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Intestinal ischemia

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569: 725:, where there is no blockage of the arteries supplying the bowel, the treatment is medical rather than surgical. People are admitted to the hospital for resuscitation with intravenous fluids, careful monitoring of laboratory tests, and optimization of their cardiovascular function. NG tube decompression and heparin anticoagulation may also be used to limit stress on the bowel and optimize perfusion, respectively. 51: 709:
As the cause of the ischemia can be due to embolic or thrombotic occlusion of the mesenteric vessels or nonocclusive ischemia, the best way to differentiate between the etiologies is through the use of mesenteric angiography. Though it has serious risks, angiography provides the possibility of direct
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supply. It can come on suddenly, known as acute intestinal ischemia, or gradually, known as chronic intestinal ischemia. The acute form of the disease often presents with sudden severe abdominal pain and is associated with a high risk of death. The chronic form typically presents more gradually with
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levels. The first device approved by the U.S. FDA (in 2004) used visible light spectroscopy to analyze capillary oxygen levels. Use during aortic aneurysm repair detected when colon oxygen levels fell below sustainable levels, allowing real-time repair. In several studies, specificity has been 83%
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Acute intestinal ischemia affects about five per hundred thousand people per year in the developed world. Chronic intestinal ischemia affects about one per hundred thousand people. Most people affected are over 60 years old. Rates are about equal in males and females of the same age. Intestinal
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In very early or very extensive acute intestinal ischemia, elevated lactate and white blood cell count may not yet be present. In extensive mesenteric ischemia, bowel may be ischemic but separated from the blood flow such that the byproducts of ischemia are not yet circulating.
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may also be used to remove or bypass the obstruction and may be required to remove any intestines that may have died. If not rapidly treated outcomes are often poor. Among those affected even with treatment the risk of death is 70% to 90%. In those with chronic disease
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Surgical revascularisation remains the treatment of choice for intestinal ischaemia related to an occlusion of the vessels supplying the bowel, but thrombolytic medical treatment and vascular interventional radiological techniques have a growing role.
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In embolic acute intestinal ischemia, CT-Angiography can be of great value for diagnosis and treatment. It may reveal the emboli itself lodged in the superior mesenteric artery, as well as the presence or absence of distal mesenteric branches.
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Regarding intestinal arterial thrombosis or embolism: "Any patient with an arrhythmia such as atrial fibrillation who complains of abdominal pain is highly suspected of having embolization to the superior mesenteric artery until proved
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Intestinal ischemia" should be suspected when individuals, especially those at high risk for acute intestinal ischemia, develop severe and persisting abdominal pain that is disproportionate to their abdominal findings"., or simply,
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A number of devices have been used to assess the sufficiency of oxygen delivery to the colon. The earliest devices were based on tonometry, and required time to equilibrate and estimate the pHi, roughly an estimate of local
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of those segments is called for. Often, obviously dead segments are removed at the first operation, and a second-look operation is planned to assess segments that are borderline that may be savable after revascularization.
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Case series report prevalence of clinical findings and provide the best available, yet biased, estimate of the sensitivity of clinical findings. In a series of 58 patients with intestinal ischemia due to mixed causes:
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Regarding nonocclusive intestinal ischemia: "Any patient who takes digitalis and diuretics and who complains of abdominal pain must be considered to have nonocclusive ischemia until proved otherwise."
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The treatment of intestinal ischemia depends on the cause and can be medical or surgical. However, if bowel has become necrotic, the only treatment is surgical removal of the dead segments of bowel.
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Regarding intestinal arterial thrombosis or embolism: "early symptoms are present and are relative mild in 50% of cases for three to four days before medical attention is sought".
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Evennett NJ, Petrov MS, Mittal A, Windsor JA (July 2009). "Systematic review and pooled estimates for the diagnostic accuracy of serological markers for intestinal ischemia".
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stage occurs first, in which the primary symptoms are severe abdominal pain and the passage of bloody stools. Many patients get better and do not progress beyond this phase.
4314: 888:). Ischemic colitis can span a wide spectrum of severity; most patients are treated supportively and recover fully, while a minority with very severe ischemia may develop 3518: 1494: 1292: 799:
Acute intestinal ischemia was first described in 1895 while chronic disease was first described in the 1940s. Chronic disease was initially known as angina abdominis.
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Pereira JM, Sirlin CB, Pinto PS, Jeffrey RB, Stella DL, Casola G (2004). "Disproportionate fat stranding: a helpful CT sign in patients with acute abdominal pain".
2059: 2009: 1959: 899:, and bowel rest (that is, no food or water by mouth) until the symptoms resolve. Those with severe ischemia who develop complications such as sepsis, intestinal 542:
for chronic intestinal ischemia and 90% or higher for acute colonic ischemia, with a sensitivity of 71–92%. This device must be placed using endoscopy, however.
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Simi M, Pietroletti R, Navarra L, Leardi S (1995). "Bowel stricture due to ischemic colitis: report of three cases requiring surgEsophageal dilatationery".
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Medina C, Vilaseca J, Videla S, Fabra R, Armengol-Miro J, Malagelada J (2004). "Outcome of patients with ischemic colitis: review of fifty-three cases".
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phase can follow if ischemia continues; in this phase, the abdominal pain becomes more widespread, the belly becomes more tender to the touch, and bowel
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Friedland S, Benaron D, Coogan S, et al. (2007). "Diagnosis of chronic mesenteric ischemia by visible light spectroscopy during endoscopy".
2030:. Townsend, Courtney M., Jr.,, Beauchamp, R. Daniel,, Evers, B. Mark, 1957–, Mattox, Kenneth L., 1938– (20th ed.). Philadelphia, PA. 2017. 4307: 3380: 2035: 1935: 1856: 1573: 857:. Although uncommon in the general population, ischemic colitis occurs with greater frequency in the elderly, and is the most common form of 1851:. Hauser, Stephen C., Pardi, Darrell S., Poterucha, John J., Mayo Clinic. (3rd ed.). Rochester : Mayo Clinic Scientific Press. 2008. 2218:
Staunton M, Malone DE (2005). "Can acute mesenteric ischemia be ruled out using computed tomography? Critically appraised topic |".
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Levy PJ, Krausz MM, Manny J (1990). "Acute mesenteric ischemia: improved results—a retrospective analysis of ninety-two patients".
2525: 915:. Most patients make a full recovery; occasionally, after severe ischemia, patients may develop long-term complications such as a 4010: 4442: 4151: 3763: 3746: 3251: 3246: 3123: 61:(CT) showing dilated loops of small bowel with thickened walls (black arrow), findings characteristic of ischemic bowel due to 3276: 2792: 4005: 3961: 3855: 3677: 4216: 2363:
Meng, X; Liu, L; Jiang, H (August 2010). "Indications and procedures for second-look surgery in acute mesenteric ischemia".
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Kao, Lillian S., and Tammy Lee. PreTest Surgery: PreTest Self-assessment and Review. New York: McGraw-Hill Medical, 2009.
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Evidence of adjacent solid organ infarctions to the kidney or spleen, consistent with a cardiac embolic shower phenomenon
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Brandt, LJ; Boley, SJ (May 2000). "AGA technical review on intestinal ischemia. American Gastrointestinal Association".
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specifically. It has also been defined as poor circulation in the vessels supplying blood flow to any or several of the
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Lee ES, Bass A, Arko FR, et al. (2006). "Intraoperative colon mucosal oxygen saturation during aortic surgery".
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Finding on colonoscopy may include: fragile mucosa, segmental erythema, longitudinal ulcer, and loss of haustrations
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While not always present and often overlapping, three progressive phases of intestinal ischemia have been described:
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Font VE, Hermann RE, Longworth DL (1989). "Chronic mesenteric venous thrombosis: difficult diagnosis and therapy".
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Brandt LJ, Boley SJ (2000). "AGA technical review on intestinal ischemia. American Gastrointestinal Association".
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Cappell M (1998). "Intestinal (mesenteric) vasculopathy. II. Ischemic colitis and chronic mesenteric ischemia".
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The prognosis depends on prompt diagnosis (less than 12–24 hours and before gangrene) and the underlying cause:
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In the absence of adequate quantitative studies to guide diagnosis, various heuristics help guide diagnosis:
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Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., 2002 Saunders, p. 2332.
4399: 4107: 4015: 3976: 3904: 2691:"American Gastroenterological Association Medical Position Statement: guidelines on intestinal ischemia" 2544: 1750:"Use of T-stat to Predict Colonic Ischemia during and after Endovascular Aneurysm Repair: A case report" 1509:"American Gastroenterological Association Medical Position Statement: guidelines on intestinal ischemia" 1488: 1286: 784: 722: 276: 163: 4026: 3207: 374:
decreases, resulting in abdominal bloating, no further bloody stools, and absent bowel sounds on exam.
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Symptoms of intestinal ischemia vary and can be acute (especially if embolic), subacute, or chronic.
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was present in 95% (median of 24 hours duration). The other three patients presented with shock and
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Clair, Daniel G.; Beach, Jocelyn M. (2016-03-10). Campion, Edward W. (ed.). "Mesenteric Ischemia".
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phase can develop as fluids start to leak through the damaged colon lining. This can result in
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Nuzzo, Alexandre; Corcos, Olivier (13 October 2016). "Reversible Acute Mesenteric Ischemia".
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or by using sigmoid or endoscopic placement of a visible light spectroscopic catheter (see
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In the case of prompt diagnosis and therapy, acute intestinal ischemia can be reversible.
737: 456: 401:, and confusion. Patients who progress to this phase are often critically ill and require 332: 328: 236: 232: 79: 2992: 2289: 861:. Causes of the reduced blood flow can include changes in the systemic circulation (e.g. 1455:"Contemporary management of acute mesenteric ischemia: Factors associated with survival" 4384: 4346: 4272: 4187: 3741: 3714: 3579: 3514: 3510: 3400: 3370: 2340: 2315: 1774: 1749: 912: 858: 422: 402: 245: 111: 2923: 2858: 2707: 2690: 2667: 2419: 1525: 1508: 1319: 1270: 732:
If the ischemia has progressed to the point that the affected intestinal segments are
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is the treatment of choice. Those who have thrombosis of the vein may be treated with
299:. Chronic disease is a risk factor for acute disease. The best method of diagnosis is 4436: 4205: 4158: 3951: 3894: 3877: 3789: 3534: 3361: 3236: 3202: 3147: 2980: 2614: 2079:"Diagnosis of bowel infarction: a comparison of plain films and CT scans in 23 cases" 1558: 1450: 315: 272: 264: 193: 159: 151: 2778: 2476: 2182: 2140: 2028:
Sabiston textbook of surgery : the biological basis of modern surgical practice
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Patients with mild to moderate ischemic colitis are usually treated with IV fluids,
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Findings on gastroscopy may include edematous gastric mucosa, and hyperperistalsis.
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Alpern M, Glazer G, Francis I (1988). "Ischemic or infarcted bowel: CT findings".
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Boley, SJ, Brandt, LJ, Veith, FJ (1978). "Ischemic disorders of the intestines".
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http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3069&nbr=2295
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Park WM, Gloviczki P, Cherry KJ, Hallett JW, Bower TC, Panneton JM, Schleck C,
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in 16% (not stated if this number also included occult blood – presumably not)
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Ischemic colitis is usually suspected on the basis of the clinical setting,
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elevated 91% (probably an overestimate as only tested in 57% of patients)
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In a series of 58 patients with intestinal ischemia due to mixed causes:
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organs, including the stomach, liver, colon and intestine. The terms
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Restriction of blood flow to the small intestine resulting in injury
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Schoots IG, Koffeman GI, Legemate DA, Levi M, van Gulik TM (2004).
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Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD (2004).
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infusion of vasodilators in the setting of nonocclusive ischemia.
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Sreenarasimhaiah, J (April 2005). "Chronic mesenteric ischemia".
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Vascular medicine : a companion to Braunwald's heart disease
880:, and laboratory test results; the diagnosis can be confirmed by 2164:"Acute mesenteric ischemia: diagnosis with contrast-enhanced CT" 4296: 2996: 1025:(Aufl. 2014 ed.). New York: Springer Verlag. p. 182. 587:
depends on whether a small bowel obstruction (SBO) is present.
279:. There are four mechanisms by which poor blood flow occurs: a 2162:
Taourel P, Deneuville M, Pradel J, RĂ©gent D, Bruel J (1996).
2316:"Diagnosis and management of intestinal ischaemic disorders" 1896:
Practical gastrointestinal endoscopy : the fundamentals
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Trans-femoral antegrade intestinal angioplasty and stenting
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Mayo Clinic gastroenterology and hepatology board review
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CT and MR Angiography: Comprehensive Vascular Assessment
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Best Practice & Research. Clinical Gastroenterology
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It is difficult to diagnose intestinal ischemia early.
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blood clot from elsewhere getting lodged in an artery
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Hunter G, Guernsey J (1988). "Mesenteric ischemia".
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Bobadilla, JL (August 2013). "Mesenteric ischemia".
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(2008). 1444: 1442: 1440: 892:and become critically, sometimes fatally, ill. 759:Open retrograde intestinal angioplasty stenting 2122: 2120: 2118: 2116: 2114: 1343:"Acute mesenteric ischemia: a clinical review" 231:is a medical condition in which injury to the 4308: 3008: 583:(CT scan) is often used. The accuracy of the 8: 3114:Esophagogastric junction outflow obstruction 2220:Canadian Association of Radiologists Journal 1493:: CS1 maint: multiple names: authors list ( 1291:: CS1 maint: multiple names: authors list ( 1132:Mesenteric Vascular Disease: Current Therapy 343:, with surgery used if they do not improve. 1560:Cope's Early Diagnosis of the Acute Abdomen 1056: 1054: 1052: 1050: 1048: 1046: 964: 962: 960: 958: 956: 4315: 4301: 4293: 4134: 3785: 3301: 3153:Esophageal intramural pseudodiverticulosis 3037: 3015: 3001: 2993: 2882: 2058:: CS1 maint: location missing publisher ( 2008:: CS1 maint: location missing publisher ( 1958:: CS1 maint: location missing publisher ( 954: 952: 950: 948: 946: 944: 942: 940: 938: 936: 572:CT image showing mesenteric ischemia with 217:: 5 per 100,000 per year (developed world) 49: 32: 2706: 2622: 2562:Amini, Afshin; Nagalli, Shivaraj (2023), 2458: 2339: 2094: 1773: 1524: 1470: 1358: 1124: 1122: 1090: 1088: 2077:Smerud M, Johnson C, Stephens D (1990). 1014: 1012: 1010: 1008: 1006: 1004: 1002: 1000: 835:refers to ischemia of the large bowel. 567: 310:Treatment of acute ischemia may include 932: 318:provided at the site of obstruction by 2051: 2001: 1951: 1872: 1657:(Eighth ed.). Elsevier Saunders. 1486: 1284: 576:and gas in mesenterial and liver veins 347:ischemia was first described in 1895. 307:(CT) used when that is not available. 3381:Small intestinal bacterial overgrowth 971:The Surgical Clinics of North America 815:generally defined as ischemia of the 630:prevalence of intestinal ischemia 62% 596:prevalence of intestinal ischemia 23% 291:, and insufficient blood flow due to 7: 2594:Higgins P, Davis K, Laine L (2004). 2294:The Lecturio Medical Concept Library 1384:Cleveland Clinic Journal of Medicine 2799:. Press Association. 28 August 2013 285:new blood clot forming in an artery 1022:Geriatric Trauma and Critical Care 781:arterial thrombosis: 77% mortality 316:medications to break down the clot 25: 4266:Spontaneous bacterial peritonitis 4113:Exocrine pancreatic insufficiency 1978:Corman's colon and rectal surgery 1232:. 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New York: 1129:Gustavo S. Oderich (2014). 865:) or local factors such as 762:Trans-catheter thrombolysis 666:Intestinal mesenteric edema 4464: 3957:Gallstone / Cholelithiasis 3481:Functional colonic disease 3277:Zollinger–Ellison syndrome 1095:Geoffrey D. Rubin (2012). 842: 750:Open surgical thrombectomy 654:(at prevalence of 62%) 61% 648:(at prevalence of 62%) 93% 620:(at prevalence of 23%) 95% 614:(at prevalence of 23%) 79% 3158:Acute esophageal necrosis 2763:10.1007/s10350-003-0033-6 2377:10.1007/s00595-009-4140-4 2332:10.1136/bmj.326.7403.1372 2096:10.2214/ajr.154.1.2104734 1894:Cotton, Peter B. (2003). 1766:10.1016/j.jvs.2007.09.037 1727:10.1016/j.gie.2006.05.007 1692:10.1016/j.jss.2006.05.014 1619:10.1007/s00268-009-0074-7 1205:10.1016/j.bpg.2004.11.002 1160:Creager, Mark A. (2013). 1135:. Springer. p. 105. 983:10.1016/j.suc.2013.04.002 652:negative predictive value 646:positive predictive value 618:negative predictive value 612:positive predictive value 250:unintentional weight loss 239:occurs due to not enough 116:unintentional weight loss 57: 48: 3257:Gastric dumping syndrome 3132:Laryngopharyngeal reflux 3119:Diffuse esophageal spasm 829:large intestine ischemia 813:small intestine ischemia 574:pneumatosis intestinalis 320:interventional radiology 289:superior mesenteric vein 67:superior mesenteric vein 3873:Alcoholic liver disease 3406:Bile acid malabsorption 3350:Peptic (duodenal) ulcer 1566:Oxford University Press 1472:10.1067/mva.2002.120373 4443:Diseases of intestines 3883:Hepatic encephalopathy 3267:Buried bumper syndrome 3198:Peptic (gastric) ulcer 3082:Mallory–Weiss syndrome 3025:human digestive system 2820:Hepatogastroenterology 2797:The Guardian newspaper 2603:Aliment Pharmacol Ther 2504:10.1056/NEJMicm1509318 1879:: CS1 maint: others ( 1519:(5): 951–3. May 2000. 1019:Yelon, Jay A. (2014). 839:In the large intestine 785:non-occlusive ischemia 577: 515:White blood cell count 269:chronic kidney failure 256:, and fear of eating. 156:chronic kidney failure 4108:Pancreatic pseudocyst 3977:Porcelain gallbladder 3089:Zenker's diverticulum 2545:"Mesenteric Ischemia" 2526:"Mesenteric ischemia" 2290:"Intestinal Ischemia" 2062:) CS1 maint: others ( 2012:) CS1 maint: others ( 1962:) CS1 maint: others ( 1811:10.1056/NEJMra1503884 1396:10.3949/ccjm.56.8.823 1226:Liapis, C.D. (2007). 723:non-occlusive disease 672:Bowel wall thickening 571: 470:Diagnostic heuristics 277:myocardial infarction 164:myocardial infarction 3912:Hepatorenal syndrome 3851:Budd–Chiari syndrome 3808:Autoimmune hepatitis 3633:Intestinal adhesions 3391:Short bowel syndrome 3220:Functional dyspepsia 3138:Esophageal stricture 3104:Nutcracker esophagus 2543:Dr. Rabih A. Chaer. 2259:10.1148/rg.243035084 1061:Britt, L.D. (2012). 878:physical examination 691:Intramural bowel gas 18:Mesenteric ischaemia 4051:Choledocholithiasis 3922:Metabolic disorders 3888:Acute liver failure 3861:Portal hypertension 3813:Alcoholic hepatitis 3656:Radiation proctitis 3575:Mesenteric ischemia 3547:Gastroenterocolitis 3376:Blind loop syndrome 3186:MĂ©nĂ©trier's disease 3094:Barrett's esophagus 2083:AJR Am J Roentgenol 1715:Gastrointest Endosc 809:mesenteric ischemia 581:Computed tomography 564:Computed tomography 305:computed tomography 261:atrial fibrillation 229:Intestinal ischemia 180:computed tomography 148:Atrial fibrillation 59:Computed tomography 36:Intestinal ischemia 4226:Undefined location 4217:Grynfeltt–Lesshaft 4118:Pancreatic fistula 4101:Pancreatic abscess 4056:Biliary dyskinesia 4027:Mirizzi's syndrome 3528:Large and/or small 3208:Dieulafoy's lesion 3077:Boerhaave syndrome 2956:External resources 2727:2007-09-27 at the 2135:(1 Pt 1): 149–52. 1064:Acute care surgery 863:low blood pressure 853:(colon) is termed 699:Free abdominal air 658:Early findings on 578: 427:metabolic acidosis 395:low blood pressure 387:metabolic acidosis 351:Signs and symptoms 297:spasms of arteries 293:low blood pressure 206:~80% risk of death 104:sudden severe pain 4430: 4429: 4290: 4289: 4286: 4285: 4126: 4125: 3728: 3727: 3585:Bowel obstruction 3287: 3286: 2990: 2989: 2853:(4): 827–60, vi. 2037:978-0-323-29987-9 1937:978-0-07-179675-0 1858:978-1-4200-9224-0 1575:978-0-19-517545-5 1347:Arch. Intern. Med 1308:Med Clin North Am 977:(4): 925–40, ix. 905:bowel perforation 807:The related term 753:Intestinal bypass 695:Portal venous gas 410:Clinical findings 226: 225: 171:Diagnostic method 129:> 60 years old 30:Medical condition 16:(Redirected from 4455: 4317: 4310: 4303: 4294: 4278:Pneumoperitoneum 4135: 4045:Common bile duct 3927:Wilson's disease 3917:Peliosis hepatis 3786: 3663:Proctalgia fugax 3570:Abdominal angina 3495:Ogilvie syndrome 3444:Pseudomembranous 3302: 3262:Gastric volvulus 3227:Pyloric stenosis 3038: 3023:Diseases of the 3017: 3010: 3003: 2994: 2883: 2871: 2870: 2842: 2836: 2835: 2815: 2809: 2808: 2806: 2804: 2789: 2783: 2782: 2751:Dis Colon Rectum 2746: 2740: 2737: 2731: 2720: 2710: 2695:Gastroenterology 2686: 2680: 2679: 2656:Gastroenterology 2651: 2645: 2644: 2626: 2600: 2591: 2585: 2584: 2583: 2582: 2564:"Bowel Ischemia" 2559: 2553: 2552: 2540: 2534: 2533: 2522: 2516: 2515: 2487: 2481: 2480: 2462: 2460:10.1002/bjs.4459 2438: 2432: 2431: 2408:Gastroenterology 2403: 2397: 2396: 2360: 2354: 2353: 2343: 2326:(7403): 1372–6. 2311: 2305: 2304: 2302: 2300: 2286: 2280: 2277: 2271: 2270: 2242: 2236: 2235: 2215: 2209: 2208: 2206: 2205: 2199: 2193:. Archived from 2168: 2159: 2153: 2152: 2124: 2109: 2108: 2098: 2074: 2068: 2067: 2057: 2049: 2024: 2018: 2017: 2007: 1999: 1974: 1968: 1967: 1957: 1949: 1924: 1918: 1917: 1891: 1885: 1884: 1878: 1870: 1845: 1839: 1838: 1794: 1788: 1787: 1777: 1745: 1739: 1738: 1710: 1704: 1703: 1675: 1669: 1668: 1650: 1639: 1638: 1602: 1596: 1595: 1563: 1550: 1539: 1538: 1528: 1513:Gastroenterology 1505: 1499: 1498: 1492: 1484: 1474: 1446: 1435: 1434: 1414: 1408: 1407: 1379: 1373: 1372: 1362: 1338: 1332: 1331: 1303: 1297: 1296: 1290: 1282: 1254: 1248: 1247: 1229:Vascular surgery 1223: 1217: 1216: 1188: 1182: 1181: 1157: 1151: 1150: 1126: 1117: 1116: 1092: 1083: 1082: 1058: 1041: 1040: 1016: 995: 994: 966: 855:ischemic colitis 849:Ischemia of the 845:Ischemic colitis 833:ischemic colitis 825:colonic ischemia 787:: 73% mortality. 669:Bowel dilatation 532:During endoscopy 399:rapid heart rate 88:gastroenterology 84:vascular surgery 53: 33: 21: 4463: 4462: 4458: 4457: 4456: 4454: 4453: 4452: 4433: 4432: 4431: 4426: 4368: 4362:Small intestine 4357:Large intestine 4330: 4321: 4291: 4282: 4247: 4236:Internal hernia 4122: 4067: 4032:Biliary fistula 3990: 3981: 3967:Adenomyomatosis 3962:Cholesterolosis 3938: 3932:Hemochromatosis 3803:Viral hepatitis 3775: 3724: 3682: 3668:Rectal prolapse 3637: 3604:Fecal impaction 3594:Intussusception 3557:Crohn's disease 3523: 3506:Toxic megacolon 3418: 3416:Large intestine 3410: 3355:Curling's ulcer 3308: 3306:Small intestine 3295: 3283: 3191:Gastroenteritis 3162: 3027: 3021: 2991: 2986: 2985: 2951: 2950: 2894: 2880: 2875: 2874: 2844: 2843: 2839: 2817: 2816: 2812: 2802: 2800: 2791: 2790: 2786: 2748: 2747: 2743: 2738: 2734: 2729:Wayback Machine 2688: 2687: 2683: 2653: 2652: 2648: 2598: 2593: 2592: 2588: 2580: 2578: 2561: 2560: 2556: 2542: 2541: 2537: 2524: 2523: 2519: 2489: 2488: 2484: 2440: 2439: 2435: 2405: 2404: 2400: 2362: 2361: 2357: 2313: 2312: 2308: 2298: 2296: 2288: 2287: 2283: 2278: 2274: 2244: 2243: 2239: 2217: 2216: 2212: 2203: 2201: 2197: 2166: 2161: 2160: 2156: 2126: 2125: 2112: 2076: 2075: 2071: 2050: 2038: 2026: 2025: 2021: 2000: 1988: 1976: 1975: 1971: 1950: 1938: 1926: 1925: 1921: 1906: 1893: 1892: 1888: 1871: 1859: 1847: 1846: 1842: 1805:(10): 959–968. 1796: 1795: 1791: 1747: 1746: 1742: 1712: 1711: 1707: 1677: 1676: 1672: 1665: 1652: 1651: 1642: 1604: 1603: 1599: 1576: 1552: 1551: 1542: 1507: 1506: 1502: 1485: 1448: 1447: 1438: 1416: 1415: 1411: 1381: 1380: 1376: 1353:(10): 1054–62. 1340: 1339: 1335: 1314:(5): 1091–115. 1305: 1304: 1300: 1283: 1259:Curr Probl Surg 1256: 1255: 1251: 1240: 1225: 1224: 1220: 1190: 1189: 1185: 1174: 1159: 1158: 1154: 1143: 1128: 1127: 1120: 1109: 1094: 1093: 1086: 1075: 1060: 1059: 1044: 1033: 1018: 1017: 998: 968: 967: 934: 929: 851:large intestine 847: 841: 805: 797: 769: 747: 738:bowel resection 716: 707: 566: 554: 540: 534: 508: 500: 472: 457:rectal bleeding 453:> 100 in 33% 412: 353: 333:anticoagulation 275:, and previous 237:small intestine 222:: 1 per 100,000 218: 106: 80:General surgery 31: 28: 23: 22: 15: 12: 11: 5: 4461: 4459: 4451: 4450: 4445: 4435: 4434: 4428: 4427: 4425: 4424: 4419: 4418: 4417: 4412: 4407: 4402: 4394: 4393: 4392: 4387: 4378: 4376: 4370: 4369: 4367: 4366: 4365: 4364: 4359: 4354: 4349: 4340: 4338: 4332: 4331: 4322: 4320: 4319: 4312: 4305: 4297: 4288: 4287: 4284: 4283: 4281: 4280: 4275: 4273:Hemoperitoneum 4270: 4269: 4268: 4257: 4255: 4249: 4248: 4246: 4245: 4244: 4243: 4238: 4233: 4222: 4221: 4220: 4219: 4214: 4201: 4200: 4195: 4190: 4185: 4180: 4179: 4178: 4173: 4162: 4161: 4156: 4155: 4154: 4143: 4141: 4132: 4128: 4127: 4124: 4123: 4121: 4120: 4115: 4110: 4105: 4104: 4103: 4098: 4093: 4088: 4077: 4075: 4069: 4068: 4066: 4065: 4060: 4059: 4058: 4053: 4040: 4039: 4034: 4029: 4020: 4019: 4018: 4013: 4008: 3997: 3995: 3983: 3982: 3980: 3979: 3974: 3969: 3964: 3959: 3954: 3948: 3946: 3940: 3939: 3937: 3936: 3935: 3934: 3929: 3919: 3914: 3909: 3908: 3907: 3902: 3892: 3891: 3890: 3885: 3875: 3870: 3869: 3868: 3863: 3858: 3853: 3841: 3840: 3839: 3829: 3828: 3827: 3817: 3816: 3815: 3810: 3805: 3794: 3792: 3783: 3777: 3776: 3774: 3773: 3772: 3771: 3761: 3760: 3759: 3754: 3744: 3742:Blood in stool 3738: 3736: 3730: 3729: 3726: 3725: 3723: 3722: 3717: 3715:Anal dysplasia 3712: 3707: 3702: 3692: 3690: 3684: 3683: 3681: 3680: 3675: 3670: 3665: 3660: 3659: 3658: 3647: 3645: 3639: 3638: 3636: 3635: 3630: 3629: 3628: 3618: 3617: 3616: 3606: 3601: 3596: 3591: 3582: 3580:Angiodysplasia 3577: 3572: 3561: 3560: 3559: 3549: 3544: 3543: 3542: 3531: 3529: 3525: 3524: 3522: 3521: 3515:Diverticulosis 3511:Diverticulitis 3508: 3499: 3498: 3497: 3488: 3478: 3473: 3472: 3471: 3466: 3461: 3456: 3451: 3446: 3436: 3430: 3428: 3412: 3411: 3409: 3408: 3403: 3401:Milroy disease 3398: 3393: 3388: 3383: 3378: 3373: 3371:Tropical sprue 3368: 3359: 3358: 3357: 3347: 3346: 3345: 3340: 3335: 3324: 3322: 3299: 3293:Lower GI tract 3289: 3288: 3285: 3284: 3282: 3281: 3280: 3279: 3269: 3264: 3259: 3254: 3249: 3244: 3239: 3234: 3229: 3224: 3223: 3222: 3212: 3211: 3210: 3205: 3195: 3194: 3193: 3188: 3183: 3172: 3170: 3164: 3163: 3161: 3160: 3155: 3150: 3145: 3140: 3135: 3129: 3128: 3127: 3121: 3116: 3111: 3106: 3096: 3091: 3086: 3085: 3084: 3079: 3069: 3068: 3067: 3062: 3057: 3046: 3044: 3035: 3033:Upper GI tract 3029: 3028: 3022: 3020: 3019: 3012: 3005: 2997: 2988: 2987: 2984: 2983: 2972: 2960: 2959: 2957: 2953: 2952: 2949: 2948: 2937: 2926: 2911: 2895: 2890: 2889: 2887: 2886:Classification 2879: 2878:External links 2876: 2873: 2872: 2837: 2810: 2784: 2741: 2732: 2681: 2646: 2586: 2554: 2535: 2517: 2482: 2433: 2414:(5): 954–968. 2398: 2355: 2306: 2281: 2272: 2237: 2210: 2154: 2110: 2069: 2036: 2019: 1986: 1969: 1936: 1919: 1904: 1886: 1857: 1840: 1789: 1760:(3): 632–634. 1740: 1721:(2): 294–300. 1705: 1670: 1664:978-1455753048 1663: 1640: 1613:(7): 1374–83. 1597: 1574: 1540: 1500: 1436: 1409: 1374: 1333: 1298: 1249: 1238: 1218: 1183: 1172: 1152: 1141: 1118: 1107: 1084: 1073: 1042: 1031: 996: 931: 930: 928: 925: 913:intensive care 859:bowel ischemia 843:Main article: 840: 837: 804: 801: 796: 793: 789: 788: 782: 779: 776: 768: 765: 764: 763: 760: 757: 754: 751: 746: 743: 715: 712: 706: 703: 702: 701: 696: 693: 680: 679: 676: 673: 670: 667: 656: 655: 649: 643: 637: 631: 622: 621: 615: 609: 603: 597: 565: 562: 553: 550: 538: 533: 530: 525: 524: 518: 507: 504: 499: 496: 495: 494: 491: 487: 484: 471: 468: 467: 466: 460: 454: 448: 442: 436: 430: 423:abdominal pain 411: 408: 407: 406: 403:intensive care 375: 364: 352: 349: 329:bypass surgery 248:after eating, 246:abdominal pain 224: 223: 212: 208: 207: 204: 198: 197: 187: 183: 182: 173: 167: 166: 145: 139: 138: 137:Acute, chronic 135: 131: 130: 127: 123: 122: 114:after eating, 112:abdominal pain 97: 91: 90: 77: 71: 70: 55: 54: 46: 45: 44:Bowel ischemia 42: 38: 37: 29: 26: 24: 14: 13: 10: 9: 6: 4: 3: 2: 4460: 4449: 4446: 4444: 4441: 4440: 4438: 4423: 4420: 4416: 4413: 4411: 4408: 4406: 4403: 4401: 4398: 4397: 4395: 4391: 4388: 4386: 4383: 4382: 4380: 4379: 4377: 4375: 4371: 4363: 4360: 4358: 4355: 4353: 4350: 4348: 4345: 4344: 4342: 4341: 4339: 4337: 4333: 4329: 4325: 4318: 4313: 4311: 4306: 4304: 4299: 4298: 4295: 4279: 4276: 4274: 4271: 4267: 4264: 4263: 4262: 4259: 4258: 4256: 4254: 4250: 4242: 4239: 4237: 4234: 4232: 4229: 4228: 4227: 4224: 4223: 4218: 4215: 4213: 4210: 4209: 4208: 4207: 4203: 4202: 4199: 4196: 4194: 4191: 4189: 4186: 4184: 4181: 4177: 4174: 4172: 4169: 4168: 4167: 4164: 4163: 4160: 4157: 4153: 4150: 4149: 4148: 4147:Diaphragmatic 4145: 4144: 4142: 4140: 4136: 4133: 4129: 4119: 4116: 4114: 4111: 4109: 4106: 4102: 4099: 4097: 4094: 4092: 4089: 4087: 4084: 4083: 4082: 4079: 4078: 4076: 4074: 4070: 4064: 4061: 4057: 4054: 4052: 4049: 4048: 4047: 4046: 4042: 4041: 4038: 4035: 4033: 4030: 4028: 4024: 4021: 4017: 4014: 4012: 4009: 4007: 4004: 4003: 4002: 3999: 3998: 3996: 3994: 3988: 3984: 3978: 3975: 3973: 3970: 3968: 3965: 3963: 3960: 3958: 3955: 3953: 3952:Cholecystitis 3950: 3949: 3947: 3945: 3941: 3933: 3930: 3928: 3925: 3924: 3923: 3920: 3918: 3915: 3913: 3910: 3906: 3903: 3901: 3898: 3897: 3896: 3895:Liver abscess 3893: 3889: 3886: 3884: 3881: 3880: 3879: 3878:Liver failure 3876: 3874: 3871: 3867: 3864: 3862: 3859: 3857: 3854: 3852: 3849: 3848: 3847: 3846: 3842: 3838: 3835: 3834: 3833: 3830: 3826: 3823: 3822: 3821: 3818: 3814: 3811: 3809: 3806: 3804: 3801: 3800: 3799: 3796: 3795: 3793: 3791: 3787: 3784: 3782: 3778: 3770: 3767: 3766: 3765: 3762: 3758: 3755: 3753: 3750: 3749: 3748: 3745: 3743: 3740: 3739: 3737: 3735: 3731: 3721: 3718: 3716: 3713: 3711: 3708: 3706: 3703: 3701: 3697: 3694: 3693: 3691: 3689: 3685: 3679: 3676: 3674: 3671: 3669: 3666: 3664: 3661: 3657: 3654: 3653: 3652: 3649: 3648: 3646: 3644: 3640: 3634: 3631: 3627: 3624: 3623: 3622: 3619: 3615: 3612: 3611: 3610: 3607: 3605: 3602: 3600: 3597: 3595: 3592: 3590: 3586: 3583: 3581: 3578: 3576: 3573: 3571: 3567: 3566: 3562: 3558: 3555: 3554: 3553: 3550: 3548: 3545: 3541: 3538: 3537: 3536: 3535:Enterocolitis 3533: 3532: 3530: 3526: 3520: 3516: 3512: 3509: 3507: 3503: 3500: 3496: 3492: 3489: 3487: 3484: 3483: 3482: 3479: 3477: 3474: 3470: 3467: 3465: 3462: 3460: 3457: 3455: 3452: 3450: 3447: 3445: 3442: 3441: 3440: 3437: 3435: 3432: 3431: 3429: 3426: 3422: 3417: 3413: 3407: 3404: 3402: 3399: 3397: 3394: 3392: 3389: 3387: 3384: 3382: 3379: 3377: 3374: 3372: 3369: 3367: 3363: 3362:Malabsorption 3360: 3356: 3353: 3352: 3351: 3348: 3344: 3341: 3339: 3336: 3334: 3331: 3330: 3329: 3326: 3325: 3323: 3320: 3316: 3312: 3307: 3303: 3300: 3298: 3294: 3290: 3278: 3275: 3274: 3273: 3270: 3268: 3265: 3263: 3260: 3258: 3255: 3253: 3250: 3248: 3245: 3243: 3240: 3238: 3237:Gastroparesis 3235: 3233: 3230: 3228: 3225: 3221: 3218: 3217: 3216: 3213: 3209: 3206: 3204: 3203:Cushing ulcer 3201: 3200: 3199: 3196: 3192: 3189: 3187: 3184: 3182: 3179: 3178: 3177: 3174: 3173: 3171: 3169: 3165: 3159: 3156: 3154: 3151: 3149: 3148:Megaesophagus 3146: 3144: 3141: 3139: 3136: 3133: 3130: 3125: 3122: 3120: 3117: 3115: 3112: 3110: 3107: 3105: 3102: 3101: 3100: 3097: 3095: 3092: 3090: 3087: 3083: 3080: 3078: 3075: 3074: 3073: 3070: 3066: 3063: 3061: 3058: 3056: 3053: 3052: 3051: 3048: 3047: 3045: 3043: 3039: 3036: 3034: 3030: 3026: 3018: 3013: 3011: 3006: 3004: 2999: 2998: 2995: 2982: 2978: 2977: 2973: 2971: 2967: 2966: 2962: 2961: 2958: 2954: 2947: 2943: 2942: 2938: 2936: 2932: 2931: 2927: 2925: 2921: 2920: 2916: 2912: 2910: 2906: 2905: 2901: 2897: 2896: 2893: 2888: 2884: 2877: 2868: 2864: 2860: 2856: 2852: 2848: 2841: 2838: 2833: 2829: 2826:(3): 279–81. 2825: 2821: 2814: 2811: 2798: 2794: 2788: 2785: 2780: 2776: 2772: 2768: 2764: 2760: 2756: 2752: 2745: 2742: 2736: 2733: 2730: 2726: 2723: 2718: 2714: 2709: 2704: 2700: 2696: 2692: 2685: 2682: 2677: 2673: 2669: 2665: 2662:(5): 954–68. 2661: 2657: 2650: 2647: 2642: 2638: 2634: 2630: 2625: 2624:2027.42/74164 2620: 2616: 2612: 2609:(7): 729–38. 2608: 2604: 2597: 2590: 2587: 2577: 2573: 2569: 2565: 2558: 2555: 2550: 2546: 2539: 2536: 2532:. 2019-04-24. 2531: 2527: 2521: 2518: 2513: 2509: 2505: 2501: 2497: 2493: 2486: 2483: 2478: 2474: 2470: 2466: 2461: 2456: 2452: 2448: 2444: 2437: 2434: 2429: 2425: 2421: 2417: 2413: 2409: 2402: 2399: 2394: 2390: 2386: 2382: 2378: 2374: 2370: 2366: 2365:Surgery Today 2359: 2356: 2351: 2347: 2342: 2337: 2333: 2329: 2325: 2321: 2317: 2310: 2307: 2295: 2291: 2285: 2282: 2276: 2273: 2268: 2264: 2260: 2256: 2253:(3): 703–15. 2252: 2248: 2247:Radiographics 2241: 2238: 2233: 2229: 2225: 2221: 2214: 2211: 2200:on 2008-02-27 2196: 2192: 2188: 2184: 2180: 2176: 2172: 2165: 2158: 2155: 2150: 2146: 2142: 2138: 2134: 2130: 2123: 2121: 2119: 2117: 2115: 2111: 2106: 2102: 2097: 2092: 2089:(1): 99–103. 2088: 2084: 2080: 2073: 2070: 2065: 2061: 2055: 2047: 2043: 2039: 2033: 2029: 2023: 2020: 2015: 2011: 2005: 1997: 1993: 1989: 1987:9781451111149 1983: 1979: 1973: 1970: 1965: 1961: 1955: 1947: 1943: 1939: 1933: 1929: 1923: 1920: 1915: 1911: 1907: 1905:1-4051-0235-7 1901: 1897: 1890: 1887: 1882: 1876: 1868: 1864: 1860: 1854: 1850: 1844: 1841: 1836: 1832: 1828: 1824: 1820: 1816: 1812: 1808: 1804: 1800: 1793: 1790: 1785: 1781: 1776: 1771: 1767: 1763: 1759: 1755: 1751: 1744: 1741: 1736: 1732: 1728: 1724: 1720: 1716: 1709: 1706: 1701: 1697: 1693: 1689: 1685: 1681: 1674: 1671: 1666: 1660: 1656: 1649: 1647: 1645: 1641: 1636: 1632: 1628: 1624: 1620: 1616: 1612: 1608: 1601: 1598: 1593: 1589: 1585: 1581: 1577: 1571: 1567: 1562: 1561: 1555: 1554:Cope, Zachary 1549: 1547: 1545: 1541: 1536: 1532: 1527: 1522: 1518: 1514: 1510: 1504: 1501: 1496: 1490: 1482: 1478: 1473: 1468: 1465:(3): 445–52. 1464: 1460: 1459:J. Vasc. 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660:CT scan 585:CT scan 337:heparin 303:, with 220:Chronic 108:Chronic 65:of the 4410:Spleen 4385:Anemic 4381:Types 4206:Lumbar 4176:Direct 4159:Hiatus 4139:Hernia 3991:Other 3757:Melena 3643:Rectum 3126:(GERD) 2970:001156 2865:  2830:  2777:  2769:  2715:  2674:  2639:  2631:  2574:  2510:  2475:  2467:  2426:  2391:  2383:  2348:  2338:  2265:  2230:  2189:  2147:  2103:  2044:  2034:  1994:  1984:  1944:  1934:  1912:  1902:  1865:  1855:  1833:  1825:  1817:  1782:  1772:  1733:  1698:  1661:  1633:  1625:  1590:  1582:  1572:  1533:  1479:  1429:  1402:  1367:  1326:  1279:365467 1277:  1236:  1211:  1170:  1139:  1105:  1071:  1029:  989:  890:sepsis 558:X-rays 556:Plain 447:in 35% 441:in 35% 435:in 44% 433:nausea 4405:Brain 4400:Heart 4352:Heart 4347:Brain 4131:Other 4086:Acute 3837:MASLD 3790:Liver 3764:Lower 3747:Upper 3589:Ileus 3425:Colon 3319:Ileum 3134:(LPR) 2946:29034 2924:557.9 2909:K55.9 2775:S2CID 2637:S2CID 2599:(PDF) 2473:S2CID 2389:S2CID 2198:(PDF) 2167:(PDF) 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Index

Mesenteric ischaemia

Computed tomography
thrombosis
superior mesenteric vein
Specialty
General surgery
vascular surgery
gastroenterology
Symptoms
sudden severe pain
abdominal pain
unintentional weight loss
vomiting
Risk factors
Atrial fibrillation
heart failure
chronic kidney failure
prone to forming blood clots
myocardial infarction
Diagnostic method
Angiography
computed tomography
Stenting
medications to break down clot
Prognosis
large
small intestine
blood
abdominal pain

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