From the classroom to the emergency room, OR and beyond. You're joining Trauma ICU Rounds with your

host, Dr. Dennis Kim. Welcome back to trauma ICU rounds. I'm your host, Dennis Kim. Last week, we

discussed NSTIs, and the term pain out of proportion came up a few times throughout the podcast

and as I was planning this week's episode, I thought that the topic of acute mesenteric

ischemia would be interesting to talk about, particularly given that patients with this

somewhat elusive disease process oftentimes also present with pain out of proportion to physical exam findings.

By the end of the session, you should be able to, number one, understand the pathophysiology

underlying acute mesenteric ischemia.

Number two, discuss the four causes of acute mesenteric ischemia.

Three, describe the initial clinical presentation and diagnostic approach to patients with this

disease process.

And finally, number four, discuss key operative and management strategies for patients with acute

mesenteric ischemia.

Now, acute mesenteric ischemia. Now acute mesenteric is a potentially life-threatening, vascular, and intra-abdominal

surgical emergency associated with significant morbidity.

Despite improvements in our understanding of the path of physiology of AMI, mortality rates remain high between 50 to 80%.

Now, one of the major reasons that mortality remains so high is that there are oftentimes delays, both in terms of diagnosis and definitive management, which really brings home the importance of having

a high index of suspicion, particularly among patients presenting with severe abdominal pain

and risk factors for this particular surgical disease process.

Acute mesenteric ischemia encompasses a variety of pathophysiologic processes, the final pathway of which is bowel necrosis

with associated multiple organ dysfunction syndrome. In order to avoid such complications, early recognition,

combined with reestablishment of flow and source control are critical.

...