Mesenteric Ischemia, Arterial

More Tummy Pain

Step 1: View clinicals

A 72 year old woman presents with severe, generalized abdominal pain for 1 hour, in association with nausea, vomiting and watery diarrhea. Her medical history is significant only for well controlled hypertension for 5 years; she is currently on therapy with losartan only. A full blood count is significant for a leukocyte count of 15,000/mm3 with 90% neutrophils, while serial ECGs are only significant for atrial fibrillation. A chest x-ray, serum amylase, and serum lipase levels are found to be normal.


Step 2: Order all relevant investigations

Abdominal X-Ray

The abdominal x-ray appears normal.

Ultrasound Abdomen

The ultrasound scan of the abdomen appears normal.

CT + CTA Abdomen

The CT scan shows distension of the small intestine and proximal colon; CT angiography reveals occlusion of the superior mesenteric artery (SMA) close to its origin by an embolus.

Colonoscopy

You realize that colonoscopy might waste valuable time.


Step 3: Select appropriate management

Systemic Thrombolytics
Anticoagulation
NG Tube
IV Antibiotics


Score: ★★☆