Summary
Definition
History and exam
Key diagnostic factors
- dor abdominal
- desconforto abdominal
Other diagnostic factors
- hematoquezia/melena
- diarreia
- perda de peso
- sopro abdominal
- vasculite
- tontura, palidez, dispneia
- fobia alimentar (sitofobia)
Risk factors
- pacientes de idade avançada
- história de tabagismo
- estados hipercoaguláveis
- fibrilação atrial
- infarto do miocárdio
- defeitos estruturais do coração
- história de vasculite
- aterosclerose
- cirurgia cardiovascular recente
- choque
- insuficiência cardíaca congestiva
- síndrome do intestino irritável
- carcinoma colônico
- constipação
- uso prolongado de laxantes
- uso de vasopressores, digitálicos e cocaína
Diagnostic investigations
1st investigations to order
- angiotomografia
- Hemograma completo
- perfil bioquímico incluindo proteína C-reativa
- painel da coagulação, tipo e rastreamento, prova cruzada
- gasometria arterial/nível de lactato
- eletrocardiograma (ECG)
- radiografia torácica ortostática
- radiografias abdominais
- sigmoidoscopia ou colonoscopia
- endoscopia digestiva alta
Investigations to consider
- angiografia por ressonância magnética
- angiografia mesentérica
- ultrassonografia duplex mesentérica
Emerging tests
- espectroscopia de infravermelho próximo abdominal
Treatment algorithm
evidência de infarto, perfuração ou peritonite
sem evidência de infarto, perfuração ou peritonite
isquemia mesentérica crônica
isquemia colônica não aguda
Contributors
Authors
Monjur Ahmed, AGAF, FACG, FACP, FASGE, FRCP, MD, MRCP
Professor of Medicine
Thomas Jefferson University
Gastroenterologist
Thomas Jefferson University Hospital
Philadelphia
PA
Disclosures
MA declares that he has no competing interests.
Acknowledgements
Dr Monjur Ahmed would like to gratefully acknowledge Dr Alex von Roon, Dr James Lewis, Dr Amir Bastawrous, Dr Jennifer Holder-Murray, and Dr Alessandro Fichera, previous contributors to this topic.
Disclosures
AVR, JL, AB, JHM, and AF declare that they have no competing interests.
Peer reviewers
Eli D. Ehrenpreis, MD
Professor of Medicine
Rosalind Franklin University Medical School
Chicago
IL
Disclosures
EDE declares that he has no competing interests.
Andrew Poullis, BSc, MBBS, MD, FRCP
Consultant Gastroenterologist
St George’s Hospital
London
UK
Disclosures
AP declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Brandt LJ, Feuerstadt P, Longstreth GF, et al. ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI). Am J Gastroenterol. 2015 Jan;110(1):18-44.Full text Abstract
Bala M, Catena F, Kashuk J, et al. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2022 Oct 19;17(1):54.Full text Abstract
Björck M, Koelemay M, Acosta S, et al. Editor's choice - management of the diseases of mesenteric arteries and veins: clinical practice guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017 Apr;53(4):460-510.Full text Abstract
American College of Radiology. ACR appropriateness criteria: radiologic management of mesenteric ischemia. 2022 [internet publication].Full text
Tilsed JV, Casamassima A, Kurihara H, et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg. 2016 Apr;42(2):253-70.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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