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Originally Published: Modern Resident, February/March 2015
Intestinal ischemia is a serious illness with severe and life threatening complications. The likelihood of developing complications improves with earlier diagnosis. However, early diagnosis can be difficult, especially in the setting of no known risk factors.
Acute mesenteric ischemia is any process that causes hypoperfusion to the small intestine. The large intestine can also become ischemic from hypoperfusion, usually referred to as ischemic colitis. Intestinal hypoperfusion can be due to arterial or venous obstruction from acute embolism, thrombosis or low-flow states.
We all learned in medical school, “abdominal pain out-of-proportion to physical exam” means acute mesenteric ischemia. However, in real-life situations, many emergency department patients presenting with abdominal pain would fit into this category. The question becomes, who gets a workup and who does not? First, a careful history should be performed; about one third of patients with acute intestinal ischemia will have a previous history of embolic event. Patients with peripheral vascular disease, cardiac disease, atrial fibrillation, hypercoaguable states and hypovolemic states are all at increased risk of developing intestinal ischemia.