Ischemic diseases of the bowel

Summary

The incidence of acute ischemia of the small bowel is increasing. Although occasionally it is secondary to occlusion of major vessels and amenable to direct surgical attack, it is more often secondary to a perfusion problem without occlusions of large vessels. The diagnosis of ischemia should be considered for any elderly patient with abdominal pain and gastrointestinal bleeding which is not secondary to some overt cause. Early diagnosis requires a differentiation of occlusive from nonocclusive disease, and arteriography appears to be the only reasonable approach. Supportive therapy, including fluid replacement, cardiac support and control of sepsis, is necessary in all these cases. It is applied preoperatively over the course of several hours when the patients have perfusion problems; however, in the cases of patients with largevessel occlusion, the supportive therapy is applied during the intraoperative and postoperative periods. The patient with chronic mesenteric ischemia should have elective surgical correction of the occlusion to the splanchnic flow, not only for relief of pain and correction of weight loss but also to prevent progression to an acute complete occlusion.