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Mesenteric ischaemia — MCCQE Part 1 MCQ

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HardAbdominal PainMesenteric ischaemiaMCCQE Part 1

A 79-year-old woman with atrial fibrillation develops abrupt severe abdominal pain out of proportion to examination. Lactate is elevated, and CT angiography shows an embolic superior mesenteric artery occlusion without free perforation. What is the most appropriate immediate management?

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Correct answer: D — Resuscitate, give antibiotics and heparin if appropriate, and pursue urgent revascularization with surgical assessment

Acute mesenteric ischemia is a time-critical vascular and surgical emergency. Begin fluid resuscitation and correction of metabolic abnormalities, administer broad-spectrum antibiotics early because mucosal barrier failure promotes bacterial translocation, and use full-dose unfractionated heparin unless contraindicated. Urgently involve vascular, endovascular, and general surgical expertise to restore mesenteric blood flow and assess bowel viability; resect clearly nonviable bowel. Endovascular revascularization is preferred for arterial occlusion when suitable expertise and anatomy are available, but overt peritonitis mandates prompt operative exploration. Waiting for peritoneal signs allows progression to infarction and worsens survival. Colonoscopy, laxatives, and acid suppression neither restore perfusion nor address the risk of necrotic bowel.

Reference: World Society of Emergency Surgery, Acute Mesenteric Ischemia Updated Guidelines: https://pmc.ncbi.nlm.nih.gov/articles/PMC9580452/