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Last reviewed: 16 Mar 2025
Last updated: 17 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

  • abdominal pain
  • abdominal tenderness
  • presence of risk factors

Other diagnostic factors

  • haematochezia/melaena
  • diarrhoea
  • nausea
  • weight loss
  • abdominal bruit
  • vasculitis
  • light headedness, pallor, dyspnoea
  • food fear (sitophobia)

Risk factors

  • old age
  • history of smoking
  • hypercoagulable states
  • atrial fibrillation
  • myocardial infarction
  • structural heart defects
  • history of vasculitis
  • recent cardiovascular surgery
  • shock
  • congestive heart failure
  • atherosclerosis
  • irritable bowel syndrome
  • colonic carcinoma
  • constipation
  • long-term laxative use
  • use of vasopressors, digoxin, cocaine

Diagnostic investigations

1st investigations to order

  • CT scan with contrast/CT angiogram
  • FBC
  • arterial blood gases and serum lactate
  • urea and electrolytes
  • liver function tests
  • CRP
  • coagulation studies, group and save and crossmatch
  • ECG
  • erect CXR
  • sigmoidoscopy or colonoscopy
  • upper gastrointestinal endoscopy
  • D-dimer

Investigations to consider

  • mesenteric angiography
  • mesenteric duplex ultrasound
  • magnetic resonance angiography
  • amylase
  • studies for ova, cysts, and parasites
  • faecal culture
  • Clostridium difficile toxin assay
  • abdominal x-rays

Treatment algorithm

Contributors

Expert advisers

Jennifer Straatman

Consultant Upper GI surgeon

Queen Alexandra Hospital

Portsmouth

UK

Disclosures

JS declares that she has no competing interests.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:

Alex von Roon, MB, ChB, PhD, FRCS

Clinical Senior Lecturer

Honorary Consultant Colorectal Surgeon

Department of Surgery and Cancer

Imperial College London

London

UK

James Lewis, MBBS, BSc, MRCS

Clinical Research Fellow

Department of Surgery and Cancer

Imperial College London

London

UK

John Abercrombie FRCS

General and Colorectal Surgeon

Queen’s Medical Centre

Nottingham

UK

Disclosures

AVR and JL declare that they have no competing interests. JA is a member of the Council of The Royal College of Surgeons of England and Clinical Lead for General Surgery, Getting It Right First Time. JA provides expert advice regarding suitability of surgical treatments for Spire Healthcare.

Peer reviewers

Frances Howse, MA (Oxon), BM (Hons), FRCS (Eng)

Consultant

Acute and General Surgery

University Hospital Southampton NHS Foundation Trust

Southampton

UK

Disclosures

FH declares that she has no competing interests.

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