The following is a summary of “High risk and low prevalence diseases: Mesenteric ischemia,” published in the March 2023 issue of Emergency Medicine by Molyneux, et al.

Mesenteric ischemia is a serious and rare abdominal vascular emergency that often goes misdiagnosed, leading to high morbidity and mortality rates. For a study, researchers sought to highlight the pearls and pitfalls of mesenteric ischemia, including its presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

Mesenteric ischemia encompasses superior mesenteric arterial embolism, arterial thrombosis, venous mesenteric ischemia, and non-occlusive mesenteric ischemia. It is associated with various risk factors such as advanced age, cardiovascular disease, hypercoagulable state, and end-stage renal disease. The presentation varies depending on the underlying pathophysiology, with the arterial embolic disease typically presenting with sudden and severe pain while the early stages and other forms may present with nonspecific symptoms such as generalized abdominal pain, weight loss, vomiting, and diarrhea.

Laboratory testing can aid in diagnosing leukocytosis and elevated lactate levels, suggesting the disease, but normal values should not be used to exclude the diagnosis. The imaging modality of choice is triple-phase computed tomography with non-contrast, arterial, and delayed phases. Initial management in the ED involves fluid resuscitation, symptomatic therapy, broad-spectrum antibiotics, and anticoagulation. Definitive treatment requires emergent consultation with a multidisciplinary team, including diagnostic and interventional radiologists and cardiovascular and general surgeons.

In conclusion, understanding mesenteric ischemia can aid emergency clinicians in diagnosing and managing this disease. Early recognition and prompt intervention were crucial for improving patient outcomes.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723000037