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Acute mesenteric ischaemia — SCE Acute Medicine MCQ

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HardAcute Gastrointestinal PresentationsAcute mesenteric ischaemiaSCE Acute Medicine

CT angiography shows a proximal superior mesenteric artery embolus in a patient with severe pain, lactate 6 mmol/L and early peritonism. What is the priority?

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Correct answer: C — Arrange revascularisation and assess bowel viability urgently

The best answer is “Arrange revascularisation and assess bowel viability urgently”. This is correct because acute mesenteric arterial occlusion rapidly progresses to transmural infarction. Endovascular or open revascularisation and operative assessment depend on stability, anatomy and peritoneal signs. Anticoagulation and resuscitation accompany rather than replace source restoration, while colonoscopy and observation waste viable-bowel time.

Reference: European Society for Vascular Surgery mesenteric-artery guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC9580452/