Acute Intestinal Ischemia in Adults: Evidence-Based Emergency Imaging

Acute intestinal ischemia is defined as inadequate blood supply to the gut. It has a high mortality rate, ranging between 32% and 93% depending on etiology. Acute intestinal ischemia may be caused by arterial or venous occlusion or by nonocclusive hypoperfusion states. The incidence increases with age and the majority of patients are over the age of 60. A high index of clinical suspicion is necessary for early detection and treatment of acute intestinal ischemia as signs, symptoms, and laboratory tests for intestinal ischemia are nonspecific. Multidetector computed tomography angiography is highly sensitive and specific in detecting small bowel ischemia and may be used as a first-line imaging method. In patients for whom contrast-enhanced computed tomography is contraindicated, abdominal radiographs are of little value in the diagnosis of intestinal ischemia; however, ultrasound and magnetic resonance angiography may be used as alternative imaging modalities. While surgery is the mainstay of treatment of acute intestinal ischemia, endovascular revascularization can be considered in patients without clinical evidence of peritonitis but with radiological evidence of advanced ischemia and recent onset of symptoms and with a low threshold for converting to open surgery if required.