Mesenteric ischaemia

Abstract

Mesenteric ischaemic is a life--threatening condition that occurs as a result of interrupted or reduced blood flow to the bowel. It is categorised as acute or chronic and encompasses a range of pathology and symptoms. This article looks at the presentation, diagnosis, and management of the following: acute and chronic mesenteric ischaemia, ischaemic colitis, and venous infarction. EPIDEMIOLOGYAcute mesenteric ischaemia (AMI) is a surgical emergency with published mortality rates varying between 50% and 100% 1 . Establishing the incidence of AMI is difficult as it is usually diagnosed intra--operatively, or at autopsy (with varying post--mortem rates). A recent meta-analysis has suggested that the annual incidence of AMI lies between 0.09% and 0.2%, per patient, per year 1 . Median age at presentation is approximately 70 years, and the incidence increases with age, showing no gender difference.

Coeliac axis thrombosis and acute hepatic failure in a patient with dilated cardiomyopathy

“…Coeliac axis thrombosis can result in devastating symptoms of severe abdominal pain and bowel ischaemia 13. However, the pathology is such that patients may be asymptomatic despite the thrombosis and this is because there is a good collateral blood supply between the superior mesenteric artery, inferior mesenteric artery and coeliac axis 13. Therefore, two of the three arteries need to be stenosed or blocked in order for symptoms to arise 13.…”

“…However, the pathology is such that patients may be asymptomatic despite the thrombosis and this is because there is a good collateral blood supply between the superior mesenteric artery, inferior mesenteric artery and coeliac axis 13. Therefore, two of the three arteries need to be stenosed or blocked in order for symptoms to arise 13. The main treatment is urgent re-vascularisation by percutaneous angioplasty or surgery, in order to prevent ischaemic damage or infarction 6.…”