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Acute mesenteric ischaemia — RCPSC EM MCQ

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HardGI/Abdominal emergenciesAcute mesenteric ischaemiaRCPSC EM

A 78-year-old with atrial fibrillation has sudden severe abdominal pain out of proportion to examination, lactate 5.2 mmol/L and a soft abdomen. What is the most appropriate diagnostic action?

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Correct answer: D — Obtain CT angiography with urgent surgical or vascular input

The best answer is “Obtain CT angiography with urgent surgical or vascular input”. Acute mesenteric ischaemia is strongly suggested by abrupt pain out of proportion with embolic risk from AF. CT angiography is the diagnostic gold standard and should be pursued urgently, with early surgical or vascular involvement because bowel infarction can develop before peritonitis. Observation, oral rehydration, duplex and colonoscopy delay the needed arterial evaluation.

Reference: Emergency Care BC: Mesenteric Ischemia: https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/