Acute mesenteric ischemia

INTRODUCTION

Mesenteric ischemia is caused by a reduction in intestinal blood flow, which most commonly arises from occlusion, vasospasm, and/or hypoperfusion of the mesenteric vasculature. The clinical consequences can be catastrophic, including sepsis, bowel infarction, and death, making rapid diagnosis and treatment imperative.

Intestinal ischemia can be divided into acute and chronic, based upon the rapidity and the degree to which blood flow is compromised.

  • Acute mesenteric ischemia refers to the sudden onset of intestinal hypoperfusion, which can be due to occlusive or nonocclusive obstruction of arterial or venous blood flow. Occlusive arterial obstruction is most commonly due to emboli or thrombosis of mesenteric arteries, while occlusive venous obstruction is most commonly due to thrombosis or segmental strangulation. Nonocclusive arterial hypoperfusion is most commonly due to primary splanchnic vasoconstriction.
  • Chronic mesenteric ischemia (also called intestinal angina) refers to episodic or constant intestinal hypoperfusion, which usually develops in patients with mesenteric atherosclerotic disease.

Acute mesenteric ischemia involving the small intestine will be reviewed here. Chronic mesenteric small intestinal ischemia and colonic ischemia are discussed separately. (See "Chronic mesenteric ischemia" and "Colonic ischemia".) The American Gastroenterological Association (AGA) guideline for intestinal ischemia [1], as well as other AGA guidelines, can be accessed through the AGA web site at http://www.gastro.org/practice/medical-position-statements.

VASCULAR SUPPLY OF THE INTESTINES

An extensive collateral circulation exists to protect the intestines from transient periods of inadequate perfusion. However, prolonged reduction in splanchnic blood flow leads to vasoconstriction in the affected vascular bed, which can eventually reduce collateral blood flow [2,3]. The likelihood of developing intestinal ischemia depends upon the adequacy of systemic perfusion and collateral circulation, the number and caliber of splanchnic vessels that are affected, and the duration of the ischemic insult.

                         

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Literature review current through: 20.6: May 2012
This topic last updated: Aug 19, 2009
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