Chronic Mesenteric Ischemia: What Clinical Features Lead to the Diagnosis of CMI? Can This Diagnosis Be Made in the Emergency Department? What Is the Appropriate Disposition?

Abstract

Chronic mesenteric ischemia (CMI) is a rare disease. The classic presentation is intermittent abdominal pain in an elderly female patient with long-term smoking history and extensive atherosclerotic disease. Due to inadequate blood flow to meet intestinal metabolic demands, chronic mesenteric ischemia often causes abdominal pain several hours after eating. As disease progresses, patients report diarrhea, weight loss, and large meal aversion. Chronic mesenteric ischemia is difficult to diagnose in the emergency department due to nonspecific symptoms and exam findings that trigger work-ups for other acute causes of abdominal pain in the elderly. CT angiography is the most common imaging modality used for diagnosis and is readily available in most emergency departments, making the diagnosis of CMI possible in the acute care setting. Patients diagnosed with chronic mesenteric ischemia can often be discharged with vascular surgery follow-up and dietary modification instructions, though patients with failure to thrive and/or symptoms at rest warrant admission for further treatment and evaluation.