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Acute mesenteric arterial occlusion

Gregory Pearl, MD
Ramyar Gilani, MD
Section Editors
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Acute mesenteric ischemia refers to the sudden onset of small intestinal hypoperfusion, which can be due to reduction or cessation of arterial inflow. Ischemia due to acute mesenteric arterial occlusion can be caused by embolic obstruction of the intestinal blood supply, most commonly to the superior mesenteric artery (SMA). Acute ischemia can also occur due to acute thrombotic obstruction, often in the setting of an already diseased mesenteric vessel (eg, atherosclerosis).

Acute mesenteric ischemia due to acute arterial obstruction involving the small intestine will be reviewed here. Colonic ischemia, chronic mesenteric ischemia, and other forms of mesenteric ischemia, including mesenteric venous occlusion and nonocclusive mesenteric ischemia, are reviewed elsewhere. (See "Mesenteric venous thrombosis in adults" and "Chronic mesenteric ischemia" and "Colonic ischemia" and "Nonocclusive mesenteric ischemia".)


The arterial anatomy of the intestinal circulation is given in the figures (figure 1 and figure 2 and picture 1). Ischemic injury to the intestine develops when there is insufficient delivery of oxygen and nutrients required for cellular metabolism. An overview of intestinal anatomy, normal intestinal vascular physiology, and the response to acute ischemia are discussed in detail elsewhere. (See "Overview of intestinal ischemia in adults", section on 'Intestinal vascular anatomy' and "Overview of intestinal ischemia in adults", section on 'Physiology and mechanisms of ischemia'.)

The intestine may be able to compensate to some extent because of increased oxygen extraction as well as the presence of collateral flow pathways (figure 3) [1]. The status of the collateral circulation is particularly important in determining the severity of symptoms [2]. Acute superior mesenteric arterial occlusion, in the absence of preexisting stenosis such as with embolism, causes a greater reduction in blood flow compared with other causes of intestinal ischemia. This is due to the lack of collateralization in the presence of relatively normal arterial vasculature. By contrast, acute thrombosis of atherosclerotic lesions may have had the opportunity to develop collateral pathways to provide some degree of perfusion even in the setting of complete occlusion. Inciting factors such as dehydration or low cardiac output states can lead to acute thrombosis of even modest stenosis, causing typical signs and symptoms of acute mesenteric ischemia with no prior history. For some patients, progression from stenosis to occlusion can be asymptomatic due largely to a sufficient time course to develop these collaterals.


The two major causes of acute mesenteric arterial occlusion are mesenteric arterial embolism and mesenteric arterial thrombosis. In an autopsy study, the ratio of superior mesenteric embolus to thrombus ratio was 1.4:1 [3].

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Literature review current through: Nov 2017. | This topic last updated: Oct 25, 2016.
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