{ "schemaVersion": 2, "eyebrow": "Vascular Emergency", "title": "Acute Mesenteric Ischemia", "summary": "Acute mesenteric ischemia requires immediate CT angiography, resuscitation, and coordinated vascular-surgical management. Etiology—arterial embolism, arterial thrombosis, nonocclusive hypoperfusion, venous thrombosis, or strangulation—determines revascularization, anticoagulation, laparotomy, and bowel-preservation strategy.", "seoDescription": "Physician guide to acute mesenteric ischemia: CTA diagnosis, etiologic differentiation, resuscitation, revascularization, laparotomy, and bowel viability.", "clinicalQuestion": "How should physicians rapidly diagnose, phenotype, and treat acute mesenteric ischemia while preventing irreversible bowel necrosis?", "specialty": "Emergency Medicine and Vascular Surgery", "audience": "U.S. physicians and medical trainees", "tags": [ "acute mesenteric ischemia", "superior mesenteric artery occlusion", "mesenteric ischemia CTA", "nonocclusive mesenteric ischemia", "mesenteric venous thrombosis", "bowel necrosis" ], "keyTakeaways": [ "Obtain abdomen-pelvis CTA with IV contrast promptly when AMI is suspected; arterial and venous phases define vascular occlusion and bowel perfusion. [7][20]", "Do not use a normal lactate, D-dimer, leukocyte count, or benign early abdominal examination to exclude AMI; laboratory abnormalities are nonspecific and lactate may remain normal despite extensive ischemia. [4][20]", "Peritonitis, shock, or CT evidence suggesting transmural injury requires urgent operative exploration and resection of nonviable bowel, with revascularization when arterial inflow is compromised. [16][18][19]", "Differentiate arterial embolism, acute-on-chronic arterial thrombosis, nonocclusive mesenteric ischemia, mesenteric venous thrombosis, and strangulating obstruction because the definitive intervention differs. [19][23]", "Arterial-phase CTA should be specifically ordered and communicated as an AMI evaluation; diagnostic detection on acute-abdomen CT depends on clinician suspicion. [11][20]" ], "sections": [ { "id": "recognize-and-escalate", "eyebrow": "Immediate Action", "heading": "When to activate an acute mesenteric ischemia pathway", "intro": "Treat AMI as a time-critical bowel- and life-threatening vascular emergency.", "paragraphs": [ "Activate emergency surgical and vascular/endovascular consultation when severe acute abdominal pain is disproportionate to early examination findings, particularly in an older patient with atrial fibrillation, recent myocardial infarction, heart failure, prior arterial embolism, or antecedent postprandial pain with weight loss. These features raise concern for either embolic SMA occlusion or acute thrombosis superimposed on chronic atherosclerotic mesenteric disease. [1][16][23]", "Escalate directly to urgent operative assessment rather than pursuing serial examinations when guarding, rigidity, rebound tenderness, septic physiology, or hemodynamic deterioration suggests infarcted or perforated bowel. Intestinal resection is required when bowel necrosis is present; mortality remains approximately 50% to 80%, making diagnostic delay a major modifiable hazard. [16]", "Maintain suspicion in ICU and perioperative patients with otherwise unexplained abdominal distension, pain, worsening shock, or rising metabolic derangement during vasopressor-dependent low-flow states. Nonocclusive mesenteric ischemia (NOMI) results from splanchnic hypoperfusion and vasoconstriction and may coexist with sepsis or other critical illness, which can obscure the diagnosis. [21][23]" ], "bullets": [ "Communicate the concern for \"acute mesenteric ischemia\" directly to radiology when ordering CT, because detection on acute-abdomen CT is influenced by the referring clinician's stated suspicion. [11]", "Arrange care at a center with hybrid-operating-room capability and surgeons able to perform both endovascular and open mesenteric interventions when transfer will not create unsafe delay. [16]" ], "subsections": [], "table": { "caption": "Etiologic pattern recognition directs the immediate definitive pathway. [19][23]", "columns": [ "Etiologic branch", "Discriminating clinical context", "CTA target", "Immediate definitive direction" ], "rows": [ [ "Arterial embolism", "Abrupt severe pain; atrial fibrillation, left ventricular dysfunction, endocarditis, or other embolic substrate. [23]", "SMA arterial filling defect or occlusion. [3][20]", "Urgent arterial revascularization; explore if peritonitis or suspected necrosis. [16][22]" ], [ "Arterial thrombosis", "Postprandial pain, food aversion, nausea, and weight loss before the acute event; severe atherosclerosis. [1][23]", "Occlusion near the SMA origin with atherosclerotic disease. [1]", "Revascularize arterial inflow; assess bowel viability operatively if advanced ischemia is suspected. [16][22]" ], [ "NOMI", "Critical illness, hypotension, shock, or vasopressor requirement. [21][23]", "Bowel ischemic injury without a primary occlusive arterial lesion. [19]", "Correct systemic hypoperfusion and reassess urgently for transmural injury requiring surgery. [19][21]" ], [ "Mesenteric venous thrombosis", "Venous occlusive pattern; may occur with hypercoagulable states, infection, or malignancy. [23]", "Mesenteric venous thrombus with bowel and mesenteric edema. [18]", "Anticoagulation is part of initial management; operate for necrosis or peritonitis. [21][16]" ], [ "Strangulating obstruction", "Obstructive presentation with a mechanical closed-loop or strangulating process. [19]", "Bowel obstruction plus ischemic wall or mesenteric findings. [18][19]", "Urgent operative reduction and treatment of the mechanical cause; resect gangrenous bowel. [2]" ] ] } }, { "id": "diagnostic-workup", "eyebrow": "Diagnosis", "heading": "Obtain multiphase CTA without waiting for laboratory confirmation", "intro": "CTA establishes both the vascular lesion and the extent of bowel injury.", "paragraphs": [ "Order CTA of the abdomen and pelvis with IV contrast as the initial test for suspected AMI. For an AMI protocol, obtain arterial-phase imaging to identify arterial occlusion and enable vascular reconstruction, plus venous-phase imaging to assess intestinal perfusion and venous pathology; multiplanar reconstructions improve evaluation of mesenteric artery origins. CTA is the ACR-recommended initial study and has reported sensitivity and specificity of approximately 96% and 94%, respectively. [7][20]", "Do not substitute plain abdominal radiography or ultrasound for CTA in a patient with meaningful clinical suspicion. Plain films have limited diagnostic value, and ultrasound is not recommended for AMI because it is time-consuming and has limited diagnostic value; CTA is preferred over MRA for speed, availability, and cost in the acute setting. [20][21]", "Interpret CTA in two parallel tracks: identify the cause of vascular compromise and identify signs of established bowel injury. Reduced or absent bowel-wall enhancement is the most specific CT feature of ischemia, with reported specificity near 96%; decreased enhancement is particularly specific for arterial-occlusive ischemia. Bowel-wall thickening, pneumatosis intestinalis, portomesenteric venous gas, mesenteric edema, and mesenteric arterial or venous thromboembolism further support the diagnosis and help define severity. [18][19][20]", "Request immediate surgical review of CTA showing reduced enhancement, pneumatosis, portal or mesenteric venous gas, or a vascular occlusion with dilated small bowel. In an elderly AMI cohort, organ failure, elevated serum lactate, and small-bowel dilation on CT were identified as predictors of irreversible bowel-wall necrosis. [3][6][18]" ], "bullets": [ "Avoid oral contrast when CTA is being performed for suspected AMI because it can obscure bowel-wall assessment. [21]", "For suspected chronic mesenteric ischemia without an acute peritoneal syndrome, CTA abdomen-pelvis with IV contrast or contrast-enhanced MRA is an appropriate initial examination. [7]" ], "subsections": [ { "heading": "Laboratory tests: assess physiology, not exclusion", "paragraphs": [ "Obtain CBC, electrolytes, bicarbonate, renal function, coagulation studies, and serum lactate to characterize systemic illness and prepare for intervention, but do not use any isolated result to rule out AMI. Leukocytosis, metabolic acidosis, D-dimer elevation, and serum lactate elevation are nonspecific; no laboratory test reliably establishes or excludes early AMI. [3][4]", "Interpret lactate as a late or severity-associated marker rather than a screening test. Early bowel ischemia may have a negative arterial lactate and even metabolic alkalosis after profound vomiting; normal serum lactate can also occur with extensive ischemia because hepatic clearance may mask mesenteric lactate delivery. [20]" ], "bullets": [ "D-lactate has pooled sensitivity 0.72 and specificity 0.74 for AMI and should not replace CTA or operative assessment when clinical suspicion is high. [20]", "A serum lactate sensitivity of 91% with specificity of 42% in early bowel ischemia illustrates why an elevated value cannot establish the diagnosis and a normal value cannot safely defer CTA. [3]" ] } ], "table": null }, { "id": "stabilization-and-source-control", "eyebrow": "Resuscitation", "heading": "Stabilize while arranging reperfusion or laparotomy", "intro": "Resuscitation must occur in parallel with imaging and procedural mobilization.", "paragraphs": [ "Begin intravenous fluid resuscitation, administer broad-spectrum antibiotics, and initiate anticoagulation as part of initial AMI management while defining the mechanism and procedural plan. These measures do not substitute for revascularization in arterial occlusion or resection when bowel is nonviable. [21]", "Use serial abdominal examinations and reassessment of hemodynamics, acid-base status, and lactate trend to identify progression toward transmural injury, but do not delay intervention for laboratory normalization. A soft abdomen may coexist with severe early ischemia; peritoneal signs mark a late and dangerous transition toward infarction or perforation. [1][16][20]", "When arterial occlusion is confirmed without clear peritonitis, mobilize endovascular and open vascular capability immediately. Endovascular strategies described for arterial AMI include catheter-directed thrombolysis, aspiration thrombectomy, angioplasty, and stenting; the choice depends on lesion anatomy and local expertise. In one retrospective series, endovascular treatment was technically successful in 87% of treated patients, but this observational result should not defer surgery when bowel viability is uncertain. [22]" ], "bullets": [ "Prioritize open exploration when peritonitis, bowel necrosis, or perforation is suspected clinically or radiographically. [16][19]", "Use a combined endovascular-surgical strategy when arterial inflow restoration and direct assessment or resection of bowel are both required. [3][16]" ], "subsections": [], "table": null }, { "id": "cause-directed-treatment", "eyebrow": "Definitive Management", "heading": "Match treatment to the mechanism and bowel viability", "intro": "The central procedural question is whether salvageable bowel remains after reperfusion.", "paragraphs": [ "For arterial embolism, pursue urgent restoration of SMA flow because abrupt occlusion can produce profound ischemia despite intact collateral pathways. Cardiac arrhythmia is a major clinical clue; CTA confirms the occlusion and provides the anatomic basis for endovascular or open revascularization planning. [16][22][24]", "For acute arterial thrombosis, anticipate underlying ostial or proximal atherosclerotic disease and a history of chronic intestinal angina, nausea, food avoidance, or weight loss. The slow progression of atherosclerosis can permit collateral development, but acute thrombosis converts compensated chronic mesenteric insufficiency into an emergency that requires arterial revascularization and bowel assessment. [1][23]", "For NOMI, the decisive intervention is correction of the low-flow or vasoconstrictive state while urgently evaluating for bowel necrosis. NOMI should be considered in critically ill patients with abdominal pain requiring vasopressor support; CTA may show ischemic bowel injury without a primary arterial occlusion. Deterioration, peritoneal signs, or CT features of transmural injury should trigger operative exploration rather than continued medical observation. [19][21]", "For mesenteric venous thrombosis, identify venous occlusion on CTA and treat with anticoagulation as part of initial management. Proceed to laparotomy when peritonitis, perforation, or necrotic bowel is present; venous thrombosis does not protect against transmural infarction. [18][21]", "For strangulating obstruction, source control is mechanical: urgently reduce the hernia, volvulus, or other strangulating lesion and resect gangrenous bowel. Adhesive obstruction may be managed conservatively when feasible, but gangrene mandates resection; complicated hernia and volvulus similarly require reduction or resection with repair directed at the underlying pathology. [2]" ], "bullets": [ "Do not interpret pneumatosis or portomesenteric venous gas in isolation; integrate these findings with enhancement, vascular anatomy, abdominal examination, and systemic physiology when deciding on exploration. [18][20]", "After revascularization, inspect the entire bowel and resect clearly nonviable segments; direct intraoperative assessment remains necessary because standard visual inspection alone is imperfect. [6][16]" ], "subsections": [ { "heading": "Intraoperative bowel-viability assessment", "paragraphs": [ "At laparotomy, assess bowel color, distention, peristalsis, mesenteric arcade pulsations, and bleeding from cut surfaces, but recognize that traditional visual assessment can misclassify ischemic bowel. Adjunct approaches evaluate oxygenation, myoelectric activity, or perfusion; near-infrared indocyanine-green fluorescence angiography is one perfusion-based technique described for intraoperative assessment. [6]", "Preserve bowel when viability is credible after restoration of perfusion, but resect unequivocally necrotic bowel. The operative tradeoff is between leaving ischemic bowel that can progress to sepsis and short-bowel consequences from unnecessary resection; equivocal viability warrants deliberate surgical reassessment rather than confidence based on appearance alone. [6][16]" ], "bullets": [] } ], "table": { "caption": "CTA and clinical severity determine whether endovascular therapy, laparotomy, or both are required. [3][16][19][22]", "columns": [ "Clinical-imaging state", "Primary action", "Reason not to delay" ], "rows": [ [ "Arterial occlusion; no peritonitis; bowel appears potentially viable", "Urgent endovascular or open mesenteric revascularization. [16][22]", "Persistent SMA occlusion risks progression to irreversible ischemia. [1][16]" ], [ "Arterial occlusion plus peritonitis, shock, or CT features concerning for necrosis", "Exploration with bowel assessment/resection plus revascularization as indicated. [3][16]", "Necrotic bowel requires resection and cannot be rescued by anticoagulation alone. [16]" ], [ "NOMI with escalating shock or bowel-injury findings", "Correct hypoperfusion urgently; explore when transmural injury is suspected. [19][21]", "NOMI can progress to transmural necrosis despite absence of a fixed arterial occlusion. [19]" ], [ "Mesenteric venous thrombosis without peritonitis", "Anticoagulation and close surgical surveillance. [21]", "Clinical progression or infarction requires prompt conversion to operative management. [16][18]" ], [ "Strangulating obstruction or gangrene", "Urgent operative reduction and resection of nonviable bowel. [2]", "Mechanical strangulation causes ongoing ischemia until relieved. [19]" ] ] } }, { "id": "monitoring-and-aftercare", "eyebrow": "Reassessment", "heading": "Monitor for ongoing ischemia after the initial intervention", "intro": "Clinical trajectory and bowel viability determine the need for further intervention.", "paragraphs": [ "After revascularization or initial laparotomy, monitor hemodynamics, abdominal findings, lactate and acid-base trend, and evidence of recurrent sepsis or intestinal dysfunction. Persistent shock, worsening examination, or ongoing metabolic deterioration should prompt urgent reassessment for residual ischemia, failed reperfusion, or additional nonviable bowel; serum lactate alone is insufficient to establish bowel viability. [3][20]", "Review the CTA mechanism after stabilization to identify the source of the acute event. Atrial fibrillation, ventricular dysfunction, endocarditis, and arterial atherosclerosis favor arterial embolic or thrombotic mechanisms, whereas critical illness with vasopressor dependence favors NOMI and venous thrombosis may signal hypercoagulable disease, infection, or malignancy. [21][23]", "Patients with an acute-on-chronic arterial presentation require longitudinal attention to symptomatic chronic mesenteric insufficiency—postprandial pain, nausea, food aversion, and weight loss—because these features identify the atherosclerotic substrate that preceded the acute event. CTA or contrast-enhanced MRA is appropriate for chronic mesenteric ischemia evaluation when the patient is clinically stable. [1][7][23]" ], "bullets": [ "Document the etiology explicitly in the discharge and procedural record—embolic, thrombotic, NOMI, venous, or strangulation-related—because recurrence prevention and follow-up differ by mechanism. [19][23]", "Coordinate vascular, acute-care surgery, and critical-care follow-up when revascularization, bowel resection, vasopressor-associated NOMI, or persistent viability uncertainty complicated the index event. [16][22]" ], "subsections": [], "table": null } ], "faq": [], "references": [ { "number": 1, "title": "Acute Mesenteric Ischemia: A Clinical Review", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/217022", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 2, "title": "Etiology, clinical profile, management, and outcomes of intestinal obstruction in a resource-limited setting: a prospective study | Scientific Reports", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-026-45380-w", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 3, "title": "Acute mesenteric ischaemia in the elderly - results of combined endovascular and surgical treatment. 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Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Acute Mesenteric Ischemia: A Clinical Review", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/217022", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "Acute mesenteric ischemia is a life-threatening vascular emergency that requires early diagnosis and intervention to adequately restore mesenteric blood flow and to prevent bowel necrosis and patient death. Acute mesenteric thrombosis accounts for 25% to 30% of all ischemic events.2-4,22 Almost all ", "score": 0.6549173 }, { "number": 2, "title": "Etiology, clinical profile, management, and outcomes of intestinal obstruction in a resource-limited setting: a prospective study | Scientific Reports", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-026-45380-w", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Management strategies were determined intraoperatively based on bowel viability and underlying pathology. Adhesive obstruction was treated conservatively when feasible or surgically with adhesiolysis and resection if gangrene was present6.\"),7: 2017 update of the evidence-based guidelines from the w", "score": 0.24573648 }, { "number": 3, "title": "Acute mesenteric ischaemia in the elderly - results of combined endovascular and surgical treatment. Primary study | Scientific Reports", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41598-024-84026-7", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Laboratory findings of AMS closure include leukocytosis, metabolic acidosis, elevated D-dimer and serum lactate. Serum lactate concentration has a sensitivity of 91% but a specificity of only 42% in the early stages of bowel ischaemia4, 445–452 (2002).\"),5, 381–384 (1994).\"). The diagnosis of AMS em", "score": 0.7657514 }, { "number": 4, "title": "Acute mesenteric ischemia: A review of the main imaging techniques and signs - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S2173510720300501", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "# Update in Radiology Acute mesenteric ischemia: A review of the main imaging techniques and signsIsquemia mesentérica aguda: Revisión de las principales técnicas y signos radiológicos☆. Acute mesenteric ischaemia is an abdominal emergency because reduced blood flow to bowel loops rapidly leads to i", "score": 0.67527276 }, { "number": 5, "title": "Insights into acute mesenteric ischaemia: an up-to-date ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/bjr/article/96/1151/20230232/7498961", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by L Garzelli · 2023 · Cited by 49 — ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI) .", "score": 0.6437107 }, { "number": 6, "title": "Techniques for intraoperative evaluation of bowel viability in mesenteric ischemia: A review - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0002961020300544", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "# Review Article Techniques for intraoperative evaluation of bowel viability in mesenteric ischemia: A review. While several imaging modalities aid in the diagnosis of AMI preoperatively, there are limited intraoperative tools for surgeon decision making regarding bowel viability. Finally, we offer ", "score": 0.6279746 }, { "number": 7, "title": "ACR Appropriateness Criteria® Imaging of Mesenteric Ischemia - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1546144018311608", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "# Appropriate use criteria ACR Appropriateness Criteria® Imaging of Mesenteric Ischemia. While several imaging examination options are available for the initial evaluation of both acute and chronic mesenteric ischemia, CTA of the abdomen and pelvis is overall the most appropriate choice for both con", "score": 0.62770075 }, { "number": 8, "title": "Chronic Ischemic Gastritis in a Patient With a... : ACG Case ...", "detail": "journals.lww.com", "url": "https://journals.lww.com/acgcr/fulltext/2024/10000/chronic_ischemic_gastritis_in_a_patient_with_a.32.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "by IM Parisi · 2024 · Cited by 1 — clinical guidelines on the diagnosis and treatment of patients with chronic mesenteric ischaemia.", "score": 0.5582553 }, { "number": 9, "title": "Tricky acute mesenteric ischemia: what can we do?", "detail": "academic.oup.com", "url": "https://academic.oup.com/gastro/article/doi/10.1093/gastro/goaf067/8191289", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by X Cui · 2025 · Cited by 1 — The World Society of Emergency Surgery (WSES) guidelines prioritize diagnostic laparoscopy for patients with acute abdominal conditions or", "score": 0.48425868 }, { "number": 10, "title": "(PDF) Tricky acute mesenteric ischemia: what can we do?", "detail": "academic.oup.com", "url": "https://academic.oup.com/gastro/article-pdf/doi/10.1093/gastro/goaf067/63693140/goaf067.pdf", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "This review synthesizes current evidence by examining AMI pathophysiology, anatomical considerations, risk factors, and diagnostic-therapeutic advancements,", "score": 0.47753036 }, { "number": 11, "title": "Detecting acute mesenteric ischemia in CT of the acute abdomen is dependent on clinical suspicion: Review of 95 consecutive patients - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0720048X1530098X", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "# Detecting acute mesenteric ischemia in CT of the acute abdomen is dependent on clinical suspicion: Review of 95 consecutive patients. (1) To evaluate the ability of emergency room radiologists to detect acute mesenteric ischemia (AMI) from computed tomography (CT) images in patients with acute abd", "score": 0.4485476 }, { "number": 12, "title": "S2229 Patient Outcomes and Natural History of 222...", "detail": "journals.lww.com", "url": "https://journals.lww.com/ajg/fulltext/2024/10001/s2229_patient_outcomes_and_natural_history_of_222.2230.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "by B Saha · 2024 · Cited by 1 — Clinical Guidelines Collections. Sclerosing mesenteritis (SM) is a rare inflammatory condition of the mesentery. Chronic Mesenteric Ischemia", "score": 0.43669468 }, { "number": 13, "title": "S1809 Acute Mesenteric Ischemia in COVID-19 Patients", "detail": "journals.lww.com", "url": "https://journals.lww.com/ajg/fulltext/2023/10001/s1809_acute_mesenteric_ischemia_in_covid_19.2150.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Mesentric ischemia (MI) is not common;ly suspected. MI needs prompt diagnosis and aggressive management. Treatment involved surgical resection of the necrotic", "score": 0.3620219 }, { "number": 14, "title": "Acute and Chronic Mesenteric Ischemia Due to Superior... : Official journal of the American College of Gastroenterology | ACG", "detail": "journals.lww.com", "url": "https://journals.lww.com/ajg/fulltext/2011/10002/acute_and_chronic_mesenteric_ischemia_due_to.640.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Title: Acute and Chronic Mesenteric Ischemia Due to Superior... : Official journal of the American College of Gastroenterology | ACG\n# Official journal of the American College of Gastroenterology | ACG. **Purpose:** Introduction: The clinical presentation of mesenteric ischemia is dependent on the u", "score": 0.3407928 }, { "number": 15, "title": "Rheumatoid arthritis associated vasculitis: a rare entity", "detail": "academic.oup.com", "url": "https://academic.oup.com/jscr/article/2024/8/rjae446/7745395", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by MA Campos Ramos · 2024 · Cited by 2 — The nonspecific clinical presentation of vasculitides with mesenteric involvement leading to intestinal ischemia poses several challenges", "score": 0.22174688 }, { "number": 16, "title": "Diagnosis and Management of Acute Mesenteric Ischemia Is Reviewed | ACS", "detail": "www.facs.org", "url": "https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/acs-brief/april-22-2025-issue/diagnosis-and-management-of-acute-mesenteric-ischemia-is-reviewed", "authors": "www.facs.org", "host": "www.facs.org", "snippet": "Embolic ischemia should be suspected in patients with cardiac arrythmia. Imaging with CT angiography is the preferred method for confirming the diagnosis.\n\nIf possible, patients should be managed in facilities with hybrid operating rooms and surgeons with expertise in endovascular and open vascular ", "score": 0.4457955 }, { "number": 17, "title": "CT of Acute Bowel IschemiaRadiology", "detail": "pubs.rsna.org", "url": "https://pubs.rsna.org/doi/abs/10.1148/radiol.2263011540", "authors": "pubs.rsna.org", "host": "pubs.rsna.org", "snippet": "# CT of Acute Bowel Ischemia1. Therefore, it often is a combination of nonspecific clinical, laboratory, and radiologic findings—especially detailed knowledge about the pathogenesis of acute bowel ischemia in different conditions—that helps most in correct interpretation of CT findings. To improve u", "score": 0.7343678 }, { "number": 18, "title": "CT and MR Imaging Findings of Bowel Ischemia from Various Primary CausesRadioGraphics", "detail": "pubs.rsna.org", "url": "https://pubs.rsna.org/doi/abs/10.1148/radiographics.20.1.g00ja0629", "authors": "pubs.rsna.org", "host": "pubs.rsna.org", "snippet": "# CT and MR Imaging Findings of Bowel Ischemia from Various Primary Causes1. The CT and MR imaging findings include bowel wall thickening with or without the target sign, intramural pneumatosis, mesenteric or portal venous gas, and mesenteric arterial or venous thromboembolism. *Acute mesenteric isc", "score": 0.7295395 }, { "number": 19, "title": "Acute Mesenteric Ischemia: Pathophysiology-based Approach to Imaging Findings and Diagnosis | RadioGraphics", "detail": "pubs.rsna.org", "url": "https://pubs.rsna.org/doi/10.1148/rg.250012", "authors": "pubs.rsna.org", "host": "pubs.rsna.org", "snippet": "# Acute Mesenteric Ischemia: Pathophysiology-based Approach to Imaging Findings and Diagnosis * 1Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 * 2Department of Pathology and Laboratory Medicine, University of Wisconsin Scho", "score": 0.7077487 }, { "number": 20, "title": "Acute Mesenteric Ischemia - PMC", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9374525", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "If AMI is suspected, CT should be performed with contrast enhancement in the arterial and venous phases. The arterial phase allows for accurate detection of vascular pathology with detailed vascular reconstruction, while the venous phase provides assessment of intestinal perfusion (\nFig. 1\n). Multi-", "score": 0.6504012 }, { "number": 21, "title": "Bowel Ischemia - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK554527", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "An interprofessional team member should be aware of the signs and symptoms of intestinal ischemia. Prompt recognition of the disease and early treatment can decrease the morbidity and mortality rate of intestinal ischemia. Severe abdominal pain out of proportion of physical examination should arise ", "score": 0.5752307 }, { "number": 22, "title": "The role of endovascular therapy in acute mesenteric ischemia - PMC", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566773", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "## Introduction\n\nVascular pathologies of the small and large bowel can be of venous or arterial etiology. Mesenteric ischemia is classified as acute (caused by thromboembolism or hypoperfusion) or chronic. The development of imaging technology has gradually increased the diagnostic rate of venous or", "score": 0.7686816 }, { "number": 23, "title": "[PDF] Mesenteric ischemia - Cleveland Clinic Journal of Medicine", "detail": "www.ccjm.org", "url": "https://www.ccjm.org/content/ccjom/91/9/545.full.pdf", "authors": "www.ccjm.org", "host": "www.ccjm.org", "snippet": "respectively), followed by nonocclusive mesenteric ischemia (20%–22%) from splanchnic hypoperfusion and vasoconstriction and venous thrombosis (10%).6,8 Arterial embolism Acute arterial embolism causing partial or complete occlusion of the vessel lumen accounts for most (49%) cases of acute mesenter", "score": 0.75809944 }, { "number": 24, "title": "Acute Mesenteric Ischemia: A Rare Complication Following Minimally Invasive Modified McKeown Laparoscopic Esophagectomy | ACS", "detail": "www.facs.org", "url": "https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v4n7/06-sharieff-acute-mesenteric-ischemia", "authors": "www.facs.org", "host": "www.facs.org", "snippet": "# Acute Mesenteric Ischemia: A Rare Complication Following Minimally Invasive Modified McKeown Laparoscopic Esophagectomy. Mesenteric venous thrombosis and non-occlusive mesenteric ischemia (vasospasm) have been proposed as potential causes of AMI after complex laparoscopic procedures like bariatric", "score": 0.741169 } ], "publishedAt": "2026-08-24T16:52:20.534231+00:00", "updatedAt": "2026-08-24T16:52:20.534231+00:00", "readingMinutes": 7, "slug": "acute-mesenteric-ischemia" }