
Benjamin M.
Yeh.
Radiological Evaluation of Bowel Ischemia.
Radiologic Clinics of North America.
November 2015; 53 (6): 1241-1254
Gregory Walker T.
Mesenteric Ischemia.
Semin Intervent Radiol.
2009 Sep; 26(3): 175–183
Khoshini R,
Garrett B,
Sial S, Eysselein V.
The Role of Radiologic...