Acute Mesenteric Ischemia

Neeraja Murali; Sarah Lee; Joseph P Martinez

doi:10.1016/j.emc.2025.09.001

Acute Mesenteric Ischemia

Emerg Med Clin North Am. 2026 May;44(2):249-263. doi: 10.1016/j.emc.2025.09.001. Epub 2026 Feb 19.

Authors

Neeraja Murali¹, Sarah Lee², Joseph P Martinez³

Affiliations

¹ Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: nmurali@som.umaryland.edu.
² Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
³ Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

PMID: 41895876
DOI: 10.1016/j.emc.2025.09.001

Abstract

Acute mesenteric ischemia (AMI) presents variably based on etiology-arterial embolism (often from atrial fibrillation), arterial thrombosis (due to atherosclerosis), mesenteric venous thrombosis (linked to hypercoagulability), or nonocclusive ischemia (from low-flow states in critically ill patients). Diagnosis is confirmed with biphasic multidetector CT angiography. Early recognition is essential, as delayed diagnosis worsens outcomes. Treatment varies from anticoagulation to surgery or endovascular intervention. Resuscitation, rapid diagnosis, and revascularization ("3 R"s) are key. AMI should not be ruled out with normal laboratories if the patient has risk factors for the disease. Multidisciplinary collaboration is crucial to improve outcomes and preserve bowel viability.

Keywords: Acute mesenteric ischemia; Embolus; Nonocclusive; Thrombus.

Publication types

Review

MeSH terms

Acute Disease
Computed Tomography Angiography
Humans
Mesenteric Ischemia* / diagnosis
Mesenteric Ischemia* / etiology
Mesenteric Ischemia* / therapy