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 22 May 2018

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News

Intestinal ischemia fails to be correctly diagnosed in the emergency department

A significant portion of patients with acute ischemia in the inferior mesenteric artery distribution, who present with GI bleeding, fail to be diagnosed in the emergency department, according to a study in May's Academic Emergency Medicine.

News image

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Researchers from St. Louis, Missouri, USA, determined if emergency physicians are identifying intestinal ischemia as a potential cause of gastrointestinal (GI) hemorrhage.

Failure to diagnosis acute mesenteric ischemia (AMI) in a timely manner may increase morbidity and mortality.

The team conducted a 12-month retrospective chart review of all patients with a primary discharge diagnosis of AMI at their institution.

The number and percent of patients with AMI in the superior mesenteric artery distribution (SMAI) were compared with those with AMI in the inferior mesenteric artery distribution (IMAI).

Of the 100 patients with a discharge diagnosis of AMI, this was the primary diagnosis in 51.

It was found that 28 of the 51 patients had SMAI and 20 had IMAI. A further 1 had celiac ischemia, 1 had both SMAI and IMAI, and 1 presumed ischemia.

The mean age for SMAI and IMAI was 62 and 77 years, respectively.

Only 9% of IMAI patients presenting to emergency department correctly diagnosed.
Academic Emergency Medicine

Of the patients with SMAI, 89% had abdominal pain, compared to 70% patients with IMAI.

In IMAI, 90% of patients had a chief complaint of GI bleeding, compared to 10% with SMAI.

All 20 IMAI patients were guaiac-positive, whereas only 21% SMAI individuals were guaiac-positive.

Furthermore, of 11 IMAI patients presenting to the emergency department, only 1 was correctly diagnosed with AMI.

The authors found that obstructive series were positive in 9 of 21 patients (43%) with AMI, versus computed tomography (CT), which was positive in 21 of 27 patients (77%).

CT was positive in 16 of 19 with SMAI (84%) and 5 of 8 with IMAI (63%).

Brian Sean Ullery, of Washington University, St. Louis, said on behalf of his group, "A significant portion of IMAI patients present with gross GI bleeding and are not diagnosed in the emergency department as having AMI.

"This may delay treatment, and could result in increased morbidity and mortality."

"The diagnosis of AMI should be considered in patients with GI bleeding and risk factors for AMI," he concluded.

Acad Emerg Med 2002; 9(5): 379-80
08 May 2002

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