Mesenteric ischemia CT

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Computerised axial tomographic angiography should be performed as soon as possible in order to diagnose mesenteric ischemia becasue of its ability to define the arterial anatomy and demonstrate the site of occlusion.

• Computerised axial tomographic angiography (CTA) without intravenous contrast should be the first investigation done for the diagnosis of mesenteric ischemia regardless of the etiology.^[1][2]
• Intravenous contrast is avoided for the following reasons:^{[3][4][5][6][7][8][9]}
  • It can obscure the vessels
  • Delays the diagnosis
  • Hides the bowel wall enhancement
• CTA shows the following findings consistent with mesenteric ischemia, which are as follows:^{[10][11][12][13][14]}

Early radiological features:

• • Bowel dilation
  • Focal or segmental bowel wall thickening
  • Mesenteric stranding

Late radiological features:

• • Intestinal pneumatosis (presence of air within the bowel wall)
  • Portal venous gas
• Following radiological features are seen on CTA in mesenteric ischemia of different etiologies:^[15][8]