II. Epidemiology
- Age over 60 years
III. Causes
- Superior Mesenteric Artery Embolism (50%)
- Cardiac thrombus source is most common
- Asoociated with other emboli (20%)
- Malignancy
- Coagulation Disorder
- Associated with underlying cardiovascular disease
- Cardiac Arrhythmia
- Myocardial Infarction
- Valvular Disease
- Superior Mesenteric Artery Thrombosis (15-25%)
- Underlying Chronic Mesenteric Ischemia
- Associated conditions
- Abdominal Trauma
- Acute infection
IV. Symptoms
- Vomiting
- Sudden severe Abdominal Pain
- Pain is out of proportion to physical findings
- Forceful bowel evacuation
V. Diagnosis: Classic Triad on presentation
- Cardiac disease
- Acute Abdominal Pain
- Acute gastrointestinal emptying (Vomiting and forceful bowel evacuation)
VI. Labs
-
Metabolic Acidosis
- Acute Abdominal Pain and Metabolic Acidosis is Acute Mesenteric Ischemia until definitively excluded
VII. Imaging
- Abdominal XRay
- Normal initially
- Late findings
- Thumb printing
- Pneumatosis
- Portal venous gas
- Angiography (gold standard)
- CT Abdomen (consider CT Angiography)
- MRA Abdomen
VIII. Management
- Vascular Surgery for embolectomy
- Urokinase
IX. Prognosis
- Mortality: 70-90%
X. References
- Fraboni (2012) Board Review Express, San Jose
