Skip to main content
SpringerLink
Log in

Ischemic Disorders of the Large and Small Bowel

  • Chapter
  • First Online:
Principles and Practice of Geriatric Surgery

  • 1698 Accesses

Abstract

The patient is a 76-year-old male with a history of coronary artery disease who presents with an 18 month history of vague abdominal pain. The patient reports of pain after meals and approximately a 70 lbs weight loss over this time. The patient has been seen by the local gastroenterologist and has undergone both upper and lower endoscopy, which were both normal. The patient presented back to the emergency room with more complaints of abdominal pain and bloating. As part of his emergency room workup, the patient had a CT scan of the abdomen and pelvis. This revealed a tight stenosis in the superior mesenteric artery (SMA) as well as a large 6 cm abdominal aortic aneurysm (Figs. 65.1 and 65.2). Vascular surgery was consulted. It was decided that, since the patient was a poor open surgical candidate and that the patient had suitable aortic anatomy for an aortic endograft, a staged endoluminal procedure to address both the SMA stenosis and the large abdominal aortic aneurysm was recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. McMillan WD, McCarthy WJ, Bresteker MR et al (1995) Mesenteric artery bypass: objective patency determination. J Vasc Surg 21:720–741

    Article  Google Scholar 

  2. Schwartz LB, Puret CM, Craig DM, et al (in press) Input impedance of revascularized skeletal muscle, renal, and mesenteric vascular beds. Vasc Surg

    Google Scholar 

  3. Ahlborg G, Weitzberg E, Lundberg JM (1995) Circulating endothelin-1 reduces splanchnic and renal blood low and splanchnic ­glucose productions in humans. J Appl Physiol 79:141–145

    PubMed  CAS  Google Scholar 

  4. VanHoutte PM (1978) Heterogeneity in vascular smooth muscle cells. In: Caley G, Altura BM (eds) Microcirculation. University Park Press, Baltimore, pp 181–308

    Google Scholar 

  5. Reilly PM, Buckley GB (1993) Vasoactive mediators and splanchnic perfusion. Crit Care Med 21:S55–S68

    Article  PubMed  CAS  Google Scholar 

  6. Granger DN, Richardson PDI, Kvietys PR, Mortillaro NA (1980) Intestinal blood flow. Gastroenterology 78:837–863

    PubMed  CAS  Google Scholar 

  7. Heys SD, Brittenden J, Crofts TJ (1993) Acute mesenteric ischemia: the continuing difficulty and early diagnosis. Postgrad Med J 69:48–51

    Article  PubMed  CAS  Google Scholar 

  8. Kaleya RN, Boley SJ (1992) Acute mesenteric ischemia: an aggressive diagnostic and therapeutic approach: 1993 Roussel lecture. Can J Surg 5:613–623

    Google Scholar 

  9. Stoney RJ, Cunningham CG (1993) Acute mesenteric ischemia. Surgery 114:489–490

    PubMed  CAS  Google Scholar 

  10. Kaleya RN, Sammartano RJ, Boley SJ (1992) Aggressive approach to acute mesenteric ischemia. Surg Clin North Am 72:157–182

    PubMed  CAS  Google Scholar 

  11. Cambria RP, Brewster DC, Gertler J et al (1988) Vascular complications associated with spontaneous aortic dissection. J Vasc Surg 7:199–209

    PubMed  CAS  Google Scholar 

  12. Deehan DJ, Heys SD, Brittenden J, Eremin O (1995) Mesenteric ischaemia: prognostic factors and influence of delay upon outcome. J R Coll Surg Edinb 40:112–115

    PubMed  CAS  Google Scholar 

  13. Bassiouny HS (1997) Nonocclusive mesenteric ischemia. Surg Clin North Am 77:319–326

    Article  PubMed  CAS  Google Scholar 

  14. McNeil JR, Stark RD, Greenway CV (1970) Intestinal vasoconstriction after hemorrhage: roles of vasopressin and angiotensin. Am J Physiol 219:1342–1347

    Google Scholar 

  15. Mikkelsen E, Andersson DK, Pedersen OL (1979) Effects of digoxin on isolated human mesenteric vessels. Acta Pharmacol Toxicol (Copenh) 5:249–256

    Google Scholar 

  16. Gewertz BL, Zarins CK (1991) Postoperative vasospasm after antegrade mesenteric revascularization: a report of three cases. J Vasc Surg 14:382–385

    Article  PubMed  CAS  Google Scholar 

  17. Hallet JW, James ME, Ahlquist DA et al (1990) Recent trends in the diagnosis and management of chronic intestinal ischemia. Ann Vasc Surg 4:126–132

    Article  Google Scholar 

  18. Calderon M, Reul GJ, Gregoric ID et al (1992) Long term results of the surgical management of symptomatic chronic intestinal ischemia. J Cardiovasc Surg 33:723–728

    CAS  Google Scholar 

  19. Derrick JR, Pollard HS, Moore RM (1959) The pattern of atherosclerotic narrowing of the celiac and superior mesenteric arteries. Ann Surg 149:684–689

    Article  PubMed  CAS  Google Scholar 

  20. Councilman WT (1894) Three cases of occlusion in the superior mesenteric artery. Boston Med Surg J 130:410–411

    Article  Google Scholar 

  21. Lye CR (1988) Chronic mesenteric ischemia. Can J Surg 31:159–161

    PubMed  CAS  Google Scholar 

  22. Gluecklich B, Deterling RA, Matsumoto GH et al (1979) Chronic mesenteric ischemia masquerading as cancer. Surg Gynecol Obstet 148:49–56

    PubMed  CAS  Google Scholar 

  23. Watt JK (1968) Arterial diseases of the gut. Br Med J 3:231–233

    Article  PubMed  CAS  Google Scholar 

  24. Howard TJ, Plaskon LA, Wiebke EA, Wilcox MG (1996) Nonocclusive mesenteric ischemia remains a diagnostic dilemma. Am J Surg 171:405–408

    Article  PubMed  CAS  Google Scholar 

  25. Smerud MJ, Johnson CD, Stephens DH (1990) Diagnosis of bowel infarction: a comparison of plain films and CT scans in 23 cases. Am J Roentgenol 154:99

    CAS  Google Scholar 

  26. Sabba C, Ferraioli G, Sarin SK et al (1990) Feasibility spectrum for Doppler flowmetry of splanchnic vessels: in normal and cirrhotic populations. J Ultrasound Med 9:705

    PubMed  CAS  Google Scholar 

  27. Zwolak RM, Fillinger MF, Walsh DB et al (1998) Mesenteric and celiac duplex scanning: a validation study. J Vasc Surg 27:1078

    Article  PubMed  CAS  Google Scholar 

  28. Bowersox JC, Zwolak RM, Walsh DB et al (1991) Duplex ultrasonography in the diagnosis of celiac and mesenteric artery occlusive disease. J Vasc Surg 14:780

    Article  PubMed  CAS  Google Scholar 

  29. Moneta GL, Lee RW, Yeager RA et al (1993) Mesenteric duplex scanning: a blinded prospective study. J Vasc Surg 17:79

    Article  PubMed  CAS  Google Scholar 

  30. Fleischmann D (2003) Multiple detector-row CT angiography of the renal and mesenteric vessels. Eur J Radiol 45(Suppl):79–87

    Article  Google Scholar 

  31. Wasser MN, Geelkerken RH, Kouwenhoven M et al (1996) Systolically gated 3D phase contrast MRA of mesenteric arteries in suspected mesenteric ischemia. J Comput Assist Tomogr 20:262

    Article  PubMed  CAS  Google Scholar 

  32. Carlos RC, Stanley JC, Stafford-Johnson D, Prince MR (2001) Interobserver variability in the evaluation of chronic mesenteric ischemia with gadolinium-enhanced MR angiography. Acad Radiol 8:879

    Article  PubMed  CAS  Google Scholar 

  33. Meaney JF, Prince MR, Nostrant TT, Stanley JC (1997) Gadolinium-enhanced MR angiography of visceral arteries in patients with suspected chronic mesenteric ischemia. J Magn Reson Imaging 7:171

    Article  PubMed  CAS  Google Scholar 

  34. Stanley CJ, Ozaki KC, Zelenock GB (1997) Bypass grafting for chronic mesenteric ischemia. Surg Clin North Am 7:381–395

    Article  Google Scholar 

  35. Reiner L, Himinez FA, Rodriquez FL (1963) Atherosclerosis in the mesenteric circulation: observations and correlations with aortic and coronary atherosclerosis. Am Heart J 66:200–209

    Article  PubMed  CAS  Google Scholar 

  36. McMillan WD, McCarthy WJ, Bresticker MR et al (1995) Mesenteric artery bypass: objective patency determination. J Vasc Surg 21:729–740, discussion 740–741

    Article  PubMed  CAS  Google Scholar 

  37. Taylor LM Jr, Moneta GL (1991) Intestinal ischemia. Ann Vasc Surg 5:403–406

    Article  PubMed  Google Scholar 

  38. Johnston KW, Lindsay TF, Walker PM, Kalman PG (1995) Mesenteric arterial bypass grafts: early and late results on suggested surgical approach for chronic and acute mesenteric ischemia. Surgery 118:1–7

    Article  PubMed  CAS  Google Scholar 

  39. Cunningham CG, Reilly LM, Stoney R (1992) Chronic visceral ischemia. Surg Clin North Am 72:231–244

    PubMed  CAS  Google Scholar 

  40. Hansen KJ, Deitch S (1997) Transaortic mesenteric endarterectomy. Surg Clin North Am 77:397–407

    Article  PubMed  CAS  Google Scholar 

  41. Allen R, Maratin G, Rees C et al (1996) Mesenteric angioplasty in the treatment of chronic intestinal ischemia. J Vasc Surg 24:415–423

    Article  PubMed  CAS  Google Scholar 

  42. Kougias P, El Sayed HF, Zhou W, Lin PH (2007) Management of chronic mesenteric ischemia. The role of endovascular therapy. J Endovasc Ther 14:395–405

    Article  PubMed  Google Scholar 

  43. Brown DJ, Schermerhorn ML, Cronenwett JL et al (2005) Mesenteric stenting for chronic mesenteric ischemia. J Vasc Surg 42(2):268–274

    Article  PubMed  Google Scholar 

  44. Zerbib P, Lebuffe G, Chambon JP et al (2008) Endovascular versus open revascularization for chronic mesenteric ischemia: a comparative study. Langenbecks Arch Surg 393(6):865–870

    Article  PubMed  CAS  Google Scholar 

  45. Rhee RY, Gloviczki P, Mendonca CT et al (1994) Mesenteric venous thrombosis: still a lethal disease in the 1990s. J Vasc Surg 20:688

    Article  PubMed  CAS  Google Scholar 

  46. Rhee RY, Gloviczki P (1997) Mesenteric venous thrombosis. Surg Clin North Am 77:327

    Article  PubMed  CAS  Google Scholar 

  47. Kitchens CS (1992) Evolution of our understanding of the pathophysiology of primary mesenteric venous thrombosis. Am J Surg 163:346

    Article  PubMed  CAS  Google Scholar 

  48. Grieshop RJ, Dalsing MC, Ckrit DF et al (1991) Acute mesenteric venous thrombosis: revisited in time of diagnostic clarity. Am J Surg 57:53

    Google Scholar 

  49. Hedayati N, Riha GM, Lin PH et al (2008) Prognostic factors and treatment outcome in mesenteric vein thrombosis. Vasc Endovasc Surg 42(3):217–224

    Article  Google Scholar 

  50. Rhmouni A, Mathieu D, Golli M et al (1992) Value of CT and sonography in the conservative management of acute splenoportal and superior mesenteric venous thrombosis. Gastrointest Radiol 17:135

    Article  Google Scholar 

  51. Gehl HB, Bohndorf K, Flose KC et al (1990) Two-dimensional MR angiography in the evaluation of abdominal vein with gradient refocused sequences. J Comput Assist Tomogr 14:619

    Article  PubMed  CAS  Google Scholar 

  52. Inhara T (1971) Acute superior mesenteric venous thrombosis: treatment by thrombectomy. Ann Surg 74:956

    Article  Google Scholar 

  53. Bilbao JI, Rodriquez-Cabello J, Longo J et al (1989) Portal thrombosis: percutaneous transhepatic treatment with urokinase: a case report. Gastrointest Radiol 14:326

    Article  PubMed  CAS  Google Scholar 

  54. Boley SJ, Kaleya RN, Brandt LJ (1992) Mesenteric venous thrombosis. Surg Clin North Am 72:183

    PubMed  CAS  Google Scholar 

  55. Sonneland J, Anson LJ, Beaton LE (1958) Surgical anatomy of the arterial supply of the colon from the superior mesenteric artery based upon a study of 60 specimens. Surg Gynecol Obstet 106:385–397

    PubMed  CAS  Google Scholar 

  56. Turnage RH, Guice KS, Oldham KT (1994) Endotoxemia and remote organ injury following intestinal reperfusion. J Surg Res 56:571–578

    Article  PubMed  CAS  Google Scholar 

  57. Sisley AC, Desai T, Harig JM, Gewertz BL (1994) Neutrophil depletion attenuates human intestinal reperfusion injury. J Surg Res 57:192–196

    Article  PubMed  CAS  Google Scholar 

  58. Bradbury AW, Brittenden J, McBride K, Ruckley CV (1995) Mesenteric ischemia in multi-disciplinary approach. Br J Surg 82:1446–1459

    Article  PubMed  CAS  Google Scholar 

  59. Booley SJ, Brandt LF, Veith SJ (1978) Ischemic disorders of the intestines. Curr Probl Surg 15:1–85

    Article  Google Scholar 

  60. Longo WE, Ballantyne GH, Gusberg BJ (1992) Ischemic colitis: patterns and prognosis. Dis Colon Rectum 35:726–730

    Article  PubMed  CAS  Google Scholar 

  61. Price AB (1990) Ischemic colitis. Curr Top Pathol 81:229–246

    Article  PubMed  CAS  Google Scholar 

  62. Robert JH, Mentha G, Rohner A (1993) Ischaemic colits: two distinct patterns of severity. Gut 34:4–6

    Article  PubMed  CAS  Google Scholar 

  63. Alpern MB, Glazer PM, Francis IR (1988) Ischemic or infracted bowel: CT findings. Radiology 66:149–152

    Google Scholar 

  64. Philpotts LE, Heiken JP, Westcott MA, Gore RM (1994) Colitis: use of CT findings and differential diagnosis. Radiology 190:445–449

    PubMed  CAS  Google Scholar 

  65. Jacobs JE, Birnbaum BA (1995) CT of inflammatory disease of the colon. Semin Ultrasound CT MR 16:91–101

    Article  PubMed  CAS  Google Scholar 

  66. Teefey SA, Roarke NC, Brink JA et al (1996) Bowel wall thickening: differentiation of inflammation from ischemia with color Doppler and duplex, ultrasound. Radiology 198:547–551

    PubMed  CAS  Google Scholar 

  67. Wilkerson DK, Mezrich R, Drake C et al (1990) MR imaging of acute occlusive intestinal ischemia. J Vasc Surg 11:567–571

    PubMed  CAS  Google Scholar 

  68. Scholz FJ (1993) Ischemic bowel disease. Radiol Clin North Am 31:1197–1218

    PubMed  CAS  Google Scholar 

  69. Toursarkissian B, Thompson RW (1997) Ischemic colitis. Surg Clin North Am 77:461–470

    Article  PubMed  CAS  Google Scholar 

  70. Guttormson N, Brubrick MP (1989) Mortality from ischemic ­colitis. Dis Colon Rectum 342:469–472

    Article  Google Scholar 

  71. Ernst CB, Hagihara PF, Dougherty ME et al (1976) Ischemic colitis incidence following abdominal aortic reconstruction: a prospective study. Surgery 80:417–421

    PubMed  CAS  Google Scholar 

  72. Hagihara PF, Enrst CB, Griffen WO Jr (1979) Incidence of ischemic colitis following abdominal aortic reconstruction. Surg Gynecol Obstet 149:571–573

    PubMed  CAS  Google Scholar 

  73. Senekowitsch C, Assadian A, Assadian O et al (2006) Replanting the inferior mesentery artery during infrarenal aortic aneurysm repair: influence on postoperative colon ischemia. J Vasc Surg 43:689–694

    Article  PubMed  Google Scholar 

  74. Longo WE, Lee TC, Barnett MG et al (1996) Ischemic colitis complicating abdominal aortic aneurysm surgery in the U.S. veteran. J Surg Res 60:351–354

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Vascular Surgery, Barnes-Jewish Hospital, University of Washington School of Medicine, St. Louis, MO, USA

    Jack R. Oak

Authors
  1. Jack R. Oak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gregorio A. Sicard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jack R. Oak .

Editor information

Editors and Affiliations

  1. School of Medicine, Department of Surgery, Yale University, New Haven, 06520, Connecticut, USA

    Ronnie Ann Rosenthal

  2. Downstate Medical Center, State University of New York, Clarkson Ave. 450, Brooklyn, 11203, New York, USA

    Michael E. Zenilman

  3. , Chairman, Department of Surgery, Sinai Hospital, 2401 West Belvedere Avenue, Baltimore, 21215, Maryland, USA

    Mark R. Katlic

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Oak, J.R., Sicard, G.A. (2011). Ischemic Disorders of the Large and Small Bowel. In: Rosenthal, R., Zenilman, M., Katlic, M. (eds) Principles and Practice of Geriatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-6999-6_65

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-6999-6_65

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-6998-9

  • Online ISBN: 978-1-4419-6999-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation