Ischemic Disorders of the Large and Small Bowel

  • Jeffrey M. Reilly
  • Gregorio A. Sicard

Abstract

Intestinal ischemia is usually a disease that affects the elderly. It is useful to categorize it as acute or chronic because of the different presentations of patients and the urgency of treatment. It can also be further subdivided by etiology; causes include arterial insufficiency secondary to thrombosis or embolus, venous thrombosis, and nonocclusive mesenteric ischemia.

Keywords

Pancreatitis Diarrhea Angiotensin Coumadin Thrombin 

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References

  1. 1.
    McMillan WD, McCarthy WJ, Bresteker MR, et al. Mesenteric artery bypass: objective patency determination. J Vasc Surg 1995;21:729–741.PubMedCrossRefGoogle Scholar
  2. 2.
    Buchardt-Hansen HJ. Abdominal angina: results of arterial reconstruction in 12 patients. Acta Chiurg Scand 1976;142:319–325.Google Scholar
  3. 3.
    Rapp JH, Reilly LM, Qvarfordt PG, et al. Durability of endarterectomy and antegrade grafts in the treatment of chronic visceral ischemia. J Vasc Surg 1986;3:799–806.PubMedGoogle Scholar
  4. 4.
    Schwartz LB, Puret CM, Craig DM, et al. Input impedance of revascularized skeletal muscle, renal, and mesenteric vascular beds. Vasc Surg (in press).Google Scholar
  5. 5.
    Ahlborg G, Weitzberg E, Lundberg JM. Circulating endothelin-1 reduces splanchnic and renal blood flow and splanchnic glucose production in humans. J App Physiol 1995;79:141–145.Google Scholar
  6. 6.
    VanHoutte PM. Heterogeneity in vascular smooth muscle cells. In: Caley G, Altura BM (eds). Microcirculation. Baltimore: University Park Press, 1978:181–308.Google Scholar
  7. 7.
    Reilly PM, Bulkley GB. Vasoactive mediators and splanchnic perfusion. Crit Care Med 1993;21:S55-S68.PubMedCrossRefGoogle Scholar
  8. 8.
    Granger DN, Richardson PDI, Kvietys PR, Mortillaro NA. Intestinal blood flow. Gastroenterology 1980;78:837–863.PubMedGoogle Scholar
  9. 9.
    Heys SD, Brittenden J, Crofts TJ. Acute mesenteric ischemia: the continuing difficulty and early diagnosis. Postgrad Med J 1993;69:48–51.PubMedCrossRefGoogle Scholar
  10. 10.
    Kaleya RN, Boley SJ. Acute mesenteric ischemia: an aggressive diagnostic and therapeutic approach: 1993 Roussel lecture. Can J Surg 1992;5:613–623.Google Scholar
  11. 11.
    Stoney RJ, Cunningham CG. Acute mesenteric ischemia. Surgery 1993;114:489–490.PubMedGoogle Scholar
  12. 12.
    Cambria RP, Brewster DC, Gertler J, et al. Vascular complications associated with spontaneous aortic dissection. J Vasc Surg 1988;7:199–209.PubMedGoogle Scholar
  13. 13.
    Cogbill TH, Gundersen AE, Travelli R. Mesenteric vascular insufficiency and claudication following acute dissecting thoracic aortic aneurysm. J Vasc Surg 1985;2:472–476.PubMedGoogle Scholar
  14. 14.
    Vignati PV, Welch JP, Ellison L, Cohen JL. Acute mesenteric ischemia caused by isolated superior mesenteric artery dissection. J Vasc Surg 1992;16:109–112.PubMedCrossRefGoogle Scholar
  15. 15.
    Kaleya RN, Sammartano RJ, Boley SJ. Aggressive approach to acute mesenteric ischemia. Surg Clin North America 1992;72:157–182.Google Scholar
  16. 16.
    Deehan DJ, Heys SD, Brittenden J, Eremin O. Mesenteric ischaemia: prognostic factors and influence of delay upon outcome. J R Coll Surg Edinb 1995;40:112–115.PubMedGoogle Scholar
  17. 17.
    Case records of the Massachusetts General Hospital (case 35082). N Engl J Med 1949;240:308–310.CrossRefGoogle Scholar
  18. 18.
    Haglund U, Lundgren O. Nonocclusive acute intestinal vascular failure. Br J Surg 1979;6:155–158.CrossRefGoogle Scholar
  19. 19.
    Berger RL, Byrne JJ. Intestinal gangrene associated with heart disease. Surg Gynecol Obstet 1961;113:522–529.Google Scholar
  20. 20.
    Jenson CV, Smith GA. A clinical study of 51 cases of mesenteric infarction. Surgery 1956;40:930–937.PubMedGoogle Scholar
  21. 21.
    Wilson GSM, Block J. Mesenteric vascular occlusion. Arch Surg 1956;73:330–345.CrossRefGoogle Scholar
  22. 22.
    Bassiouny HS. Nonocclusive mesenteric ischemia. Surg Clin North Am 1997;77:319–326.PubMedCrossRefGoogle Scholar
  23. 23.
    McNeill JR, Stark RD, Greenway CV. Intestinal vasoconstriction after hemorrhage: roles of vasopressin angiotensin. Am J Physiol 1970;219:1342–1347.PubMedGoogle Scholar
  24. 24.
    Kim EH, Gewertz BL. Chronic digitalis administration alters mesenteric vascular reactivity. J Vasc Surg 1987; 5:382–389.PubMedGoogle Scholar
  25. 25.
    Mikkelsen E, Andersson DK, Pedersen OL. Effects of digoxin on isolated human mesenteric vessels. Acta Pharmacol Toxicol (Copenh) 1979;5:249–256.Google Scholar
  26. 26.
    Gewertz BL, Zarins CK. Postoperative vasospasm after antegrade mesenteric revascularization: a report of three cases. J Vasc Surg 1991;14:382–385.PubMedCrossRefGoogle Scholar
  27. 27.
    Clark ET, Gewertz BL. Intermittent ischemia potentiates intestinal reperfusion injury. J Vasc Surg 1991;3:606.Google Scholar
  28. 28.
    Howard TJ, Plaskon LA, Wiebke EA, Wilcox MG. Nonocclusive mesenteric ischemia remains a diagnostic dilemma. Am J Surg 1996;171:405–408.PubMedCrossRefGoogle Scholar
  29. 29.
    Boley SJ, Brandt LJ, Veith FJ. Ischemic disorders of the intestine. Curr Probl Surg 1978;15:1.PubMedCrossRefGoogle Scholar
  30. 30.
    Jamieson WG, Lozon A, Durand D, Wall W. Changes in serum phosphate levels associated with intestinal infarction and necrosis. Surg Gynecol Obstet 1975;140:19–21.PubMedGoogle Scholar
  31. 31.
    Tomchek FS, Wittenberg J, Ottinger LW. The roentgenograph spectrum of bowel infarction. Radiology 1970; 96:249–260.Google Scholar
  32. 32.
    Boley SJ, Sprayregen SS, Veith FJ. An aggressive roentgenologic and surgical approach to acute mesenteric ischemia. In: Niehaus LM (ed). Surgery Annual. Norwalk, CT: Appleton-Century-Crofts, 1973:355.Google Scholar
  33. 33.
    Sigelman SS, Bragen S, Boley SJ. Angiographic diagnosis of mesenteric arterial vasoconstriction. Radiology 1974;22:533.Google Scholar
  34. 34.
    Kairaluoma MI, Karkola P, Heikkinene S, et al. Mesenteric infarction. Am J Surg 1977;133:188.PubMedCrossRefGoogle Scholar
  35. 35.
    Ottinger LW, Austen WG. A study of 136 patients with mesenteric infarction. Surg Gynecol Obstet 1967;124:251.PubMedGoogle Scholar
  36. 36.
    Rhee RY, Gloviczki P, Mendonca CT, et al. Mesenteric venous thrombosis: still a lethal disease in the 1990s. J Vasc Surg 1994;20:688.PubMedCrossRefGoogle Scholar
  37. 37.
    Rhee RY, Gloviczki P. Mesenteric venous thrombosis. Surg Clin North Am 1997;77:327.PubMedCrossRefGoogle Scholar
  38. 38.
    Kitchens CS. Evolution of our understanding of the pathophysiology of primary mesenteric venous thrombosis. Am J Surg 1992;163:346.PubMedCrossRefGoogle Scholar
  39. 39.
    Bontempo FA, Hassett AC, Faruki H, et al. The factor V Leiden mutation: spectrum of thrombotic events in laboratory evaluation. J Vasc Surg 1997;25:271–275.PubMedCrossRefGoogle Scholar
  40. 40.
    Inagakia H, Sakakibara O, Miyaike H, et al. Mesenteric venous thrombosis and familiar-free protein S deficiency. Am J Gastroenterol 1993;88:134.Google Scholar
  41. 41.
    Tollefson DFJ, Friedman KD, Marlar RA, et al. Protein C deficiency; a cause of an unusual or unexplained thrombosis. Arch Surg 1988;123:881.PubMedCrossRefGoogle Scholar
  42. 42.
    Wilson C, Walker ID, Davidson JF, et al. Mesenteric venous thrombosis and empty thrombin 3 deficiency. J Clin Pathol 1987;40:906.PubMedCrossRefGoogle Scholar
  43. 43.
    Abdu R, Zakhour BJ, Dallis DJ. Mesenteric venous thrombosis 1911–1984. Surgery 1987;101:383.PubMedGoogle Scholar
  44. 44.
    Boley SJ, Kaleya RN, Brandt LJ. Mesenteric venous thrombosis. Surg Clin North Am 1992;72:183.PubMedGoogle Scholar
  45. 45.
    Carr N, Jamison MH. Superior mesenteric venous thrombosis. Br J Surg 1981;68:343.PubMedCrossRefGoogle Scholar
  46. 46.
    Clavien PA, Harder F. Mesenteric venous thrombosis. Helv Chir Acta 1988;55:29.PubMedGoogle Scholar
  47. 47.
    Grieshop RJ, Dalsing MC, Ckrit DF, et al. Acute mesenteric venous thrombosis: revisited in time of diagnostic clarity. Am J Surg 1991;57:573.Google Scholar
  48. 48.
    Harward TRS, Green D, Bergan JJ, et al. Mesenteric venous thrombosis. J Vasc Surg 1989;9:328.PubMedGoogle Scholar
  49. 49.
    Rhmouni A, Mathieu D, Golli M, et al. Value of CT and sonography in the conservative management of acute splenoportal and superior mesenteric venous thrombosis. Gastrointest Radiol 1992;17:135.CrossRefGoogle Scholar
  50. 50.
    Gehl HB, Bohndorf K, Klose KC, et al. Two-dimensional MR angiography in the evaluation of abdominal vein with gradient refocused sequences. J Comput Assist Tomogr 1990;14:619.PubMedCrossRefGoogle Scholar
  51. 51.
    Inhara T. Acute superior mesenteric venous thrombosis: treatment by thrombectomy. Ann Surg 1971;74:956.CrossRefGoogle Scholar
  52. 52.
    Bilbao JI, Rodriquez-Cabello J, Longo J, et al. Portal thrombosis: percutaneous transhepatic treatment with urokinase: a case report. Gastrointest Radiol 1989; 14:326.PubMedCrossRefGoogle Scholar
  53. 53.
    Robin P, Gurel Y, Lang M, et al. Complete thrombolysis of mesenteric vein occlusion with recombinant tissue type plasminogen activator. Lancet 1988;1:1391.PubMedCrossRefGoogle Scholar
  54. 54.
    Hallet JW, James ME, Ahlquist DA, et al. Recent trends in the diagnosis and management of chronic intestinal ischemia. Ann Vasc Surg 1990;4:126–132.CrossRefGoogle Scholar
  55. 55.
    Moawad J, Gewertz BL. Chronic mesenteric ischemia: clinical presentation and diagnosis. Surg Clin North Am 1997;77:357–369.PubMedCrossRefGoogle Scholar
  56. 56.
    Calderon M, Reul GJ, Gregoric ID, et al. Long-term results of the surgical management of symptomatic chronic intestinal ischemia. J Cardiovasc Surg 1992;33:723–728.Google Scholar
  57. 57.
    Derrick JR, Pollard HS, Moore RM. The pattern of atherosclerotic narrowing of the celiac and superior mesenteric arteries. Ann Surg 1959;149:684–689.PubMedCrossRefGoogle Scholar
  58. 58.
    Reiner L, Himinez FA, Rodriquez FL. Atherosclerosis in the mesenteric circulation: observations and correlations with aortic and coronary atherosclerosis. Am Heart J 1963;66:200–209.PubMedCrossRefGoogle Scholar
  59. 59.
    Councilman WT. Three cases of occlusion in the superior mesenteric artery. Boston Med Surg J 1894;130:410–411.CrossRefGoogle Scholar
  60. 60.
    Gluecklich B, Deterling RA, Matsumoto GH, et al. Chronic mesenteric ischemia masquerading as cancer. Surg Gynecol Obstet 1979;148:49–56.PubMedGoogle Scholar
  61. 61.
    Lye CR. Chronic mesenteric ischemia. Can J Surg 1988; 31:159–161.PubMedGoogle Scholar
  62. 62.
    Watt JK. Arterial disease of the gut. Br Med J 1968;3:231–233.PubMedCrossRefGoogle Scholar
  63. 63.
    Koslin DP, Mulligan SA, Burland LL. Duplex assessment of the splanchnic vasculature. Semin Ultrasound CT MR 1992;13:34–39.PubMedGoogle Scholar
  64. 64.
    Moneta GL, Lee RW, Yeager RA, et al. Mesenteric duplex scanning: a blinded perspective study. J Vasc Surg 1993;17:79–86.PubMedCrossRefGoogle Scholar
  65. 65.
    McMillan WD, McCarthy WJ, Bresticker MR, et al. Mesenteric artery bypass: objective patency determination. J Vasc Surg 1995;21:729–741.PubMedCrossRefGoogle Scholar
  66. 66.
    Li KC, Whitney WS, McDonnell CH, et al. Chronic mesenteric ischemia: evaluation with phase contrast-cine MR imaging. Radiology 1994;190:175–179.PubMedGoogle Scholar
  67. 67.
    Dunphy JE. Abdominal pain of vascular origin. Am J Med Sci 1936;192:109–113.CrossRefGoogle Scholar
  68. 68.
    Shanley CJ, Ozaki KC, Zelenock GB. Bypass grafting for chronic mesenteric ischemia. Surg Clin North Am 1997; 7:381–395.CrossRefGoogle Scholar
  69. 69.
    McAfee MK, Cherry KJ Jr, Nassens JM, et al. Influence of complete revascularization on chronic mesenteric ischemia. Am J Surg 1992;164:220–224.PubMedCrossRefGoogle Scholar
  70. 70.
    McMillan WD, McCarthy WJ, Bresticker MR, et al. Mesenteric artery bypass: objective patency determination. J Vasc Surg 1995;21:729–740; discussion 740–741.PubMedCrossRefGoogle Scholar
  71. 71.
    Baur GM, Millay DJ, Taylor LM, Porter JM. Treatment of chronic visceral ischemia. Am J Surg 1984;148:138–144.PubMedCrossRefGoogle Scholar
  72. 72.
    Taylor LM Jr, Moneta GL. Intestinal ischemia. Ann Vasc Surg 1991;5:403–406.PubMedCrossRefGoogle Scholar
  73. 73.
    Johnston KW, Lindsay TF, Walker PM, Kaiman PG. Mesenteric arterial bypass grafts: early and late results on suggested surgical approach for chronic and acute mesenteric ischemia. Surgery 1995;118:1–7.PubMedCrossRefGoogle Scholar
  74. 74.
    Cunningham CG, Reilly LM, Stoney R. Chronic visceral ischemia. Surg Clin North Am 1992;72:231–244.PubMedGoogle Scholar
  75. 75.
    Hansen KJ, Deitch S. Transaortic mesenteric endarterectomy Surg Clin North Am 1997;77:397–407.PubMedCrossRefGoogle Scholar
  76. 76.
    Allen R, Martin G, Rees C, et al. Mesenteric angioplasty in the treatment of chronic intestinal ischemia. J Vasc Surg 1996;24:415–423.PubMedCrossRefGoogle Scholar
  77. 77.
    Bertran X, Muchart J, Planas R, et al. Occlusion of the superior mesenteric artery in a patient with polycythemia vera resolution with percutaneous transluminal angioplasty. Ann Hematol 1996;72:89–91.PubMedCrossRefGoogle Scholar
  78. 78.
    Odurny A, Sniderman KW, Colapinto RR Intestinal angina: percutaneous transluminal angioplasty of the celiac and superior mesenteric arteries. Radiology 1988; 167:59–62.PubMedGoogle Scholar
  79. 79.
    Rose SC, Quigley TM, Raker EJ. Revascularization for chronic mesenteric ischemia: comparison of operative arterial bypass grafting and percutaneous transluminal angioplasty. J Vasc Intervent Radio 1995;6:339–349.CrossRefGoogle Scholar
  80. 80.
    Sonneland J, Anson LJ, Beaton LE. Surgical anatomy of the arterial supply of the colon from the superior mesenteric artery based upon a study of 60 specimens. Surg Gynecol Obstet 1958;106:385–397.PubMedGoogle Scholar
  81. 81.
    Bradley AW, Murie JA, Ruckley CV. Role of the leukocyte and the pathogenesis of vascular disease. Br J Surg 1993;80:1503–1512.CrossRefGoogle Scholar
  82. 82.
    Turnage RH, Guice KS, Oldham KT. Endotoxemia and remote organ injury following intestinal reperfusion. J Surg Res 1994;56:571–578.PubMedCrossRefGoogle Scholar
  83. 83.
    Bradbury AW, Brittenden J, McBride K, Ruckley CV Mesenteric ischemia in multi-disciplinary approach. Br J Surg 1995;82:1446–1459.PubMedCrossRefGoogle Scholar
  84. 84.
    Sisley AC, Desai T, Harig JM, Gewertz BL. Neutrophil depletion attenuates human intestinal reperfusion injury. J Surg Res 1994;57:192–196.PubMedCrossRefGoogle Scholar
  85. 85.
    Boley SJ, Brandt LF, Veith SJ. Ischemic disorders of the intestines. Curr Probl Surg 1978;15:1–85.PubMedCrossRefGoogle Scholar
  86. 86.
    Boley SJ. Colonic ischemia: 25 years later. Am J Gastroenterol 1990;85:931–934.PubMedGoogle Scholar
  87. 87.
    Thompson JS, Bragg LE, West WW. Serum enzyme levels during intestinal ischemia. Ann Surg 1990;211:369–373.PubMedCrossRefGoogle Scholar
  88. 88.
    Andus CH. Endoscopic assessment of vascular disorders. Semin Colon Rectal Surg 1994;5:27–31.Google Scholar
  89. 89.
    Longo WE, Ballantyne GH, Gusberg BJ. Ischemic colitis: patterns and prognosis. Dis Colon Rectum 1992;35:726–730.PubMedCrossRefGoogle Scholar
  90. 90.
    Scherpenisse J, VanHeese PAM. The endoscopic spectrum of colonic mucosal injury following aortic aneurysm resection. Endoscopy 1989;21:174–176.PubMedCrossRefGoogle Scholar
  91. 91.
    Price AB. Ischemic colitis. Curr Top Pathol 1990;81:229–246.PubMedCrossRefGoogle Scholar
  92. 92.
    Robert JH, Mentha G, Rohner A. Ischaemic colitis: two distinct patterns of severity. Gut 1993;34:4–6.PubMedCrossRefGoogle Scholar
  93. 93.
    Alpern MB, Glazer PM, Francis IR. Ischemic or infarcted bowel: CT findings. Radiology 1988;66:149–152.Google Scholar
  94. 94.
    Philpotts LE, Heiken JP, Westcott MA, Gore RM. Colitis: use of CT findings and differential diagnosis. Radiology 1994;190:445–449.PubMedGoogle Scholar
  95. 95.
    Jacobs JE, Birnbaum BA. CT of inflammatory disease of the colon. Semin Ultrasound CT MR 1995;16:91–101.PubMedCrossRefGoogle Scholar
  96. 96.
    Teefey SA, Roarke NC, Brink JA, et al. Bowel wall thickening: differentiation of inflammation from ischemia with color Doppler and duplex, ultrasound. Radiology 1996;198:547–551.PubMedGoogle Scholar
  97. 97.
    Wilkerson DK, Mezrich R, Drake C, et al. MR imaging of acute occlusive intestinal ischemia. J Vasc Surg 1990;11: 567–571.PubMedGoogle Scholar
  98. 98.
    Smerud MJ, Johnson CD, Stephens DH. Diagnosis of bowel infarction: a comparison of plain films and CT scans in 23 cases. Am J Radiol 1990;154:99–103.Google Scholar
  99. 99.
    Scholz FJ. Ischemic bowel disease. Radiol Clin North Am 1993;31:1197–1218.PubMedGoogle Scholar
  100. 100.
    Toursarkissian B, Thompson RW. Ischemic colitis. Surg Clin North Am 1997;77:461–470.PubMedCrossRefGoogle Scholar
  101. 101.
    Guttormson N, Brubrick MP. Mortality from ischemic colitis. Dis Colon Rectum 1989;32:469–472.PubMedCrossRefGoogle Scholar
  102. 102.
    Parrish KL, Chapman WC, Williams LF Jr. Ischemic colitis: a never changing spectrum? Am Surg 1991;57:118–121.Google Scholar
  103. 103.
    Ernst CB, Hagihara PF, Dougherty ME, et al. Ischemic colitis incidence following abdominal aortic reconstruction: a prospective study. Surgery 1976;80:417–421.PubMedGoogle Scholar
  104. 104.
    Hagihara PF, Ernst CB, Griffen WO Jr. Incidence of ischemic colitis following abdominal aortic reconstruction. Surg Gynecol Obstet 1979;149:571–573.PubMedGoogle Scholar
  105. 105.
    Longo WE, Lee TC, Barnett MG, et al. Ischemic colitis complicating abdominal aortic aneurysm surgery in the U.S. veteran. J Surg Res 1996; 60:351–354.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Jeffrey M. Reilly
  • Gregorio A. Sicard

There are no affiliations available

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