What is the best method to diagnose pain secondary to mesenteric ischemia?
Despite multiple modalities (CT, US, angiography) to assess intestinal vascular flow, high index of suspicion, a careful history, and physical examination remain the best method to diagnose mesenteric ischemia. Pain out of proportion to physical examination is a classic finding. Atrial fibrillation, recent cardiac surgery, and any hypercoagulable state should arouse suspicion. Base deficit from arterial blood gas may reflect ischemia or necrosis, but a normal blood gas or lactate should not delay exploration. Laparoscopy can be helpful if there is not excessive bowel dilation.