Mesenteric ischemia: a radiologic perspective
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REVIEW
Mesenteric ischemia: a radiologic perspective Dimpi Sinha1 · Sudhir Kale1 · Nischal G. Kundaragi2 · Sukrity Sharma1 Received: 17 September 2020 / Revised: 9 November 2020 / Accepted: 13 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Mesenteric ischemia is a broad term encompassing several clinical conditions leading to impaired vascularity of bowel loops. Absence of specific clinical presentation and a definitive laboratory marker often lead to delayed diagnosis with high morbidity and mortality in the acute setting. Imaging plays a crucial role in the diagnosis and management. Multi-detector CT (MDCT) is the first line imaging modality for the evaluation of patients with suspected mesenteric ischemia and plays an important role for assessing its severity and complications. This review article highlights the causes, pathophysiology, imaging features and possible endovascular treatment options of mesenteric ischemia. Keywords Mesenteric ischemia · Thrombosis · Embolism · Superior mesenteric artery · Superior mesenteric vein · Infarction · MDCT
Introduction Mesenteric ischemia is an uncommon condition resulting from inadequate arterial supply in the splanchnic circulation or deficient venous return, leading to bowel ischemia. Acute mesenteric ischemia (AMI) is a potentially life threatening condition. Clinical presentation is non-specific and may mimic other causes of abdominal pain. Currently, no specific laboratory test is available which can accurately detect acute mesenteric ischemia. Owing to these factors, clinical diagnosis is challenging. Delayed diagnosis leads to considerable morbidity and mortality. The mortality rate in AMI has consistently been reported to be as high as 50–69% [1–3]. This review article highlights the causes,
* Dimpi Sinha [email protected] Sudhir Kale [email protected] Nischal G. Kundaragi [email protected] Sukrity Sharma [email protected] 1
Department of Radiology, Aster CMI Hospital, Airport Road, Bangalore 560092, India
Department of Interventinal Radiology at Aster CMI Hospital, 560092, Airport road, Bangalore, India
2
pathophysiology, imaging features and possible endovascular treatment options of mesenteric ischemia.
The splanchnic circulation The splanchnic arterial circulation consists of the three main ventral branches of the abdominal aorta—the coeliac axis (CA), the superior mesenteric (SMA) and the inferior mesenteric arteries (IMA) (Fig. 1a, b). The coeliac axis divides into the common hepatic, the left gastric and the splenic artery. The common hepatic in turn gives rise to the hepatic artery proper and the gastroduodenal artery (Fig. 1a). The left gastric artery supplies the lesser curvature of the stomach. The gastroduodenal artery gives rise to the right gastric artery (which supplies the greater curvature of the stomach) and the superior pancreaticoduodenal artery. The superior pancreaticoduodenal artery forms an arterial arcade with the inferior pancreaticoduodenal arter
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