Urgent bowel reperfusion with the goal of infarction prevention is paramount and requires early diagnosis and involvement of Imaging of Mesenteric Ischemia vascular surgery, interventional radiology, and intensive care unit who need to work collaboratively, guiding resuscitation efforts and future treatment. US Duplex Doppler Abdomen The efficacy of ultrasound (US) in diagnosing acute mesenteric ischemia has been evaluated in many studies. US can demonstrate proximal mesenteric vessel thrombosis via Doppler mode and can be used in detecting proximal superior mesenteric and celiac artery stenosis with high sensitivity and specificity of 85% to 90% [63,64]. US may also reveal focal superior mesenteric or portal venous thrombosis in cases of venous occlusive ischemia [65]. Unfortunately, the presence of overlying bowel gas, obesity, and vascular calcifications are challenges for an adequate sonographic evaluation. In addition, duplex US has a limited role in detecting distal arterial emboli or in diagnosing nonocclusive mesenteric ischemia. Moreover, the length of the examination and the possible pain associated with the applied pressure to the abdomen during imaging may be limiting factors in initial evaluation of patients with suspected acute mesenteric ischemia [12,63,66]. Variant 2: Suspected chronic mesenteric ischemia. Initial Imaging. In the setting of chronic mesenteric ischemia, patients classically present with the clinical triad of postprandial abdominal pain 30 to 60 minutes after food consumption, weight loss, and food avoidance. Nausea and vomiting, postprandial diarrhea, early satiety and signs of malabsorption may also be present [12]. In an elderly patient with an underlying atherosclerosis, history of weight loss, and early satiety, chronic mesenteric ischemia should be strongly considered [28]. As with acute ischemia, clinical evaluation alone is insufficient for making the diagnosis of chronic ischemia, and imaging plays a key role for this purpose [67].
Imaging of Mesenteric Ischemia. Urgent bowel reperfusion with the goal of infarction prevention is paramount and requires early diagnosis and involvement of Imaging of Mesenteric Ischemia vascular surgery, interventional radiology, and intensive care unit who need to work collaboratively, guiding resuscitation efforts and future treatment. US Duplex Doppler Abdomen The efficacy of ultrasound (US) in diagnosing acute mesenteric ischemia has been evaluated in many studies. US can demonstrate proximal mesenteric vessel thrombosis via Doppler mode and can be used in detecting proximal superior mesenteric and celiac artery stenosis with high sensitivity and specificity of 85% to 90% [63,64]. US may also reveal focal superior mesenteric or portal venous thrombosis in cases of venous occlusive ischemia [65]. Unfortunately, the presence of overlying bowel gas, obesity, and vascular calcifications are challenges for an adequate sonographic evaluation. In addition, duplex US has a limited role in detecting distal arterial emboli or in diagnosing nonocclusive mesenteric ischemia. Moreover, the length of the examination and the possible pain associated with the applied pressure to the abdomen during imaging may be limiting factors in initial evaluation of patients with suspected acute mesenteric ischemia [12,63,66]. Variant 2: Suspected chronic mesenteric ischemia. Initial Imaging. In the setting of chronic mesenteric ischemia, patients classically present with the clinical triad of postprandial abdominal pain 30 to 60 minutes after food consumption, weight loss, and food avoidance. Nausea and vomiting, postprandial diarrhea, early satiety and signs of malabsorption may also be present [12]. In an elderly patient with an underlying atherosclerosis, history of weight loss, and early satiety, chronic mesenteric ischemia should be strongly considered [28]. As with acute ischemia, clinical evaluation alone is insufficient for making the diagnosis of chronic ischemia, and imaging plays a key role for this purpose [67].