The value of lab findings in early diagnosis of acute mesenteric ischemia

Introduction Acute mesenteric ischemia (AMI) is a life threatening disease and one of the emergency surgery conditions (1). A gradual obstruction, known as chronic mesenteric ischemia does not cause a serious problem because of formation of collateral vessels. However, an acute obstruction of either main mesenteric arteries or even one of the branches causes severe symptoms and needs early intervention (2). Four causes of abdominal ischemia exist including: 1) acute mesenteric arterial embolism, 2) acute mesenteric arterial thrombosis, 3) non-occlusive mesenteric ischemia (systemic hypoperfusion from cardiac failure, sepsis, medications), and 4) mesenteric venous thrombosis (3). Regardless of pathophysiologic cause, AMI leads to the intestinal mucosa flaking after 3 hours of start and whole intestinal thickness infarction after 6 hours and finally perforation and peritonitis (2). Clinically, the most common symptom remains a severe abdominal pain that is not proportional to the amount of tenderness. This pain is typically in colic form and localized in umbilical region. There may be other associated symptoms like nausea, vomiting, and diarrhea. Physical exam in early stage only reveals a mild tenderness (3). Early diagnosis of this condition is difficult. Procedures like plain abdominal x-ray, abdominal ultrasonography, and computed tomography (CT) scan are performed to rule out the other differential diagnosis and are often normal especially in early stages. In patients with unstable hemodynamic and peritonitis symptoms, the first procedure is emergency laparotomy (1,2). Angiography of mesenteric arteries is the most reliOriginal Article Volume 2, Issue 2, 2016, p. 46-49