Difference between revisions of "Mesenteric ischemia"

Line 19: Line 19:
| Arterial Thrombosis||
| Arterial Thrombosis||
*Athrosclerotic Disease
*Atherosclerotic Disease
| Venous Thrombosis||
| Venous Thrombosis||
Line 48: Line 48:
* Pain out of proportion to exam
* Pain out of proportion to exam. Abdomen often soft, without guarding.
* Severe, poorly localized, colicky
* Severe, generalized, colicky
==Work Up==
==Work Up==

Revision as of 00:40, 9 February 2015



4 distinct entities:

  1. Mesenteric arterial embolism (ex. Afib)
  2. Mesenteric arterial thrombosis (ex. Vasculopath)
  3. Nonocclusive mesenteric ischemia (ex. Hypovolemia from diuretics)
  4. Mesenteric venous thrombosis (ex. hypercoagulable state)
Risk Factors for Mesenteric Ischemia Types
Type Risk Factor
Arterial Embolism
  • Dysrhythmia (A. Fib)
  • Valve Disease
  • MI
Arterial Thrombosis
  • Atherosclerotic Disease
Venous Thrombosis
  • Prior thrombosis history
  • Hypercoagulable state (preg, cancer, clotting disorder)
  • Hypovolemic state
  • Heart Failure
  • Diuretic use


  • Mean age: 70yo
  • 2/3 women

Risk Factors



  • Pain out of proportion to exam. Abdomen often soft, without guarding.
  • Severe, generalized, colicky

Work Up

  • Labs
    • Lactate (higher later)
    • WBC (often >15K)
    • Chemistry (metabolic acidosis)
  • CTA
  • Mesentaric angiography considered gold standard

Differential Diagnosis

Diffuse Abdominal Pain

Diffuse Abdominal pain


Acute arterial embolus

  • Papaverine infusion (30-60 mg/h IV) OR
  • surgical embolectomy OR
  • intra-arterial thrombolysis

Nonocclusive mesenteric ischemia

  • Papaverine infusion

Mesenteric venous thrombosis

  • Heparin/warfarin either alone or in combination with surgery
  • Immediate heparinization should be started even when surgical intervention is indicated
    • Decreases progression of thrombosis and improves survival

Chronic mesenteric ischemia

  1. Angioplasty with or without stent placement or surgical revascularization


  • Admit with consultation of one or more of the following
    • IR
    • Vascular
    • Surgery


  • Rosen's
  • Tintinalli