Mesenteric Ischemia, because of its varied clinical presentations is most often difficult to diagnose. In many advanced countries, CT scan with contrast is "the" investigation for patients with acute abdomen. However, in majority of countries even today ultrasound is the first imaging modality in any patient presenting with acute abdomen. An alert sonologist can potentially think of mesenteric ischemia by observing several signs on grey scale and colour Doppler.

The grey scale findings could include distended bowel loops, free peritoneal fluid with internal echoes or focal bowel wall thickening. We have seen patients presenting with infarcts in the liver and spleen on grey scale. Patients with acute mesenteric ischemia can also present to the sonologist with air in the portal radicles, intestinal walls and in the peritoneal cavity.
Colour Doppler findings in acute mesenteric ischemia are variable -- including difficulty in evaluating the vessels, demonstration of actual thrombus in mesenteric artery or vein to vaso-spastic SMA.
In chronic mesenteric ischemia, colour Doppler offers more definitve diagnosis. It is also useful in evaluating these patients after invasive procedures.

A spectrum of grey scale and colour Doppler findings in acute and chronic mesenteric ischemia are presented in this talk.