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2015, Number 1

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Anales de Radiología México 2015; 14 (1)

Acute mesenteric ischemia: an emergency which requires a comprehensive diagnostic approach

Motta-Ramírez GA, Sánchez-García JC, Ontiveros-Rodríguez A, López-Ramírez MA, Rebollo-Hurtado V, García-Ruiz A, Noyola-Villalobos H

Language: Spanish
References: 44
Page: 66-88
PDF size: 710.77 Kb.


ABSTRACT

Background: Acute mesenteric ischemia is a vascular emergency with mortality above 60%, which requires opportune treatment. However, due to its heterogeneous pathophysiology and differences in degree and extent of ischemic damage, the clinical and radiological manifestations are varied and often nonspecific; consequently, a thorough analysis of antecedents, laboratory studies, and clinical and radiological findings is recommended in order to establish a timely diagnosis.
Objective: Identify the most common findings, direct and indirect, by computed tomography and determine low, intermediate, and high probability of a patient’s suffering from acute mesenteric ischemia on the basis of risk factors and clinical, biochemical, and radiological findings.
Material and methods: We performed a retrospective, observational, cross-sectional study, with analysis of findings from computed tomography images, of a series of cases of patients with diagnosis of acute mesenteric ischemia in a period of 9 years, 3 months and literature review. The purpose was to analyze the risk factors and clinical and biochemical data most commonly associated with acute mesenteric ischemia.
Results: Our universe included tomographic studies of 27 cases of acute mesenteric ischemia, with average age of 60.8 years. The most common clinical datum was acute abdominal pain syndrome in 19 patients (70%); the most commonly associated antecedents were type 2 diabetes mellitus and systemic high blood pressure in 7 (26%) patients each; 13 patients (48%), per clinical notes, had laboratory studies, of whom 11 (85%) had leukocyte values of 9,200 to 68,000; the most commonly identified findings were: arterial filling defect 48%, intestinal pneumatosis 29%, venous filling defect 22%, bowel obstruction syndrome 22%, and identification of free fluid 22%.
Conclusion: It is recommendable to conduct a quantitative analysis giving a specific value to the different findings, including risk factors, physical exploration, laboratory studies, and image findings, to determine the risk of acute mesenteric ischemia in a patient with acute abdominal pain syndrome. Angiotomography is the study with the greatest diagnostic precision.


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