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Hepatic flexture6/10/2023 ![]() Imaging differential considerations include: Occlusive mesenteric infarction (embolus or thrombosis) has a high mortality rate (~90%) compared to non-occlusive ischemia (~10%). resolution without ongoing complications ~50%.Percutaneous vascular intervention in acute mesenteric artery occlusion is often successful and may involve a combination of thrombus aspiration, thrombolysis and arterial stenting 5. Surgical resection is indicated in cases of peritonitis, perforation, severe sepsis and massive hemorrhage. Symptomatic strictures may also require surgery 9. Mesenteric arterial or venous occlusion can be treated with anticoagulation or thrombolysis, either systemically or locally. Increased uptake of Tc 99m (V) DMSA tracer in the ischemic bowel may be present but is unreliable 4. In mesenteric venous thrombosis, the veins may not be visualized, and collateral venous filling may be seen 7. Otherwise, angiography may show increased arterial caliber, accelerated arteriovenous transit time and dilated draining veins due to the inflammatory response. Angiography (DSA)Ĭan show mesenteric artery occlusion if present. Secondary findings supportive of an ischemic etiology include the presence of parenchymal ischemia/infarction in other abdominal organs, such as the liver, kidneys, and spleen. vascular occlusion (superior or inferior mesenteric artery or vein).pneumoperitoneum / pneumoretroperitoneum.peritoneal free fluid and mesenteric edema.pericolic fluid or fat stranding (common).peritoneal/retroperitoneal cavity findings.low-density ring of submucosal edema between enhancing mucosa and serosa (target sign).bowel wall thickening (common), usually uniform and segmental, rarely localized and mass-like 10.Doppler imaging of the SMA origin can be useful in assessing for stenosesĬontrast enhanced imaging (ideally with an arterial phase) is the modality of choice. ![]()
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