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Acute mesenteric ischaemia — ESEGH MCQ

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HardLuminal GIAcute mesenteric ischaemiaESEGH

A 74-year-old woman with atrial fibrillation presents with severe abdominal pain out of proportion to examination. Lactate is 5.2 mmol/L, white cell count is 19 x 10^9/L and arterial pH is 7.29. CT angiography shows an embolus in the superior mesenteric artery with reduced enhancement of distal small bowel. What is the most appropriate management?

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Correct answer: C — Urgent vascular and surgical intervention with resuscitation and antibiotics

This is acute mesenteric ischaemia with metabolic acidosis and CT evidence of arterial occlusion, requiring urgent revascularisation assessment and surgery if infarction is suspected. Colonoscopy and capsule endoscopy would delay life-saving treatment. PPI therapy is not relevant to small bowel ischaemia. The pearl is that pain out of proportion plus lactate in an embolic-risk patient is a vascular emergency.

Reference: ESVS Mesenteric Ischaemia Guidance; BSG Acute Abdomen Principles