Muhammad Bilawal Khan Explains AMI: Severe Abdominal Pain That Looks “Simple” Can Be Deadly
Muhammad Bilawal Khan, Senior Registrar General Surgery at Government District Head Quarters Hospital MTI BANNU KPK, posted on LinkedIn:
“Severe Abdominal Pain That Looks ‘Simple’ Can Be Deadly
Not every pain abdomen is benign.
One of the most fatal and often missed causes is Acute Mesenteric Ischemia (AMI) — a true surgical emergency.
Classic Red Flag:
Pain out of proportion to physical findings
Severe abdominal pain with a soft abdomen should immediately raise suspicion.
Common Symptoms
- Sudden severe abdominal pain
- Nausea and vomiting
- Diarrhea or bloody stools
- Abdominal distension (late)
- Fever and shock in advanced stages
High-Risk Patients
- Elderly patients
- Atrial fibrillation
- Recent myocardial infarction
- Heart failure
- Long-term smokers
- Hypercoagulable states
Key Signs
- Disproportionate pain
- Mild tenderness initially
- Guarding and rigidity in late stages
- Absent bowel sounds
- Features of sepsis
Gold Standard Investigation
CT Angiography Abdomen
Supportive findings include raised lactate, metabolic acidosis, leukocytosis and elevated D-dimer.
Management
- Immediate IV fluids and broad-spectrum antibiotics
- Urgent anticoagulation
- Endovascular embolectomy/thrombolysis
- Surgical revascularization and resection of gangrenous bowel if needed
Key Message
Never ignore severe abdominal pain with minimal clinical signs.
Early diagnosis saves bowel — and saves lives.”
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