What Is Acute Mesenteric Ischemia?
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Acute Mesenteric Ischemia - Causes, Symptoms, Diagnosis, and Treatment

Published on Jan 03, 2023 and last reviewed on Sep 06, 2023   -  4 min read


Acute mesenteric ischemia is a disorder due to a sudden decrease in the blood flow to mesenteric vessels. The causes, symptoms, and treatment is explained.


Acute mesenteric ischemia is a condition that occurs due to a sudden incline in the blood flow in the mesenteric vessels. If the condition is not diagnosed on time and treatment is not started, there is necrosis of the small and large intestines seen, which further leads to sepsis and death. Acute mesenteric ischemia is a rapid progression condition that is difficult to diagnose and thus becomes life-threatening. Diagnosing acute mesenteric ischemia is difficult because the symptoms are not very specific. The mortality rate of acute mesenteric ischemia ranges from 60 to 80 percent. Acute mesenteric ischemia is differentiated as occlusive mesenteric ischemia and nonocclusive mesenteric ischemia.

What Are the Types of Acute Mesenteric Ischemia?

Acute mesenteric ischemia is divided into:

1. Occlusive mesenteric ischemia, is further divided into:

2. Nonocclusive mesenteric ischemia.

What Are the Causes of Acute Mesenteric Ischemia?

The underlying conditions behind acute mesenteric ischemia include cardiovascular diseases such as congestive heart failure, atrial fibrillation, and myocardial infarction. Other causes are cardiac emboli, peripheral arterial emboli, or atheromatous plaque, which gets ruptured or dislodged after surgery.

Causes of Occlusive Acute Mesenteric Ischemia:

The causes include atheromatous vascular diseases such as

  1. Atherosclerosis: Accumulating plaque from fats, cholesterol, and other substances in the artery's walls.

  2. Aortic Dissection: Tear of tissue in the inner lining of the main artery aorta.

  3. Aortic Aneurysm: A large bulge in the aorta resembles a balloon and can rupture or dissect.

Other causes of occlusive mesenteric ischemia include decreased cardiac output, which can occur due to secondary causes such as myocardial infarction, dehydration, and congestive heart failure.

Causes of Nonocclusive Mesenteric Ischemia:

It is seen in critically ill patients with several comorbidities and is hemodynamically unstable.

The causes include:

  1. Drugs such as vasopressors and ergotamines reduce blood flow.

  2. Patients who underwent surgery such as cardiac or abdominal surgery recently.

  3. Decreased blood pressure due to severe conditions such as sepsis, congestive heart failure, myocardial infarction, or renal diseases.

What Are the Symptoms Seen in Acute Mesenteric Ischemia?

  • Abdominal pain is the typical symptom of acute mesenteric ischemia, which generally does not resemble the physical examination findings.

  • In cases of embolic thrombosis, there is rapid emptying of the bowel, which is violent, followed by severe abdominal pain.

  • Tenderness is felt on palpation in cases where complete bowel is involved, which further starts necrotizing.

  • The symptoms of embolism thrombosis gradually progress to necrosis and ischemia due to limited collateral blood flow.

  • Patients also complain about other symptoms such as distension, diarrhea, bloody stool, and postprandial pain.

  • Nonocclusive mesenteric ischemia progresses very slowly and is not localized to a place. Its consistency and severity also vary.

  • Patients suffering from nonocclusive mesenteric ischemia are critically ill with conditions such as cardiac disease, septic shock, respiratory failure, and decreased blood pressure.

How to Diagnose Acute Mesenteric Ischemia?

  • Computed tomography angiography is the preferred imaging method in all cases of acute mesenteric ischemia. Acute mesenteric ischemia has a sensitivity of around 94 percent to computed tomography angiography.

  • Catheter-directed angiography was also performed earlier, but it was gradually outdated as the surgical method is a stressful technique in cases of already critical patients.

  • Plain abdominal radiographs, magnetic resonance angiography, and ultrasonography have very narrow indications in cases of acute mesenteric ischemia.

  • The laboratory values and biomarkers for acute mesenteric ischemia do not show any diagnostic traces of the disease.

How to Treat Acute Mesenteric Ischemia?

  • The initial treatment for acute mesenteric ischemia is to correct the electrolyte imbalances and fluid resuscitation. It is important to avoid vasopressors or alpha-adrenergic agents, which can lead to vasospasm.

  • The initial surgical approach is necessary to evaluate the level of ischemia and necrosis. Before the surgery, the administration of broad-spectrum antibiotics is important to prevent abdominal sepsis if the necrotic bowel gets resected.

  • Revascularization (regeneration of blood supply) is the primary goal of surgeries, followed by the removal of necrosed bowel segments.

  • After the revascularization, it is necessary to evaluate the bowel for a few days to check for pulses with the help of a continuous wave doppler, peristalsis movement, and the region's normal color.

  • In cases of occlusive mesenteric ischemia, the surgical intervention depends upon the type and location of vessel occlusion and whether it is open or endovascular. Generally, bowel resection is carried out in first exploratory surgery in almost 31 percent of cases, but in approximately 53 percent of cases, second-outlook surgeries are also performed. Second-look surgeries are performed due to difficulty in assessing the extent of bowel necrosis.

  • In cases of nonocclusive mesenteric ischemia, the treatment is focused on reversing the underlying cause of the ischemia. Catheter-directed papaverine, a phosphodiesterase inhibitor delivered by a side-hole or thrombolysis catheter, is also an interventional option.

Which Diseases Show Symptoms Similar to Acute Mesenteric Ischemia?

The diseases which cause acute abdominal pain are differential diagnostic diseases for acute mesenteric ischemia, such as:

  • Diabetic Ketoacidosis: Production of high levels of ketones in complicated diabetes conditions. The symptoms are nausea, vomiting, and stomach pain.

  • Bowel Obstruction: Blockage in the small or large intestine with bowel obstruction. It leads to acute abdominal pain and cramps.

  • Ruptured Abdominal Aortic Aneurysm: Tear off in one or more walls of the aorta leading to internal bleeding. It causes acute stomach pain, and the condition is fatal.

  • Acute Colitis: Inflammation and soreness of the gastrointestinal tract. It leads to nausea, vomiting, and abdominal pain.

  • Gastrointestinal Perforation: Leakage from any part of the gastrointestinal tract leads to infection and necrosis. This can be a serious condition.

  • Malignancies: Any late-stage cancerous lesion can lead to acute stomach pain and abdominal discomfort, similar to acute mesenteric ischemia.


Acute mesenteric ischemia is a serious condition in which blood flow is restricted to a part of the bowel, which can gradually diffuse and affect the entire bowel. It leads to necrosis, sepsis of the abdomen, and ultimately death if not diagnosed and treated on time. The most common symptom of the disease is acute stomach pain. Treating the condition with surgical intervention is important by resecting the area of infection and necrosis.

Frequently Asked Questions


Can Acute Mesenteric Ischemia Lead to Death?

Acute mesenteric ischemia can lead to death. It is a life-threatening condition that can cause sepsis in the blood. As the blood has chemicals released from the body to fight, as the body starts to overload and overreact to the chemicals, it causes multiple organ failures.


What Are the Acute Mesenteric Ischaemic Diagnostic and Surgical Approaches for the Treatment?

Diagnostic approaches are 
- Angiography, which includes X-rays, MRI (Magnetic resonance imaging), and CT (Computed Tomography) is performed to determine the arteries of the small intestine.
- Doppler ultrasound is a non-invasive test used to determine the blood flow of the arteries of the small intestine.
- Surgical approaches for the treatment: a conservative approach is made by the doctor by placing a stent in the blocked arteries to widen them and provide blood flow to the small intestines.


Does Acute Mesenteric Ischemia Occur After Cardiopulmonary Bypass?

Yes, acute mesenteric ischemia can occur after a cardiopulmonary bypass. Acute mesenteric ischemia is a life-threatening condition that can occur if the blood supply to the small intestine gets blocked. This condition can be seen after going through the cardiopulmonary surgery bypass which can complicate the situation more.


What Are the Complications of Acute Mesenteric Ischemia?

If acute mesenteric ischemia is not treated immediately, it can lead to sepsis, irreversible bowel syndrome, and even death.  Treating conditions like acute mesenteric ischemia immediately after diagnosing it is very important.


What Is the Clinical Presentation of Acute Mesenteric Ischemia?

Clinical presentations of acute mesenteric ischemia are:
- Fever.
- Chills.
- Abdominal pains.
- Urgent need for the bowel.
- Nausea.
- Vomiting.
- Severe and abrupt pains in the stomach.


What Are the Acute Mesenteric Ischemia CT Findings?

Acute mesenteric ischemia is seen on the CT scan as the reduced bowel walls have been enhanced with increased bowel wall attenuation, intramural hemorrhages are decreased, and segmental mesenteric fat stranding and ascites are present on the images. 


How Common Is Acute Mesenteric Ischemia?

Acute mesenteric ischemia is a very life-threatening condition. If it occurs, then it requires immediate attention. Although it is quite rarely found. Nearly 0.9% of the cases admitted to the hospital are due to acute mesenteric ischemia.


Is Acute Mesenteric Ischemia a Fatal Condition?

Yes, acute mesenteric ischemia is a condition where the blood gets blocked and can not supply the small intestine. And basically, it is due to inadequate blood going to the bowels. If such a condition is not treated, it can even lead to death.


What Is the Acute Mesenteric Ischemia Found in a Blood Test?

Although there are no specific tests for acute mesenteric ischemia, the blood test the doctor recommends is the complete blood count (CBC), which can depict the increased levels of white blood cells. The patient can show metabolic acidosis, increased D-dimer, and serum lactate.


What Is the Effect of Acute Mesenteric Ischemia?

The effects of acute mesenteric ischemia are:
- Fever.
- Nausea.
- Vomiting.
- Severe abdominal pains.
- Diarrhea.
- If not treated, it can cause sepsis and death.


Can Acute Mesenteric Ischemia Damage the Intestinal Mucosa and What Will It Lead To?

As acute mesenteric ischemia forms, it will disturb the mucosal barrier and release bacteria and toxins into the systemic circulation. And further, it can cause death from sepsis, cardiac failure, or multiple organ failures.


Is Acute Mesenteric Ischemia Occurring After Cardiopulmonary Bypass?

Yes, acute mesenteric ischemia events can occur after cardiopulmonary bypass surgery. The event is uncommonly found in cases of cardiopulmonary bypass surgery but can be mistaken for acute mesenteric ischemia.


Can Acute Mesenteric Ischemia Lead to Bloody Diarrhea?

Yes, there are many symptoms associated with acute mesenteric ischemia. Some include abrupt abdominal pain, nausea, vomiting, diarrhea, and fever. Yes, diarrhea in acute mesenteric ischemia can also be bloody. 


Is Acute Mesenteric Ischemia an Emergency Condition?

Yes, acute mesenteric ischemia is an emergency. The blood vessels going to the small intestine are blocked and narrowed, so the patient can have a fatal condition if not treated immediately. It can lead to death if emergency surgery is not performed to widen the blocked vessel.

Last reviewed at:
06 Sep 2023  -  4 min read




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