Mesenteric ischemia: what the radiologist needs to know

Abstract

Acute mesenteric ischemia (AMI) is a life-threatening condition that often presents with abdominal pain. Early diagnosis with contrast-enhanced computed tomography and revascularization can reduce the overall mortality in AMI. This article reviews practical etiological classification, pathophysiology of imaging manifestations and common pitfalls in intestinal ischemia.

Amphetamine-induced small bowel ischemia – A case report

“…Contrast-enhanced CT (CECT) showed no occlusion in mesenteric circulation. Furthermore, the patient had no hypovolemia, hypotension, cardiac failure, or no administration of digoxin, which are the most common causes of mesenteric arterial vasoconstriction with a reduction in mesenteric blood supply [7 , 8 , 19] . Although Doppler mode ultrasound can demonstrate proximal mesenteric vessel stenosis or occlusion with a sensitivity and specificity of 85%-90% [20] , this was inconclusive in our obese patient.…”

“…Bowel ischemia can be caused by multiple conditions such as mesenteric arterial or venous occlusion, strangulating bowel obstruction, and hypoperfusion associated with non-occlusive vascular disease [7 , 8 , 11] .…”

“…No solid organ infarction, perforation, pneumatosis intestinalis, superior mesenteric or portal venous gas were noted. However, the CT findings were highly suggestive for NOMI: the dilated, thin-walled, hypoenhancing segment was interpreted as being necrotic, and the wall thickened segment as partially ischemic or initially ischemic with subsequent reperfusion [6] , [7] , [8] ( Fig. 4 ).…”

Pneumatosis intestinalis with pneumoperitoneum: Not always a surgical emergency

“…PI is rare and often localized in the submucosa or subserosa. When combined with pneumoperitoneum, PI usually indicates a surgical emergency [2 , 3] . However, some nonemergency causes that can lead to PI have been described, such as respiratory diseases, systemic diseases, immunodeficiency, after organ transplants, and iatrogenesis [4] , [5] , [6] .…”

“…Pneumoperitoneum refers to the presence of gas in the peritoneal cavity, out of the digestive tract. The presentation of these 2 symptoms together generally suggests the occurrence of life-threatening conditions, such as gastrointestinal perforation, ischemic bowel, and bowel necrosis [1] , [2] , [3] . However, some benign conditions can also cause this phenomenon, such as respiratory diseases, systemic diseases, immunodeficiency, several medications, postoperative, post-transplantation organs, and iatrogenesis [4] , [5] , [6] , [7] .…”