2. INTRODUCTION
• Acute Mesenteric Ischaemia is a catastrophic abdominal
emergency characterized by sudden critical interruption
to the intestinal blood flow which commonly leads to
bowel infarction and death.
• It is uncommon but life-threatening disease
• Mortality remains as high
• Prognosis is poor
3. EPIDEMIOLOGY
• The mean incidence of AMI was 6.2 per 100 000 person years.
• On average 5.0 of 10 000 hospital admissions were due to AMI. Occlusive
arterial AMI was the most common form constituting 68.6% of all AMI
cases
• Overall short-term mortality (in-hospital or within 30 days) of AMI – 60%
(Study -Incidence and outcomes of acute mesenteric ischaemia: a systematic
review and meta-analysis - 2021
4.
5. RISK FACTORS
• Older age
• High blood pressure
• Heart disease, including coronary artery disease, heart failure, heart
valve disease, atrial fibrillation
• High cholesterol and triglycerides in the blood
• Cigarette smoke
• Blood that easily clots
• Inflammatory conditions such as pancreatitis
• Rheumatologic conditions called vasculitis
• Use of cocaine
10. DIAGNOSIS
CLASSICAL – Abdominal pain out of proportion to the findings on physical
examination
Diarrhoea
Nausea
Vomiting
Anorexia
Abdominal distention
Melena
SIGNS
Acute abdomen
Distention, guarding, rigidity, hypotension – peritonitis – septic consequences
11. INVESTIGATIONS
• BLOOD TEST:
Most common laboratory abnormalities are:
Haemoconcentration
Leucocytosis (Neutrophilic)
Metabolic acidosis
Other serum markers
Amylase ,ALP
12. • Plain x rays – Non diagnostic
• Ultrasonography – Limited utility in acute mesenteric
ischemia
• CT Scan
• Magnetic resonance angiography- Not a choice in acute
state
• Arteriography – Method of definitive diagnosis
13. • Thumb print sign – Showing Bowel Edema And
Thickening
14.
15.
16. MANAGEMENT
• EFFECTIVE MANAGEMENT
• Early diagnosis
• Aggressive resuscitation
• Early revascularization
• On going supportive care
• Medical treatment
• Surgical treatment
• Endovascular Treatment
17. • Fluid resuscitation
• Systemic anticoagulation – Heparin
• Metabolic acidosis – sodium bicarbonate
• Appropriate antibiotics are given before surgical
exploration.
18. SURGICAL MANAGEMENT
Operative intervention remains the mainstay of management
The surgeon’s goal is to confirm the diagnosis
Assess bowel viability,
Determine the responsible aetiology,
Perform revascularization where possible
Resect nonviable bowel
Endovascular Treatment
Catheter -directed thrombolytic therapy
19. MEDICOLEGAL IMPORTANCE
CAUSE OF SUDDEN DEATH.
Diagnosis can be difficult because
• symptoms are typically non-specific.
• rapid progression
• high associated mortality rate of 60-80 percent
• Early diagnosis and timely surgical intervention are
crucial
20. CASE
• 44-yr /M
• Presenting complaint : severe abdominal pain, vomiting, obstipation
• Past history : COVID infection 2 weeks back
No past medical history of DM, HTM, DLP ,prior thrombotic events.
He is a non-alcoholic and non-smoker.
• Examination : abdomen distended, diffuse tenderness
Bowel sounds absent
Diagnosis : MESENTRIC ISCHEMIA IN POST COVID PATIENT
21. • Acute arterial obstruction of the small
intestinal vessels and mesenteric ischemia
may appear due to hypercoagulability
associated with COVID infection, mucosal
ischemia, viral dissemination, and endothelial
cell invasion
22. CONCLUSION
• Acute Mesenteric Ischaemia is an abdominal emergency both if physical
signs are present or absent.
• We have very less time for investigation, so assessing clinically is
important.
• Every minute we waste is every cm of small bowel we loose.
• Angiography is diagnostic as well as therapeutic.
• Preoperative heparin infusion is a must.
• Still Prognosis is Poor & Mortality is High
