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Acute mesenteric ischemia — ABEM Board MCQ

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HardGI/Abdominal emergenciesAcute mesenteric ischemiaABEM Board

A 74-year-old man with atrial fibrillation presents as triage level 2 with sudden severe abdominal pain. Exam shows pain out of proportion to tenderness. Lactate is 5.6 mmol/L, WBC 22,000/microL, and CT angiography shows proximal SMA occlusion. Which of the following is the most likely diagnosis?

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Correct answer: A — Acute mesenteric ischemia

Severe pain out of proportion, embolic risk, lactic acidosis, and SMA occlusion are classic for acute mesenteric ischemia.

Reference: ABEM EM Model; vascular surgery mesenteric ischemia guidance