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Mesenteric ischaemia — MCCQE Part 1 MCQ

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HardAbdominal PainMesenteric ischaemiaMCCQE Part 1

82-year-old woman with atrial fibrillation presents with sudden severe abdominal pain. Examination is initially relatively benign but lactate is elevated. Which of the following is the most appropriate next step?

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Correct answer: E — Obtain urgent CT angiography and surgical/vascular consultation

Obtain urgent CT angiography and surgical/vascular consultation is best because pain out of proportion in AF suggests acute mesenteric ischaemia. Discharge with oral analgesia only is suboptimal because analgesia alone may mask a surgical emergency; Delay surgical assessment until routine clinic is suboptimal because time-sensitive surgical presentations require urgent assessment; Treat with laxatives or antacids as sole therapy is suboptimal because a benign gastrointestinal explanation does not account for the red flags; Perform an invasive bedside procedure without imaging or senior input is suboptimal because invasive treatment can worsen outcomes when anatomy or diagnosis is uncertain. Early examination can be deceptively normal.

Reference: Canadian vascular surgery guidance