Acute Mesenteric Ischemia Is a More Common Cause than Expected of Acute Abdomen in the Elderly

Abstract

Background: The incidence of acute mesenteric ischemia (AMI) increases exponentially with age. The significance of AMI as a differential diagnosis in elderly patients with acute abdomen may be underestimated.

Methods: Consecutive patients hospitalized for AMI between 2009 and 2013 were retrospectively identified in a well-defined population. Acute appendicitis, ruptured abdominal aortic aneurysm, acute pancreatitis, and acute cholecystitis were used as reference diagnoses, and the age-specific incidence rates were calculated. In addition, long-term mortality risk was assessed for AMI survivors.

Results: The in-hospital incidence rates of AMI, acute obstructive mesenteric ischemia, and non-obstructive mesenteric ischemia were 7.3, 4.5, and 2.0/100,000/year, respectively. AMI was more common than ruptured abdominal aortic aneurysm, and the age-specific incidence of AMI was higher than the incidence of acute appendicitis in patients over age 75 years with acute abdomen. During the follow-up, the age-adjusted risk of death was 1.8 times higher in AMI survivors than in survivors of acute cholecystitis.

Conclusion: AMI may be a more common cause of acute abdomen in elderly patients than is generally thought, emphasizing the importance of performing urgent computed tomography with contrast enhancement preferably in arterial and venous phases in these patients.