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Right-sided colonic ischemia with and without acute mesenteric ischemia

One of the most frustrating calls that I remember getting from ED was related to general confusion between colonic ischemia and acute mesenteric ischemia. It would be a resident calling stating that the Lactate is normal, but “all signs point to mesenteric ischemia” even though there is no abdominal pain, stable vitals, and more often than not no co-morbidities, and reassuring imaging. Which drew my attention to this article, which examined patients with biopsy-proven Right-sided Colonic Ischemia alone or in combination with Acute Mesenteric Ischemia(confirmed by imaging or surgical evaluation of small bowel).

Summary:

  1. IRCI + AMI = disaster. Mortality of ~90%.
  2. BUN and WBC count can be used to differentiate those with acute mesenteric ischemia to those without ( BUN would be high – above 35, and WBCs will be high as well  – above 20). Nothing new here, but nice to see this in another study. We already know that CT alone can be used as well.
  3. 15% of cases of Right-sided Colon ischemia will have Acute Mesenteric Ischemia as well – so look for it, since it is such a disaster, with almost all patients undergoing surgical resection of some sort.
  4.  COPD  may be associated with development of AMI, and poor outcomes in Colonic Ischemia in general.

The article is written by the folks from Connecticut as well as Montefiore Hospital, which bailed out my Medical School recently.

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