A 76-Year-Old Woman With Abdominal Pain

Craig A. Goolsby, MD


October 02, 2017


The patient in this case had many factors in her history and physical examination that raised concern for mesenteric ischemia. She had sudden, poorly localized abdominal pain that seemed subjectively much worse than her abdominal examination suggested. She also had atrial fibrillation and known vascular disease, with admitted poor treatment compliance. CT angiography showed an embolus in the patient’s superior mesenteric artery (Figure 2), with perienteric fat stranding, ascites, and wall thickening (Figure 3), as well as pneumatosis intestinalis and superior mesenteric vein (SMV) air (Figure 1) and portal venous air (Figure 4). While treatment options for mesenteric ischemia vary, an emergency vascular surgery consultation is required to arrange definitive care and early treatment of this potentially catastrophic condition.

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Acute mesenteric ischemia (AMI) is a relatively uncommon condition that affects an estimated 0.1% of all hospital admissions.[1] AMI comprises 4 clinical entities: mesenteric venous thrombosis (MVT), acute mesenteric arterial thrombosis (AMAT), acute mesenteric arterial embolus (AMAE), and nonocclusive mesenteric ischemia (NOMI). Occlusive mesenteric arterial ischemia (OMAI) is an umbrella term that includes both AMAT and AMAE.[1] The final common pathway of these entities is bowel ischemia, eventually leading to bowel wall gangrene.[1] It can be a difficult disease to diagnose and treat, and it has a poor prognosis, with mortality rates ranging from 60%-100%.[2]


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