skip to main content

Acute mesenteric ischaemia — SCE Acute Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardAcute GI PresentationsAcute mesenteric ischaemiaSCE Acute Medicine

An 81-year-old woman with atrial fibrillation presents with severe abdominal pain that seems disproportionate to examination findings. Lactate is 5.8 mmol/L, white cell count is 22 x10^9/L and metabolic acidosis is present. CT abdomen without arterial phase is reported as non-specific. What is the most appropriate investigation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Urgent CT angiography of mesenteric vessels

Severe pain out of proportion with lactic acidosis and AF strongly suggests acute mesenteric ischaemia, requiring urgent arterial-phase CT angiography. A non-arterial CT can miss early vascular occlusion. Colonoscopy risks delay and is not first-line in suspected arterial ischaemia. The pearl is to image the vessels when the physiology suggests bowel infarction.

Reference: ESVS mesenteric ischaemia guidance