SHM Converge Scientific Abstract ePoster Gallery-A Case of Acute Mesenteric Ischemia: A Life-Threatening Catastrophe

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This case report describes a fatal example of acute mesenteric ischemia (AMI), a rare but life-threatening emergency caused by sudden loss of intestinal blood flow. AMI has a very high mortality rate, largely because it is difficult to diagnose early due to nonspecific symptoms and signs.<br /><br />The patient was a 74-year-old woman with a history of colon cancer, urothelial cancer, severe mitral regurgitation, and chronic kidney disease, but no major classic risk factors such as atrial fibrillation or known atherosclerotic disease. She presented with 6 hours of sudden, diffuse abdominal pain that was severe and out of proportion to physical exam findings. Initial labs were mostly normal except for an elevated lactate, which rose further over several hours, increasing suspicion for bowel ischemia.<br /><br />CT angiography showed a nonocclusive thrombus in the superior mesenteric artery extending into proximal branches, along with small amounts of ascites and mesenteric gas. She underwent emergent mechanical thrombectomy followed by exploratory laparotomy, which revealed hemorrhagic ascites and extensive bowel necrosis involving the ileum, right colon, and transverse colon. Because the bowel was nonviable and the disease was advanced, the family chose comfort-focused care, and the patient died within 24 hours.<br /><br />The report emphasizes that early recognition is crucial for survival in AMI. In patients with severe abdominal pain, especially pain out of proportion to exam findings and rising lactate, clinicians should strongly consider AMI even when typical risk factors are absent. Prompt imaging with CTA is essential, and in cases with clear signs of advanced ischemia, surgery may be needed immediately.

Asset Subtitle

Manish Shrestha

Meta Tag

Author List Aamod Tiwari, Manish Shrestha, Salina Munankami, Shefali Amin

Category Clinical Vignettes

Concept Acute Mesenteric Ischemia

Concept Abdominal Pain

Concept CT Angiography

Concept Surgical Intervention

Concept Endovascular Intervention

Distinguished Non-Finalist

Presenter Organization Reading Hospital

Presenting Author Manish Shrestha

Track Adult

Keywords

acute mesenteric ischemia

superior mesenteric artery

bowel necrosis

abdominal pain

elevated lactate

CT angiography

thrombectomy

exploratory laparotomy

intestinal ischemia

mortality

Acute Mesenteric Ischemia

Abdominal Pain

CT Angiography

Surgical Intervention

Endovascular Intervention