Although we all know the classic presentation of acute mesenteric ischemia (AMI), it can be tough to diagnose.
Some pearls about AMI:
Embolization to the superior mesenteric artery (SMA) is the most frequent cause of AMI.
Most patients present with acute, severe abdominal pain.
Classic presentation: acute severe abdominal pain with a paucity of physical examination findings
Presence of tenderness in most cases indicates bowel infarction has already occurred
The disease may be more insidious in patients with diseased mesenteric vessels (presence of collaterals). These patients may very well NOT present with acute, severe pain.
Must have a high index of suspicion (i.e.-suspect this disease in patients at risk who present with abdominal pain)
If you are standing at the bedside and you say, "Self, this looks like AMI," then rally the troops BEFORE labs and before CT. Get a surgeon to see the patient as soon as possible. Tell them you think the patient has AMI. Get them to move. "TIme is bowel."