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Acute mesenteric ischaemia — RCPSC EM MCQ

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HardGI/Abdominal emergenciesAcute mesenteric ischaemiaRCPSC EM

A 73-year-old woman with atrial fibrillation develops sudden severe abdominal pain after lunch. She is afebrile, heart rate is 118/min and abdomen is soft with mild diffuse tenderness. Lactate is 5.1 mmol/L, WBC is 17 x 10^9/L and venous blood gas shows metabolic acidosis. What is the most appropriate investigation?

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

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

Pain out of proportion to examination with atrial fibrillation, lactic acidosis and leucocytosis suggests acute mesenteric ischaemia. CT angiography is the key investigation if the patient can be moved safely; resuscitation and surgical/vascular consultation should proceed in parallel.

Reference: Canadian Association of Radiologists appropriateness guidance; Rosen's Emergency Medicine