Acute Mesenteric Ischemia

Although we all know the classic presentation of acute mesenteric ischemia (AMI), it can be tough to diagnose.

Some pearls about AMI:

• Embolization to the superior mesenteric artery (SMA) is the most frequent cause of AMI.
• Most patients present with acute, severe abdominal pain. 
• Classic presentation: acute severe abdominal pain with a paucity of physical examination findings
• Presence of tenderness in most cases indicates bowel infarction has already occurred
• The disease may be more insidious in patients with diseased mesenteric vessels (presence of collaterals). These patients may very well NOT present with acute, severe pain.
• Must have a high index of suspicion (i.e.-suspect this disease in patients at risk who present with abdominal pain)
• If you are standing at the bedside and you say, "Self, this looks like AMI," then rally the troops BEFORE labs and before CT. Get a surgeon to see the patient as soon as possible. Tell them you think the patient has AMI. Get them to move. "TIme is bowel."