Fact-sheet: Mesenteric ischemia
Updated on 04/05/2019 at 7:41 AM
View all RADEOS cases associated with this fact-sheet
Definition
Ischemic involvement of all or part of the digestive tract, which may be caused by low flow, mesenteric arterial thromboembolism, or mesenteric venous thrombosis
Clinical features
Severe acute abdominal pain
Vomiting
Lower gastrointestinal bleeding
Low-grade fever
Guarding is inconsistent at onset
Absent bowel sounds on auscultation
Shock
Laboratory findings
Metabolic acidosis
Elevated lactate
Elevated CPK
Leukocytosis
Radiography
Reflex ileus
Ultrasound
Peritoneal effusion
Mesenteric arterial or venous occlusion on Doppler
Bowel wall thickening with target sign
Visualization of portal venous gas: Scintillating, linear hyperechoic foci branching to the subcapsular region
CT
Performed after injection, with arterial and portal phases
Arterial-origin ischemia:
- Thrombus in the superior mesenteric artery or celiac trunk
- Calcified atheroma of the visceral arteries
- Mucosal enhancement and bowel wall thickening (ischemic bowel wall injury without necrosis)
- Absence of enhancement or virtual wall = transmural necrosis
- Pneumatosis intestinalis +/- mesenteric venous gas +/- portal venous gas
- Reflex ileus
- Peritoneal effusion
- In case of embolism, associated splenic, hepatic, or renal infarction
- In case of low flow, no arterial thrombus detected, but delayed bowel opacification, and signs of ischemic bowel wall injury that may progress to transmural necrosis
Venous-origin ischemia:
- mesenteric venous thrombus
- Marked bowel wall thickening
- Significant peritoneal effusion
- Mesenteric venous congestion
- Reflex ileus
Differential diagnosis
Infectious enteritis
Inflammatory enteritis
Infectious colitis or pseudomembranous colitis
Ischemic colitis
Differential diagnosis of portal venous gas:
-Intra-abdominal abscesses (appendicitis, sigmoiditis...)
-Crohn disease
-Gastric ulcer
Caution:
-portal venous gas: "dead tree" pattern, extending to the subcapsular region, right-angle branching+++, predominantly right liver
-pneumobilia: central, minimal branching (1 to 2 orders), smoother, predominantly left liver
