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Mesenteric Ischemia, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Decreased or occluded blood flow through the mesenteric vessels leading to ischemic or infarcted bowel

  • Can be from arterial or venous blockage, or low flow states.

  • 1 in 1,000 of all ho...

Diagnosis

Signs and Symptoms

  • Sudden-onset, severe, diffuse abdominal pain in acute ischemia:

    • Pain out of proportion to exam:

      • Patients may have relatively benign abdominal exam despite severe pain.

  • Nausea

  • V...

Treatment

Pre-Hospital

Initiate fluid replacement for dehydrated or hypotensive patients. 

Initial Stabilization/Therapy

  • Airway, breathing, and circulation management (ABCs) with fluid resuscitation as n...

Follow-Up

Disposition

Admission Criteria

Admit all patients with mesenteric ischemia. 

Discharge Criteria

None 

Followup Recommendations

Surgical consultation 

Pearls and Pitfalls

  • Aggressive pursuit of diagnosis is mandatory.

  • Mortality rises to 80% when the diagnosis is made >24 hr after symptom onset.

  • Early surgical evaluation for emergent operative interv...

Additional Reading

  • Cangemi  JR, Picco  MF. Intestinal ischemia in the elderly. Gastroenterol Clin North Am.  2009;38:527–540.

  • Krupski  WC, Selzman  CH, Whitehill  TA. Unusual causes of mesenteric ...

Codes

ICD9

  • 557.0 Acute vascular insufficiency of intestine

  • 557.1 Chronic vascular insufficiency of intestine

ICD10

  • K55.0 Acute vascular disorders of intestine

  • K55.1 Chronic vascular disorders of intestine

SNOMED

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