What are the indications for urgent referral to secondary care for a patient with suspected acute mesenteric ischaemia?

Indications for urgent referral to secondary care in patients with suspected acute mesenteric ischaemia include:

• Severe, constant abdominal pain, especially if disproportionate to physical findings.
• Signs of peritonitis such as abdominal rigidity and guarding, which may indicate bowel infarction or perforation.
• Systemic signs of sepsis or shock, including altered mental state, hypotension, tachycardia, and reduced urine output.
• Evidence of intestinal obstruction, such as absolute constipation, vomiting, or abdominal distension.
• Raised inflammatory markers or metabolic acidosis on blood tests, which suggest ongoing ischaemia or infarction.

Patients presenting with these features require same-day hospital assessment and urgent imaging, typically contrast-enhanced CT, to confirm diagnosis and guide management.

Early recognition and referral are critical due to the high morbidity and mortality associated with acute mesenteric ischaemia.

Note: While the provided context does not explicitly list acute mesenteric ischaemia referral criteria, the indications for urgent referral in acute abdominal emergencies with suspected ischaemia or infarction (such as complicated diverticulitis) overlap significantly and are applicable by analogy in clinical practice.