| Intestinal ischemia | |
|---|---|
| Other names | Bowel ischemia |
 | |
| Computed tomography (CT) showing dilated loops of small bowel with thickened walls (black arrow), findings characteristic of ischemic bowel due to thrombosis of the superior mesenteric vein. | |
| Specialty | General surgery, vascular surgery, gastroenterology |
| Symptoms | Acute: sudden severe pain[1] Chronic: abdominal pain after eating, unintentional weight loss, vomiting[2][1] |
| Usual onset | > 60 years old[3] |
| Types | Acute, chronic[1] |
| Risk factors | Atrial fibrillation, heart failure, chronic kidney failure, being prone to forming blood clots, previous myocardial infarction[2] |
| Diagnostic method | Angiography, computed tomography[1] |
| Treatment | Stenting, medications to break down clot, surgery[1][2] |
| Prognosis | ~80% risk of death[3] |
| Frequency | Acute: 5 per 100,000 per year (developed world)[4] Chronic: 1 per 100,000[5] |
Intestinal ischemia is a medical condition in which injury to the large or small intestine occurs due to not enough blood supply.[2] It can come on suddenly, known as acute intestinal ischemia, or gradually, known as chronic intestinal ischemia.[1] The acute form of the disease often presents with sudden severe abdominal pain and is associated with a high risk of death.[1] The chronic form typically presents more gradually with abdominal pain after eating, unintentional weight loss, vomiting, and fear of eating.[1][2]
Risk factors for acute intestinal ischemia include atrial fibrillation, heart failure, chronic kidney failure, being prone to forming blood clots, and previous myocardial infarction.[2] There are four mechanisms by which poor blood flow occurs: a blood clot from elsewhere getting lodged in an artery, a new blood clot forming in an artery, a blood clot forming in the superior mesenteric vein, and insufficient blood flow due to low blood pressure or spasms of arteries.[3][6] Chronic disease is a risk factor for acute disease.[7] The best method of diagnosis is angiography, with computed tomography (CT) used when that is not available.[1]
Treatment of acute ischemia may include stenting or medications to break down the clot provided at the site of obstruction by interventional radiology.[1] Open surgery may also be used to remove or bypass the obstruction and may be required to remove any intestines that may have died.[2] If not rapidly treated outcomes are often poor.[1] Among those affected even with treatment the risk of death is 70% to 90%.[3] In those with chronic disease bypass surgery is the treatment of choice.[1] Those who have thrombosis of the vein may be treated with anticoagulation such as heparin and warfarin, with surgery used if they do not improve.[2][8]
Acute intestinal ischemia affects about five per hundred thousand people per year in the developed world.[4] Chronic intestinal ischemia affects about one per hundred thousand people.[5] Most people affected are over 60 years old.[3] Rates are about equal in males and females of the same age.[3] Intestinal ischemia was first described in 1895.[1]
- ^ a b c d e f g h i j k l m Bobadilla, JL (August 2013). "Mesenteric ischemia". The Surgical Clinics of North America. 93 (4): 925–40, ix. doi:10.1016/j.suc.2013.04.002. PMID 23885938.
- ^ a b c d e f g h Yelon, Jay A. (2014). Geriatric Trauma and Critical Care (Aufl. 2014 ed.). New York: Springer Verlag. p. 182. ISBN 9781461485018. Archived from the original on 2017-09-08.
- ^ a b c d e f Britt, L.D. (2012). Acute care surgery (1st ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 621. ISBN 9781608314287. Archived from the original on 2017-09-08.
- ^ a b Geoffrey D. Rubin (2012). CT and MR Angiography: Comprehensive Vascular Assessment. Lippincott Williams & Wilkins. p. 318. ISBN 9781469801834. Archived from the original on 2017-09-08.
- ^ a b Gustavo S. Oderich (2014). Mesenteric Vascular Disease: Current Therapy. Springer. p. 105. ISBN 9781493918478. Archived from the original on 2017-09-08.
- ^ Creager, Mark A. (2013). Vascular medicine : a companion to Braunwald's heart disease (2nd ed.). Philadelphia, PA: Elsevier/Saunders. pp. 323–324. ISBN 9781437729306. Archived from the original on 2017-09-08.
- ^ Sreenarasimhaiah, J (April 2005). "Chronic mesenteric ischemia". Best Practice & Research. Clinical Gastroenterology. 19 (2): 283–95. doi:10.1016/j.bpg.2004.11.002. PMID 15833694.
- ^ Liapis, C.D. (2007). Vascular surgery. Berlin: Springer. p. 420. ISBN 9783540309567. Archived from the original on 2017-09-08.