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Mesenteric Ischemia

Mesenteric Ischemia is a topic covered in the 5-Minute Emergency Consult.

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  • 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 hospital admissions
  • 1–2% of all admissions for abdominal pain:
    • Most cases occur in patients >50 yr.
    • Mortality as high as 60–70%, particularly if diagnosis/presentation delayed >24 hr


  • Acute mesenteric arterial embolism:
    • 50% of cases of acute mesenteric ischemia
    • Mean age 70 yr
    • Emboli most commonly arise in left atria or ventricle, from a dysrhythmia, valvular lesions, or ventricular thrombus from a prior MI
    • Typically lodge 3–10 cm distal to the origin of the superior mesenteric artery (SMA):
      • Preserves blood flow to proximal small and large bowel
    • Risk factors include dysrhythmia (especially atrial fibrillation), valvular heart disease, prior MI, aortic aneurysm, or dissection.
  • Mesenteric artery thrombus:
    • SMA thrombus in 15% of cases of acute mesenteric ischemia
    • Rare in other vessels
    • Develops from plaque rupture of mesenteric atherosclerotic disease
    • 50–80% may have longstanding intestinal angina (chronic mesenteric ischemia).
    • Risk factors include age, atherosclerotic disease, HTN.
  • Mesenteric venous thrombosis:
    • 5–15% of cases of acute mesenteric ischemia
    • Subacute/indolent presentation
    • 20–40% mortality
    • Typically occurs in younger patients with underlying hypercoagulable state
    • Risk factors include:
      • Hypercoagulable state (lupus, protein C and S deficiency)
      • Sickle cell disease
      • Antithrombin III deficiency
      • Malignancy (particularly portal)
      • Pregnancy
      • Sepsis
      • Renal failure on dialysis
      • Estrogen therapy
      • Recent trauma or inflammatory conditions
  • Nonocclusive mesenteric ischemia:
    • 20–30% of cases of acute mesenteric ischemia
    • Occurs in low cardiac output states with decreased mesenteric blood flow
    • Risk factors include CHF, sepsis, hypotension, hypovolemia, diuretic use, recent surgery (especially cardiac), or recent vasopressor requirement.
    • Poorer survival rates
  • Chronic mesenteric ischemia:
    • “Intestinal angina”:
      • Postprandial, diffuse abdominal pain occurring ∼1 hr after eating, lasts 1–2 hr
      • Patients may develop food aversions and eat small meals to avoid pain.
  • Uncommon causes:
    • Spontaneous mesenteric arterial dissection
    • Median arcuate ligament syndrome—compression of the celiac axis or SMA by the arcuate ligament of the diaphragm
    • Extrinsic compression from tumors
    • Medications:
      • Digitalis
      • Ergotamine
      • Cocaine
      • Pseudoephedrine
      • Vasopressin

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Rosen, Peter, et al., editors. "Mesenteric Ischemia." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307593/all/Mesenteric_Ischemia.
Mesenteric Ischemia. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307593/all/Mesenteric_Ischemia. Accessed April 25, 2019.
Mesenteric Ischemia. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307593/all/Mesenteric_Ischemia
Mesenteric Ischemia [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307593/all/Mesenteric_Ischemia.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Mesenteric Ischemia ID - 307593 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307593/all/Mesenteric_Ischemia PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -