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Also known as Ischaemic Bowel or Mesenteric Ischaemia, this can be the result of many pathologies and can be acute or chronic.

Epidemiology

  • Typically occurs in elderly patients
  • Often associated with:
    • AF
    • PVD
    • Chronic Cardiac Disease
  • Often diagnosed at laparotomy (or post mortem!)

Common causes

  • Atherosclerosis
  • Embolism
  • Dissection
  • External compression by mass lesions
  • Fibromuscular dysplasia – non-artherosclerotic, non-inflammatory arterial changes

Common sites of occlusion

  • Splanchnic arteries
    • Superior mesenteric
    • Coeliac arteries – often occurs chronically in women
    • Renal arteries
  • Bifurcation of the aorta

Signs and symptoms

Acute

  • This is an emergency and can be life threatening!
  • Severe, diffuse abdominal pain
  • Rarely involves the liver or spleen
  • Renal artery occlusion:

Chronic

  • Is often symptomless, unless both the superior mesenteric and coeliac arteries are occluded, due to large collateral circulation between these two arterial systems
  • Intestinal Angina is the most common symptom. This is a cramping pain typically felt 20-60 minutes after eating. Can be relieved by sublingual GTN.
  • Patients often lose weight as they develop a fear of eating
  • Abdominal bruit may be heard
  • Other signs include nausea, vomiting, diarrhoea, constipation and dark stools
  • Renal artery occlusion:

Diagnosis

Chronic Mesenteric Ischaemia

  • Based mainly on clinical findings
  • Angiography may be useful
  • In severe cases, bypass surgery can be beneficial, but outcomes vary
  • Angioplasty is also sometimes helpful both with and without stenting
  • Some patients may be put on preventative measures and anti-platelet agents

Acute Mesenteric Ischaemia

  • Surgical emergency
  • Usually diagnosed with CT of the abdomen – sometimes CT angio is also required and is able to determine the location of the occlusion. There is often co-existing small bowel obstruction which can make diagnosis easier
  • Requires thrombolysis or Percutaneous intervention to prevent gut necrosis
  • If gut necrosis is already present (and it often is) then surgery is required to remove the affected bowel.
  • Outcomes are poor, particularly if >4-6hours after onset

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