In spite of all our technological advances in medicine, mesenteric ischemia remains a very difficult disease process to identify.  Often patients will present with vague and variable signs and symptoms such as poorly localized abdominal pain, nausea, vomiting, and diarrhea.  These non-specific signs and symptoms can be associated with an extremely wide variety of abdominal pathologies including, but not limited to, abdominal aortic aneurysm, volvulus, perforated viscus, incarcerated hernia, appendicitis, biliary colic, and renal colic.  It is no wonder that the vague findings and broad differential for mesenteric ischemia can frustrate physicians and lead them down an incorrect diagnostic path.

The delay in diagnosis of mesenteric ischemia can be disastrous.  If mesenteric ischemia is not considered early in the patient’s Emergency Department (ED) presentation, then the intestines will rapidly become gangrenous leading to multisystem organ failure, sepsis, and eventual death.  The difficulty in early diagnosis is why the morbidity and mortality rates for mesenteric ischemia still remain high today.

Luckily, mesenteric ischemia is not a common disease as it is only seen in 0.1% of hospital admissions and 1% of ED visits.  However, the incidence may be rising because of an aging population with significant co-morbidities such as arrhythmia, atherosclerosis, congestive heart failure, and hypercoagulability.  The main goal is to identify mesenteric ischemia early in undifferentiated abdominal pain patients so that rapid revascularization to the mesentery can be achieved preventing bowel infarction and its subsequent complications.