What are the key clinical features that suggest acute mesenteric ischaemia in a patient presenting with abdominal pain?

Key clinical features suggesting acute mesenteric ischaemia in a patient presenting with abdominal pain include:

• Sudden onset of severe abdominal pain that is often disproportionate to physical examination findings, meaning the abdomen may appear soft with minimal tenderness despite intense pain reported by the patient.
• History of cardiovascular risk factors such as atrial fibrillation, recent myocardial infarction, or peripheral arterial disease, which predispose to embolic or thrombotic events causing mesenteric ischaemia.
• Associated symptoms may include nausea, vomiting, and diarrhoea, sometimes with blood in stools as the ischaemia progresses.
• Signs of systemic illness such as tachycardia, hypotension, and signs of sepsis may develop as bowel necrosis ensues.
• Metabolic acidosis and elevated lactate levels on blood tests can support the diagnosis, reflecting tissue hypoperfusion and necrosis.

These features align with the UK clinical emphasis on recognising severe, sudden abdominal pain with minimal examination findings and relevant vascular history as red flags for acute mesenteric ischaemia ¹. The literature further supports the importance of disproportionate pain and systemic signs as key diagnostic clues (Sreenarasimhaiah, 2005).