QuestionSBA
QuestionChoice
This is not the investigation of choice for acute mesenteric ischaemia. It is useful in cases of suspected bowel obstruction.
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b
Abdominal X Ray
QuestionChoice
This is generally indicated in cases of rectal surgery to visualise whether an anastomosis is intact.
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d
Gastrograffin enema
QuestionChoice
CT angiography is required here to visualise the blood supply to the bowel, there is currently no indication for a full CT-CAP.
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e
CT Chest, abdomen and pelvis
QuestionChoice
There is nothing to suggest a colonoscopy would prove beneficial here with no PR bleeding, unexplained changes in bowel habit or malignancy.
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c
Colonoscopy
QuestionChoice
This is correct. This description is suspicious for acute mesenteric ischaemia with severe pain out of keeping with examination findings and a raised lactate (suggestive of ischaemia) on a background of atrial fibrillation. CT angiography is the preferred imaging modality to assess the blood supply to the bowel.
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a
CT Angiography
QuestionComment
Guarding and rigidity tends to point towards a peritonitic picture. Mesenteric ischaemia would usually find a soft, mildly tender abdomen on examination. 
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User
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JAK Prone
Concept
Chapter
2693
6064
Acute mesenteric ischaemia
Topic
315
Surgery
18087
Acute mesenteric ischaemia presents with severe abdominal pain, often in patients with atrial fibrillation, and is diagnosed using CT angiography.
A 75 year old man comes to the emergency department with excruciating abdominal pain following a meal. An ECG shows an irregularly irregular rhythm with no P waves visible.

Examination demonstrates guarding and rigidity and on VBG his lactate level is raised.

Which of the following investigations is diagnostic of the underlying condition?
a