Acute Mesenteric Ischaemia

Sudden decrease in the blood supply to the bowel, resulting in bowel ischaemia and, if not promptly treated, death

Aetiology

  • Most commonly caused by an embolus/thrombosis (usually embolus from AF) sticking in a narrowed (from atherosclerosis) super mesenteric artery
  • Chronic - cramps, like angina of the guts
  • Acute - small bowel gets infarcted, colon lives (due to marginal artery)

Clinical presentation

  • Generalised abdominal pain out of proportion to clinical findings
  • Nausea and vomiting

Investigations

  • Bloods - ↑ lactate, CRP may be normal, WCC may be slightly ↑
  • CT angiography is the gold standard - shows arterial blockage due to emboli or thrombus

Management

  • Surgery
    • If bowel non-viable - resection
    • If bowel viable - SMA embolectomy