Acute mesenteric ischemia: A critical role for the radiologist
Open accessAbstract
Acute mesenteric ischemia is defined as an inadequate blood supply to the gastrointestinal tract resulting in ischemic and inflammatory injury that may progress to necrosis of the bowel wall. Prognosis is poor with a mortality rate greater than 95% without treatment, dropping to around 70% when surgical treatment is performed. Contrast-enhanced computed tomography (CT) has become the cornerstone of the diagnosis by showing features of vascular disorders (occlusion and/or insufficient blood supply) and features of intestinal ischemic injury. CT should be performed as rapidly as possible. Imaging-based patient management is required, and multimodal and multidisciplinary management should be introduced. The treatment involves multidisciplinary management by gastroenterologists, vascular and digestive surgeons, cardiologists, intensivists, and diagnostic and interventional radiologists. Based on our experience at a dedicated mesenteric stroke center, this article gives an overview of the diagnosis of acute mesenteric ischemia. The goal of this review is to improve the understanding of the imaging-based diagnosis to further improve the management of this life-threatening condition.
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The diagnosis of acute mesenteric ischaemia (AMI) is based on clinical presentation, vascular stenosis or occlusion on contrast enhanced computed tomography (preferably arterial phase), and signs of intestinal injury on contrast enhanced computed tomography (preferably venous phase).
“The diagnosis of AMI is based on (1) clinical presentation, (2) vascular stenosis or occlusion on contrast enhanced computed tomography (CT) (preferably arterial phase), and (3) signs of intestinal injury on the contrast enhanced CT (preferably venous phase) (Fig. 3). 118”
Decreased bowel wall enhancement, pneumatosis, and portomesenteric venous gas are considered signs of intestinal ischaemia and are suggestive, although not definitive, signs of bowel necrosis.
“Decreased bowel wall enhancement, pneumatosis, and portomesenteric venous gas are considered signs of intestinal ischaemia and are suggestive, although not definitive signs, of bowel necrosis.”
In early AMI, early signs of intestinal injury are often present and can be subtle, such as bowel wall thickening, mild luminal dilatation, mesenteric oedema, and small amounts of peritoneal fluid.
“In early AMI, early signs of intestinal injury are often present. These can be very subtle and difficult to detect, such as bowel wall thickening, mild luminal dilatation (as a sign of bowel paralysis), mesenteric oedema (fat stranding), and small amounts of peritoneal fluid (Table 6). 118,133”
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ACUTE MESENTERIC ISCHEMIA: CASE REPORT
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- Authors
- Copin, P., Zins, M., Nuzzo, A., Purcell, Y., Beranger-Gibert, S., Maggiori, L., Corcos, O., Vilgrain, V., & Ronot, M.
- Affiliations
- Hôpital Beaujon (FR)
- Hôpital Paris Saint-Joseph (FR)
- Inserm (FR)
- Venue
- Diagnostic and Interventional Imaging
- Publisher
- Elsevier BV
- Published
- 2018-03
- Volume
- 99
- Issue
- 3
- Pages
- 123-134
- ISSN
- 2211-5684 (ISSN-L)
- OpenAlex
- W2794163759
- Cited by
- 73
- References
- 67
- Citations by year
- 2026: 10 · 2025: 6 · 2024: 8 · 2023: 8 · 2022: 9 · 2021: 14 · 2020: 14 · 2019: 3 · 2018: 1
- FWCI
- 1.77
- Type
- journal article
- Language
- en
- Update notices
- erratum (2018-05-01)
- Open access
- bronze
- doi.org
- Licence
- Locations
- Diagnostic and Interventional Imaging (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Rheumatology › Omental and Epiploic Conditions
- Keywords
- acute mesenteric ischemia, contrast-enhanced CT, intestinal ischemia, intestinal necrosis, mesenteric vascular occlusion, multidisciplinary management, interventional radiology
- MeSH terms
- Aortography, Arterial Occlusive Diseases, Ascites, Contrast Media, Dilatation, Pathologic, Embolism, Humans, Intestines, Pneumatosis Cystoides Intestinalis, Prognosis, Thrombosis, Tomography, X-Ray Computed, Mesenteric Ischemia
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