Zusammenfassung
Trotz Fortschritten in der Diagnostik und Therapie bleibt die akute mesenteriale Ischämie
eine lebensbedrohliche Situation. Die Minderdurchblutung des Darms erfordert ein rasches
Handeln, die korrekte Diagnosestellung ist jedoch aufgrund der unspezifischen klinischen
Präsentation oft schwierig. Dieser Beitrag liefert einen Überblick zu Ätiologie, bildmorphologischer
Präsentation und (seltenen) Differenzialdiagnosen der mesenterialen Ischämie.
Abstract
Despite diagnostic and therapeutic improvement over the past years, acute mesenteric
ischaemia remains a life-threatening state due to decreased bowel perfusion necessitating
immediate management with reported mortality rates of 50 – 90%. Highest prevalence
is seen in the elderly population, where comorbidities negatively influence the mortality
rate. Acute mesenteric ischaemia is caused by occlusive or non-occlusive conditions.
Arterial embolism accounts for the majority of all cases with 40 – 50%, followed by
arterial thrombosis (20 – 30%) and non-occlusive acute mesenteric ischaemia (NOMI)
(20 – 30%). Mesenteric and portal venous thrombosis (5 – 10%) are less frequent. In
terms of diagnosis, CT has become the first line imaging technique replacing angiography.
However, clinical symptoms, laboratory presentation and imaging findings are often
unspecific, so that they may simulate other intestinal diseases. Early diagnosis is
but essential for patientsʼ prognosis. There exist numerous differential diagnoses,
among which a review on common imaging manifestations and a number of rare findings
are presented in this paper. The recognition of characteristic imaging appearances
and uncommon differential diagnoses is essential for accurate interpretation and timely
management of this acute condition.
Schlüsselwörter
mesenteriale Ischämie - vaskuläre Okklusion - nicht okklusive mesenteriale Ischämie
(NOMI) - Computertomografie (CT)
Key words
mesenteric ischaemia - vascular occlusion - non-occlusive mesenteric ischaemia (NOMI)
- computed tomography (CT)
