Frimley Guidelines

Mesenteric Ischaemia/Infarction

Key Points

  • This describes abdominal pain caused by the interruption of blood flow to the mesentery, usually by thromboembolic disease.

  • Typically occurring in elderly patients with CVD risk factors.

  • Classic feature is that symptoms usually exceed physical signs.

Abbreviations

ABCABC (airway, breathing, circulation etc approach. ATLS methodology)
ATLSAdvanced trauma and life support
AXRAbdominal X-Ray
CVDCardiovascular disease
DREDigital rectal examination
WCCWhite cell count

Presentation

  • Severe diffuse abdominal pain which may radiate to the back.
  • Abdominal pain, often in the absence of peritonitis, unless there is concomitant bowel perforation.
  • Vomiting.
  • Bloody diarrhoea.
  • Usually in elderly with CVD risk factors.
  • Pain exceeds the physical signs.

Investigations

  • Very elevated WCC
  • Raised amylase
  • Raised D-Dimer (sensitive but not specific, i.e., normal results=very unlikely ischaemia)
  • DRE
  • Metabolic acidosis
  • Bowel dilatation on AXR

Management

  • ABCDE
  • Oxygen
  • Fluids
  • Analgesia
  • Urgent senior review
  • Antibiotics, consider heparin
  • Discussion with Radiology
  • MDT discussion with EST / Anaesthetics / Critical Care