Imaging evaluation of patients with clinically suspected mesenteric vascular ischemia. A Prospective Study

Abstract

BACKGROUND: Assessing the role of Multi-Detector Computed Tomographic Angiography and USG doppler in evaluating suspected patients of mesenteric ischemia.

OBJECTIVES:

 1.To determine the role of Colour Doppler and MDCT Angiography in evaluating patients   
    clinically suspected of having mesenteric vascular ischemia.

1. To determine the pattern of mesenteric vascular disorders in our setting.

PARTICIPANTS: Patients with acute abdominal pain with clinical suspicion of mesenteric vascular ischemia.

Study Design This study was a prospective observational Hospital-based study.

METHODS: Patients clinically suspected of mesenteric ischemia underwent Ultrasound (USG) Doppler and contrast-enhanced Computed Tomography (CT). On USG, we assessed any filling defect in Superior Mesenteric Artery (SMA)/Superior Mesenteric Vein (SMV), narrowing or occlusion of the proximal SMA, ascites, gut wall thickening and pneumatosis /portal venous gas. CT Angiography (CTA) was done looking for the presence of any filling defect in SMA/SMV, calibre of SMA/SMV, gut wall thickening, calibre and enhancement, and pneumatosis/portal vein gas.

RESULTS: Arterial obstruction was present in 11.5% of the patients on USG Doppler while it was present in 55% of the patients on CT scan. venous obstruction was present in 14.3% on USG Doppler while it was a CT finding in 37.2%. y ascites as a USG finding was seen in 74.3% of the patients while it was a CT finding in 85.7% of patients Gut distention as USG finding was seen in 20% of the study group while this finding was seen in 27.5% of the study group on MDCT. gut wall thickening as a USG finding was seen in 40% of the study group while as it was seen in 57.2% of the patients on CT scan. Pneumatosis/ portal venous gas was found in 5.7% of the patients on CT scan. None of the USG done could show portal venous gas/pneumatosis. Gut wall enhancement as a CT finding was present in 14(40%) out of total of 35 patients. It was absent in 10 patients (28.5%) while it was decreased in 11 patients (31.5%).

CONCLUSION: Clinico-lab and USG features are non-specific in diagnosing mesenteric ischemia. CT angiography is a sine-qua-non in mesenteric ischemia diagnosis. Patients with venous ischemia respond well to conservative management.

IMPLICATIONS: Early detection of mesenteric ischemia is critical for patient survival, so timely imaging with MDCT Angiography complemented with USG Doppler can be life-saving.