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Small Bowel Vascular Disorders

  • Victoria O. Chan
  • Dermot E. Malone
Reference work entry

Abstract

Vascular disorders of the small bowel (excluding duodenum) are common pathologic entities that represent a diagnostic challenge. This is because the small bowel is the most difficult part of the gastrointestinal (GI) tract to image due to its location, length, and tortuosity. Advances in imaging and enteroscopic techniques have occurred over the past several years, but these techniques have limitations and the optimal method of assessing the small bowel remains elusive. The aim of this chapter is to provide a comprehensive overview of the etiology, clinical features, and management of small bowel vascular disorders including the selection of appropriate imaging studies and the key features that may allow the characterization of these disorders. Broadly speaking, vascular disorders of the small bowel can be divided into those causing small bowel ischemia and those causing small bowel bleeding.

Keywords

Small Bowel Superior Mesenteric Artery Mesenteric Ischemia Hereditary Hemorrhagic Telangiectasia Wireless Capsule Endoscopy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Allen RC, Martin GH, Rees CR, Rivera FJ, Talkington CM, Garrett WV, Smith BL, Pearl GJ, Diamond NG, Lee SP, Thompson JE. Mesenteric angioplasty in the treatment of chronic intestinal ischemia. J Vasc Surg. 1996;24(3):415–21.PubMedCrossRefGoogle Scholar
  2. Bergqvist D, Svensson PJ. Treatment of mesenteric vein thrombosis. Semin Vasc Surg. 2010;23(1):65–8.PubMedCrossRefGoogle Scholar
  3. Cademartiri F, Raaijmakers RH, Kuiper JW, van Dijk LC, Pattynama PM, Krestin GP. Multi-detector row CT angiography in patients with abdominal angina. Radiographics. 2004;24(4):969–84.PubMedCrossRefGoogle Scholar
  4. Cho JS, Carr JA, Jacobsen G, Shepard AD, Nypaver TJ, Reddy DJ. Long-term outcome after mesenteric artery reconstruction: a 37-year experience. J Vasc Surg. 2002;35(3):453–60.PubMedCrossRefGoogle Scholar
  5. Chou CK, Mak CW, Tzeng WS, Chang JM. CT of small bowel ischemia. Abdom Imaging. 2004;29(1):18–22.PubMedCrossRefGoogle Scholar
  6. Comerota AJ, Miller MT. Mesenteric ischemia. In: Yeo CJ, Dempsey DT, Klein AS, et al., editors. Surgery of the alimentary tract. 6th ed. Philadelphia: Saunders; 2005. p. 1247–64.Google Scholar
  7. Duchat F, Soyer P, Boudiaf M, Martin-Grivaud S, Fargeaudou Y, Malzy P, Dray X, Sirol M, Hamzi L, Pocard M, Rymer R. Multi-detector row CT of patients with acute intestinal bleeding: a new perspective using multiplanar and MIP reformations from submillimeter isotropic voxels. Abdom Imaging. 2010;35(3):296–305.PubMedCrossRefGoogle Scholar
  8. Filippone A, Cianci R, Milano A, Valeriano S, Di Mizio V, Storto ML. Obscure gastrointestinal bleeding and small bowel pathology: comparison between wireless capsule endoscopy and multidetector-row CT enteroclysis. Abdom Imaging. 2008;33(4):398–406.PubMedCrossRefGoogle Scholar
  9. Fletcher JG. CT enterography technique: theme and variations. Abdom Imaging. 2009;34(3):283–8.PubMedCrossRefGoogle Scholar
  10. Goldin SB, Rosemurgy A. Anatomy and physiology of the mesenteric circulation. In: Yeo CJ, Dempsey DT, Klein AS, et al., editors. Surgery of the alimentary tract. 6th ed. Philadelphia: Saunders; 2005. p. 1235–46.Google Scholar
  11. Gore RM, Yaghmai V, Thakrar KH, Berlin JW, Mehta UK, Newmark GM, Miller FH. Imaging in intestinal ischemic disorders. Radiol Clin North Am. 2008;46(5):845–75.PubMedCrossRefGoogle Scholar
  12. Hanks PW, Brody JM. Blunt injury to mesentery and small bowel: CT evaluation. Radiol Clin North Am. 2003;41(6):1171–82.PubMedCrossRefGoogle Scholar
  13. Horton KM, Fishman EK. Multi-detector row CT of mesenteric ischemia: can it be done? Radiographics. 2001;21(6):1463–73.PubMedGoogle Scholar
  14. Huprich JE, Fletcher JG, Fidler JL, Alexander JA, Guimaraes LS, Siddiki HA, McCollough CH. Prospective blinded comparison of wireless capsule endoscopy and multiphase CT enterography in obscure gastrointestinal bleeding. Radiology. 2011;260(3):744–51.PubMedCrossRefGoogle Scholar
  15. Jarman BT. Small bowel imaging. Surg Clin North Am. 2011;91(1):109–25.PubMedCrossRefGoogle Scholar
  16. Kasirajan K, Greenberg RK, Clair D, Ouriel K. Endovascular management of visceral artery aneurysm. J Endovasc Ther. 2001;8(2):150–5.PubMedCrossRefGoogle Scholar
  17. Kim AY, Ha HK. Evaluation of suspected mesenteric ischemia: efficacy of radiologic studies. Radiol Clin North Am. 2003;41(2):327–42.PubMedCrossRefGoogle Scholar
  18. Kougias P, Lau D, El Sayed HF, Zhou W, Huynh TT, Lin PH. Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischemia. J Vasc Surg. 2007;46(3):467–74.PubMedCrossRefGoogle Scholar
  19. Levy AD. Mesenteric ischemia. Radiol Clin North Am. 2007;45(3):593–9.PubMedCrossRefGoogle Scholar
  20. Lorelli DR, Cambria RA, Seabrook GR, Towne JB. Diagnosis and management of aneurysms involving the superior mesenteric artery and its branches. Vasc Endovascular Surg. 2003;37(1):59–66.PubMedCrossRefGoogle Scholar
  21. Martinez JP, Hogan GJ. Mesenteric ischemia. Emerg Med Clin North Am. 2004;22(4):909–28.PubMedCrossRefGoogle Scholar
  22. Matsumoto AH, Angle JF, Spinosa DJ, Hagspiel KD, Cage DL, Leung DA, Kern JA, Tribble CG, Kron IL. Percutaneous transluminal angioplasty and stenting in the treatment of chronic mesenteric ischemia: results and longterm followup. J Am Coll Surg. 2002;194(1 Suppl):S22–31.PubMedCrossRefGoogle Scholar
  23. Messina LM, Shanley CJ. Visceral artery aneurysms. Surg Clin North Am. 1997;77(2):425–42.PubMedCrossRefGoogle Scholar
  24. Parks DA, Granger DN. Contributions of ischemia and reperfusion to mucosal lesion formation. Am J Physiol. 1986;250(6 Pt 1):G749–53.PubMedGoogle Scholar
  25. Paterno F, Longo WE. The etiology and pathogenesis of vascular disorders of the intestine. Radiol Clin North Am. 2008;46(5):877–85.PubMedCrossRefGoogle Scholar
  26. Payne D, Kubes P. Nitric oxide donors reduce the rise in reperfusion-induced intestinal mucosal permeability. Am J Physiol. 1993;265(1 Pt 1):G189–95.PubMedGoogle Scholar
  27. Raju GS, Gerson L, Das A, Lewis B. American Gastroenterological Association (AGA) Institute technical review on obscure gastrointestinal bleeding. Gastroenterology. 2007;133(5):1697–717.PubMedCrossRefGoogle Scholar
  28. Rha SE, Ha HK, Lee SH, Kim JH, Kim JK, Kim JH, Kim PN, Lee MG, Auh YH. CT and MR imaging findings of bowel ischemia from various primary causes. Radiographics. 2000;20(1):29–42.PubMedGoogle Scholar
  29. Romano S, Lassandro F, Scaglione M, Romano L, Rotondo A, Grassi R. Ischemia and infarction of the small bowel and colon: spectrum of imaging findings. Abdom Imaging. 2006;31(3):277–92.PubMedCrossRefGoogle Scholar
  30. Romano S, Romano L, Grassi R. Multidetector row computed tomography findings from ischemia to infarction of the large bowel. Eur J Radiol. 2007;61(3):433–41.PubMedCrossRefGoogle Scholar
  31. Romano S, Niola R, Maglione F, Romano L. Small bowel vascular disorders from arterial etiology and impaired venous drainage. Radiol Clin North Am. 2008;46(5):891–908.PubMedCrossRefGoogle Scholar
  32. Sarwani N, Tappouni R, Tice J. Pathophysiology of acute small bowel disease with CT correlation. Clin Radiol. 2011;66(1):73–82.PubMedCrossRefGoogle Scholar
  33. Sebastia C, Quiroga S, Espin E, Boye R, Alvarez-Castells A, Armengol M. Portomesenteric vein gas: pathologic mechanisms, CT findings, and prognosis. Radiographics. 2000;20(5):1213–24.PubMedGoogle Scholar
  34. Shanley CJ, Shah NL, Messina LM. Uncommon splanchnic artery aneurysms: pancreaticoduodenal, gastroduodenal, superior mesenteric, inferior mesenteric, and colic. Ann Vasc Surg. 1996;10(5):506–15.PubMedCrossRefGoogle Scholar
  35. Singh V, Alexander JA. The evaluation and management of obscure and occult gastrointestinal bleeding. Abdom Imaging. 2009;34(3):311–9.PubMedCrossRefGoogle Scholar
  36. Stuber T, Hoffman MHK, Stuber G, Klass O, Feuerlein S, Aschoff AJ. Pitfalls in detection of acute gastrointestinal bleeding with multi-detector row helical CT. Abdom Imaging. 2009;34(4):476–82.PubMedCrossRefGoogle Scholar
  37. Trompeter M, Brazda T, Remy CT, Vestring T, Reimer P. Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy. Eur Radiol. 2002;12(5):1179–87.PubMedCrossRefGoogle Scholar
  38. Wiesner W, Mortele KJ, Glickman JN, Ji H, Ros PR. Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. AJR. 2001;177(6):1319–23.PubMedCrossRefGoogle Scholar
  39. Wiesner W, Khurana B, Ji H, Ros PR. CT of acute bowel ischemia. Radiology. 2003;226(3):635–50.PubMedCrossRefGoogle Scholar
  40. Wittenberg J, Harisinghani MG, Jhaveri K, Varghese J, Mueller PR. Algorithmic approach to CT diagnosis of the abnormal bowel wall. Radiographics. 2002;22(5):1093–109.PubMedGoogle Scholar
  41. Yano T, Yamamoto H. Vascular, polypoid, and other lesions of the small bowel. Best Pract Res Clin Gastroenterol. 2009;23(1):61–74.PubMedCrossRefGoogle Scholar
  42. Zalcman M, Sy M, Donckier V, Closset J, Gansbeke DV. Helical CT signs in the diagnosis of intestinal ischemia in small-bowel obstruction. AJR. 2000;175(6):1601–7.PubMedCrossRefGoogle Scholar
  43. Zelenock GB, Stanley JC. Splanchnic artery aneurysms. In: Rutherford RB, editor. Vascular surgery. Philadelphia: Saunders; 2000. p. 1369–82.Google Scholar
  44. Zuckerman GR, Prakash C, Askin MP, Lewis BS. AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology. 2000;118(1):201–21.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of RadiologySt. Vincent’s University HospitalDublinIreland
  2. 2.University College Dublin School of MedicineDublinIreland

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