Mesenteric Ischemia: The Whole Spectrum

Abstract

tic branches to the foregut, midgut, and hindgut. However, many of these patients have intestinal angina when eating large meals. The venous drainage of the gut is via the portal venous system. Gastric drainage is via the splenic vein. The small bowel and the proximal colon through the splenic flexure drain via the superior mesenteric vein. The remainder of the colon drains via the inferior mesenteric vein. Collateral venous vessels are present between each major area.The celiac and mesenteric artery origins from the aorta are closely associated with the renal artery origins in the upper abdomen just below the aortic hiatus of the diaphragm. Their proximal portions each have a closely applied plexus of lymphatic and neurologic tissue. These vessels are relatively thin-walled, unlike similarly sized extremity arteries, and must be handled with care. The portal vein and major mesenteric veins are also thin-walled, easily torn, and equally easily injured during exposure. CliniCAl prESEnTATionThe pathophysiology of mesenteric ischemia is based upon insufficient blood flow to meet the metabolic demand of the bowel. Acute ischemia leads to initial hyperperistalsis, gut emptying, followed by intense ischemia pain from gut wall hypoperfusion. Since this is visceral pain, it is vague and projected across the area of the superficial abdominal wall with innervation shared with the visceral innnervation. Foregut structures generate visceral pain in the epigastrium, midgut in the periumbilical regions, hindgut in the infraumbilical region, and cloacal derivatives in the supra-pubic region of the abdomen. ischemia BACKGroUnD

Acute Mesenteric Ischemia with Intrasplenic Gas: A Rare Occurence

“…Contrast Ct scan can also demonstrate coexisting embolism of other organs like liver or spleen as in our case which supports the diagnosis of mesenteric ischemia [1]. Prompt diagnosis with urgent surgical therapy is the key for successful management of acute mesenteric ischemia from major arterial occlusion [5]. Gas in splenic parenchyma has been only rarely demonstrated on Ct in cases of acute mesenteric ischemia and in this case we presume it to be due to ischemic necrosis in the areas of splenic infarct [6,7].…”

Acute Mesenteric Ischemia

“…Additional treatment may include systemic anticoagulation and the use of catheterdirected infusion of vasodilatory and antispasmodic agents, most commonly papaverine hydrochloride [81]. The decision to intervene surgically is based on the presence of peritonitis, perforation, or overall worsening of the patient's condition [47].…”

Akute mesenteriale Ischämie

“…Ursächlich sind neben thromb embolischen Verschlüssen v. a. arterielle Thrombosen sowie die nicht okklusiven Minderperfusionen (NOMI), die zu einer akuten Ischämie des Intesti nums und damit zu einer Affektion des gesamten Organismus führen [4,14,16,17].…”

“…Mittlerweile sind die pathophysio logischen Vorgänge und deren zeitliche Bedeutung weitgehend bekannt und zu Recht wurde deshalb v. a. in einer Opti mierung der Organisation von Diagnos tik und Behandlung der Ansatz für eine Prognoseverbesserung gesehen [4,17]. Da in vielen Einrichtungen inzwischen eine zeitnahe sichere Diagnosestellung möglich ist und zudem eine zunehmen de Etablierung von spezialisierten Klini ken entwickelt wurde, müsste sich folge richtig in den letzten Jahren ein günsti geres Ergebnis von AMIVerläufen dar gestellt haben.…”