try this then - cemmsk

[ArchivalUser]

cemmsk, can you please post the explaination why CT is the answer.

Per NE journal of medicine, the best feasible Dx test is CT for mesenteric thrombosis . Angiography is cumbersome and the equipment is not available everywhere...thus though it is a gold standard, rarely it is done in reality as the regular test.

Once CT confirms the dx and then laparotomy could be followed...

[ArchivalUser]

I mean why CT is not the answer?

[ArchivalUser]

the answer to the second Q is sigmoidoscopy, it reveals friability and bulgind folds from submucosa. angiography is not helpful in the diagnosis of ischemic colitis becouse ischemic colitis is almost always non occlusive ( this is in contrast to acute mesenteric ischemia.)

dear QUANSAR the Q and explenation is from harrison: it says: patients suspected of having acute arterial mesenteric embolus should undergo immediate celiac and mesenteric angiography to localize the embolus , followed by embolectomy.

you know sometimes the practical recommendations may deviate from the classical approaches, that may be the case with the paper you have read.

[ArchivalUser]

THANKS cemmsk.

here is what I found on emedine, which is consistent to what New England journal of medicine (not paper but a review) said that CT should be the better one.

An arteriogram may show vasospasm, contrast in the bowel lumen, nonvisualized venous system, reflux of contrast into the aorta, and, finally, absent flow to necrotic bowel areas.

CT scanning and angiography have proven equally reliable in helping confirm the diagnosis of acute venous occlusion, although some researchers consider CT scanning to be the diagnostic test of choice.

CT angiography and gadolinium-enhanced magnetic resonance angiography enable volumetric acquisitions with the patient holding only a single breath, and they offer excellent diagnostic capabilities for patients with venous thrombosis

[ArchivalUser]

CEM thanks, you cleared a topic forme that I didnt know I was confused about!

[ArchivalUser]

Quansar the situation resembles the case in PTE. CT is increasingly being used and is equivocal even superior than VQ scan but the classical algorithm incorporates the VQ scan. I think I would go with angio if I encounter a Q about mesenter embolus rather than CT.

[ArchivalUser]

cemmsk, I agree with you. now since the q is from harrison I would say it is pretty convincing. I will consider CT in real practice but for exam purpose I will do angiography..

Thanks for the q. This sounds pretty H/Y

[ArchivalUser]

I feel the same, but he said its from harrisons.