RT Book, Section
A1 Harkin, Denis W.
A1 Lindsay, Thomas F.
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Wood, Lawrence D.H.
SR Print(0)
ID 2296692
T1 Chapter 86. Mesenteric Ischemia
T2 Principles of Critical Care, 3e
YR 2005
FD 2005
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071416405
LK accessanesthesiology.mhmedical.com/content.aspx?aid=2296692
RD 2022/05/26
AB Acute  mesenteric  ischemia  is  a  relatively  rare  clinical  entity,  but  when  diagnosis  is  delayed,  it  is  almost  always  fatal;  therefore,  a  high  index  of  suspicion  is  required,  especially  in  those  at  high  risk:  the  elderly,  those  with  cardiac  dysfunction,  patients  with  diffuse  atherosclerosis,  and  those  following  aortic  and  cardiac  surgery  or  arterial  catheterization.The  etiology  of  acute  mesenteric  ischemia  may  be  embolic,  thrombotic,  primary  vasoconstrictive,  or  secondary  to  venous  thrombosis.  Chronic  ischemia  is  usually  due  to  flow-limiting  lesions  (stenoses  or  occlusions)  in  the  presence  of  inadequate  collateralization.Classic  symptoms  of  acute  intestinal  ischemia  are  central  abdominal  pain  (often  out  of  proportion  to  the  benign  abdominal  examination),  weight  loss  (an  important  clue  even  in  the  acute  presentation),  bowel  emptying,  and  altered  bowel  function  (vomiting,  bloating,  constipation,  or  diarrhea).  Once  signs  of  peritonitis  or  bloody  diarrhea  present,  shock,  sepsis,  and  death  almost  always  follow.Mesenteric  angiography  is  the  investigation  of  choice,  offering  diagnostic  and  therapeutic  options,  whereas  computed  tomographic  (CT)  angiogram  and  duplex  ultrasonography  may  not  be  definitive.  Frequently,  the  diagnosis  is  confirmed  only  at  laparotomy.Treatment  is  surgical,  with  restoration  of  flow  by  bypass  or  embolectomy,  resection  of  nonviable  intestine,  and  liberal  use  of  “second  look"  laparotomy.