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Acute mesenteric ischaemia from superior mesenteric artery embolus — SCE Acute Medicine MCQ

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HardGastroenterology and hepatologyAcute mesenteric ischaemia from superior mesenteric artery embolusSCE Acute Medicine

A patient with atrial fibrillation develops sudden severe abdominal pain out of proportion to mild tenderness, metabolic acidosis and lactate 5.6 mmol/L. What is the next diagnostic step?

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

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Correct answer: D — Obtain CT angiography and urgent vascular assessment

The best answer is “Obtain CT angiography and urgent vascular assessment”. This is correct because the embolic risk, disproportionate pain and metabolic disturbance require immediate arterial imaging and revascularisation planning. Lactate can be late and non-specific, so waiting for peritonism sacrifices bowel. Colonoscopy, plain radiography and non-arterial CT do not adequately define proximal arterial occlusion.

Reference: British Society of Gastroenterology acute lower-GI-bleeding guideline: https://www.bsg.org.uk/clinical-resource/diagnosis-and-management-of-acute-lgi