Mesenteric ischemia

Mesenteric ischemia is a devastating illness that is increasing in incidence as the population ages. Correct diagnosis early in its course is the only way to reduce the extremely high mortality rate. There are no specific laboratory tests, and the physical examination is often unhelpful. Mesenteric ischemia is commonly mistaken for pancreatitis, gastroenteritis, small bowel obstruction, or myocardial infarction. Making the diagnosis requires a high index of suspicion and angiography in high-risk patients. Delays in diagnosis lead to marked increases in mortality and significant morbidity in patients who do survive. Newer imaging techniques and laboratory studies may assist emergency physicians in diagnosing mesenteric ischemia more accurately. Treatment includes revascularization, anticoagulation, and treatment of associated vasospasm and should be tailored to the specific cause of the ischemic event. Newer modalities to prevent ischemia-reperfusion injury are being sought.