Acute Mesenteric Ischemia Is a More Common Cause than Expected of Acute Abdomen in the Elderly

Abstract

AMI may be a more common cause of acute abdomen in elderly patients than is generally thought, emphasizing the importance of performing urgent computed tomography with contrast enhancement preferably in arterial and venous phases in these patients.

Acute mesenteric ischemia in elderly patients

“…However, the mean age of the patients, 64 years, was very low compared to the mean age of approximately 80 years in other studies that include unselected patients with AMI (due to arterial occlusive etiology) [1,4]. Thus, the patient population in the Arthurs' study does not represent the majority of AMI patients.…”

“…Acute mesenteric ischemia is more common than expected in the elderly AMI due to arterial occlusive disease is generally considered a rare condition with hospital incidence rates ranging from 4.5 to 5.4 per 100,000 person-years [1][2][3]. On the other hand, it has been shown that AMI is 1.5 times more common abdominal emergency than ruptured abdominal aortic aneurysm [1,4]. Rare or not, AMI should never be overlooked as a possible cause of acute abdomen especially in the elderly.…”

“…The incidence of AMI increases exponentially with age. In patients aged 75 years or older, AMI is a more prevalent cause of acute abdomen than appendicitis [1]. The incidence of AMI is roughly 10-fold in an 80-year-old than in a 60-year-old patient [1,4].…”

Detecting acute mesenteric ischemia in CT of the acute abdomen is dependent on clinical suspicion: Review of 95 consecutive patients

“…age 75 years, AMI is more common than acute appendicitis or ruptured abdominal aortic aneurysm [2]. While it is known that both timely diagnosis and rapid treatment are crucial for patient survival [3][4][5], there are no laboratory tests that would be diagnostic for AMI [6].…”

“…The aims of this retrospective study were (1) to systematically assess the ability of radiologists to detect AMI in a CT of the acute abdomen performed in acute care setting, and (2) to identify factors associated with a missed or delayed diagnosis and patient outcome. For this purpose, we stratified the vascular and intestinal CT findings of AMI subdivided into the various etiologies, and analyzed whether the suspicion of AMI made by the referring physician had any impact on the correct CT diagnosis, and further, we studied which factors were associated with mortality and bowel resection rates.…”