Mesenteric ischemia: can multidetector computed tomography angiography be a one-stop diagnostic solution?

Background Mesenteric ischemia is a medical condition in which inflammation and injury of the small intestine result from inadequate blood supply. Mesenteric ischemia is caused by a reduction in intestinal blood flow and is classified as acute (sudden onset of intestinal hypoperfusion) or chronic depending on the time course of symptoms. Multi Detector Computed Tomography MDCT has high sensitivity and specificity for diagnosing acute primary mesenteric ischemia. Aim and objectives Our objective was to evaluate the role of MDCT angiography in evaluation of patients with suspected mesenteric ischemia as regards vascular and intestinal abnormalities. Patients and methods This prospective study was performed on 60 patients clinically suspected of having mesenteric ischemia, referred to the radiology department of Cairo University hospitals from the emergency hospital and the out-patient clinics and in-patient departments of general surgery and of Endemic Infectious diseases and Hepatogastroenterology. Patients suspected clinically to have mesenteric ischemia were initially examined by Doppler and if showed mesenteric vascular suspicious findings by Doppler, they were referred to CT angiography examination. Results In our study we found that 40 patients (66.7%) out of 60 patients showed abnormal MDCT findings which explained the cause of mesenteric ischemia in these patients. The most prevalent CT findings in 40 patients with positive CT angiographic findings in acute mesenteric ischemia (AMI) were bowel wall thickening in 12 patients (30%), bowel distension in 8 patients (20%) and lack of mural enhancement in 10 patients (25%). Computed tomography angiography (CTA) detected accurately the cause of AMI where arterial thrombo-embolism was common cause of AMI (62.5%) and the SMA was the most frequent site in patients with AMI than mesenteric venous thrombosis with AMI (37.5%). 50% of patients with AMI showed pneumatosis intestinalis and surgical exploration revealed bowel infarction and resection anastomosis was done. Conclusion MDCT is fast, safe, accurate and non-invasive imaging modality of choice in patients with suspected mesenteric ischemia which is able to evaluate not only mesenteric vascular structures but also evaluate bowel wall changes and adjacent mesentery, thus detecting the primary cause of mesenteric ischemia that can lead to earlier diagnosis and intervention, also confirmation or exclusion of various other differential diagnoses of acute abdominal conditions.