Mesenteric Ischemia: Predicting Problems

BackgroundMesenteric ischemia is an uncommon diagnosis that is often overlooked until patients present with non-salvageable bowel. Our objective was to identify risk factors for mesenteric ischemia, clinical warning signs, and imaging findings that could suggest earlier diagnosis and intervention.MethodsWe queried our health system's electronic health record (EHR) to identify patients with ischemic bowel and/or a diagnosis of mesenteric ischemia between November 2013 and December 2020. Using stringent exclusion criteria, we included patients whose event was likely caused by atherosclerotic disease. From the EHR, we abstracted these patients' comorbidities and symptoms from the previous 6 months. We evaluated relevant computed tomography scans (CTs) obtained up to 2 years prior to admission and graded stenosis of the celiac artery and the superior mesenteric artery (SMA).ResultsForty-five patients met inclusion criteria. The most prevalent comorbidities were hypertension, hyperlipidemia, and heart disease. Over half of the patients in the cohort had mentioned suspicious abdominal symptoms during the 6 months preceding admission. Of the patients who had a CT within the 2 years prior to admission, there was discordance between the formal interpretations and independent reviews with significant stenosis being noted more commonly on independent review. Furthermore, in-hospital mortality was significantly higher when pre-presentation imaging noted SMA stenosis >70%.DiscussionThese data suggest that patients who were at risk of developing mesenteric ischemia had underlying vascular disease, a history of concerning symptoms, and prior CT imaging consistent with mesenteric atherosclerotic disease which could potentially be acted upon before the manifestation of an acute event.