Ischemic Disorders of Small and Large Intestine

Abstract

Mesenteric ischemia is a condition that can be fatal if not diagnosed early and treated efficiently. The acute form of mesenteric ischemia can present with pain out of proportion of abdominal findings by exam and is usually due to an acute embolus to the superior mesenteric artery. The chronic form of mesenteric ischemia tends to be indolent and present with postprandial pain and significant weight loss over a long period of time. Accurate diagnosis of chronic mesenteric ischemia is important to avoid the continuum to acute mesenteric ischemia which has an extremely high mortality. Common risk factors are cardiac arrhythmias, age, and systemic atherosclerosis. In any patient suspected of having chronic mesenteric ischemia, CT angiogram can be diagnostic. A third form of mesenteric ischemia is nonocclusive venous mesenteric ischemia which is usually associated with elderly patients in congestive heart failure or with other intra-abdominal pathologies. That condition if diagnosed appropriately can be managed with anticoagulation and close monitoring.

Standard treatment for chronic and acute mesenteric ischemia is open surgical procedure with embolectomy for an embolus and a bypass either antegrade or retrograde for the chronic form of atherosclerotic mesenteric ischemia. Percutaneous stenting of the SMA has yielded excellent short-term results and in very acute or high-risk patients. The long-term results of superior mesenteric artery stenting are not as good as surgical bypass, and some investigators feel that close monitoring of the stent is required and in many cases only used as a bridge until the patient medically stabilizes. Early diagnostic suspicion and appropriate treatment has a significant impact in good outcomes.