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Acute mesenteric ischaemia — RCPSC EM MCQ

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HardGI/Abdominal emergenciesAcute mesenteric ischaemiaRCPSC EM

A 72-year-old woman with atrial fibrillation develops sudden severe abdominal pain out of proportion to exam. Lactate is 5.4 mmol/L, WBC is 18 x 10^9/L, and creatinine is 86 µmol/L. Abdomen is soft with mild tenderness. What is the most appropriate investigation?

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Correct answer: A — CT angiography of the abdomen and pelvis

Severe pain out of proportion, atrial fibrillation, and high lactate suggest acute mesenteric ischaemia. CT angiography is the key diagnostic study when renal function permits.

Reference: Canadian Association of Radiologists appropriateness guidance; emergency surgery practice