{{short description|Restriction of blood flow to the small intestine resulting in injury}} {{Infobox medical condition (new) | name = Intestinal ischemia | image = Ischemicbowel.PNG | caption = Computed tomography (CT) showing dilated loops of small bowel with thickened walls (black arrow), findings characteristic of ischemic bowel due to thrombosis of the superior mesenteric vein. | synonyms = Bowel ischemia | field = General surgery, vascular surgery, gastroenterology | symptoms = '''Acute''': sudden severe pain<ref name=Surg2013/><br>'''Chronic''': abdominal pain after eating, unintentional weight loss, vomiting<ref name=Ye2014/><ref name=Surg2013/> | complications = | onset = > 60 years old<ref name=Britt2012/> | duration = | types = Acute, chronic<ref name=Surg2013/> | causes = | risks = Atrial fibrillation, heart failure, chronic kidney failure, being prone to forming blood clots, previous myocardial infarction<ref name=Ye2014/> | diagnosis = Angiography, computed tomography<ref name=Surg2013/> | differential = | prevention = | treatment = Stenting, medications to break down clot, surgery<ref name=Surg2013/><ref name=Ye2014/> | medication = | prognosis = ~80% risk of death<ref name=Britt2012/> | frequency = '''Acute''': 5 per 100,000 per year (developed world)<ref name=Geo2012/><br>'''Chronic''': 1 per 100,000<ref name=Gus2014/> | deaths = }} <!-- Definition and symptoms --> '''Intestinal ischemia''' is a medical condition in which injury to the large or small intestine occurs due to inadequate blood supply.<ref name=Ye2014>{{cite book|last1=Yelon|first1=Jay A.|title=Geriatric Trauma and Critical Care|date=2014|publisher=Springer Verlag|location=New York|isbn=9781461485018|page=182|edition=Aufl. 2014|url=https://books.google.com/books?id=Uoi4BAAAQBAJ&pg=PA182|url-status=live|archive-url=https://web.archive.org/web/20170908171423/https://books.google.com/books?id=Uoi4BAAAQBAJ&pg=PA182|archive-date=2017-09-08}}</ref> Onset can be sudden, known as acute intestinal ischemia, or gradual, known as chronic intestinal ischemia.<ref name=Surg2013>{{cite journal|last1=Bobadilla|first1=JL|title=Mesenteric ischemia.|journal=The Surgical Clinics of North America|date=August 2013|volume=93|issue=4|pages=925–40, ix|pmid=23885938|doi=10.1016/j.suc.2013.04.002}}</ref> The acute form of the disease often presents with sudden severe abdominal pain and is associated with a high risk of death.<ref name=Surg2013/> The chronic form typically presents more gradually with abdominal pain after eating, unintentional weight loss, vomiting, and fear of eating.<ref name=Surg2013/><ref name=Ye2014/>
<!-- Cause and diagnosis --> Risk factors for acute intestinal ischemia include atrial fibrillation, heart failure, chronic kidney failure, being prone to forming blood clots, and previous myocardial infarction.<ref name=Ye2014/> There are four mechanisms by which poor blood flow occurs: a blood clot from elsewhere getting lodged in an artery, a new blood clot forming in an artery, a blood clot forming in the superior mesenteric vein, and insufficient blood flow due to low blood pressure or spasms of arteries.<ref name=Britt2012/><ref>{{cite book|last1=Creager|first1=Mark A.|title=Vascular medicine : a companion to Braunwald's heart disease|date=2013|publisher=Elsevier/Saunders|location=Philadelphia, PA|isbn=9781437729306|pages=323–324|edition=2nd|url=https://books.google.com/books?id=TrstW0MKDA4C&pg=PA323|url-status=live|archive-url=https://web.archive.org/web/20170908171423/https://books.google.com/books?id=TrstW0MKDA4C&pg=PA323|archive-date=2017-09-08}}</ref> Chronic disease is a risk factor for acute disease.<ref>{{cite journal|last1=Sreenarasimhaiah|first1=J|title=Chronic mesenteric ischemia.|journal=Best Practice & Research. Clinical Gastroenterology|date=April 2005|volume=19|issue=2|pages=283–95|pmid=15833694|doi=10.1016/j.bpg.2004.11.002}}</ref> The best method of diagnosis is angiography, with computed tomography (CT) used when that is not available.<ref name=Surg2013/>
<!-- Treatment and prognosis --> Treatment of acute ischemia may include stenting or medications to break down the clot provided at the site of obstruction by interventional radiology.<ref name=Surg2013/> Open surgery may also be used to remove or bypass the obstruction and may be required to remove any intestines that may have died.<ref name=Ye2014/> If not rapidly treated outcomes are often poor.<ref name=Surg2013/> Among those affected even with treatment the risk of death is 70% to 90%.<ref name=Britt2012>{{cite book|last1=Britt|first1=L.D.|title=Acute care surgery|date=2012|publisher=Wolters Kluwer Health/Lippincott Williams & Wilkins|location=Philadelphia|isbn=9781608314287|page=621|edition=1st|url=https://books.google.com/books?id=7GRnoeg6aZEC&pg=PA621|url-status=live|archive-url=https://web.archive.org/web/20170908171423/https://books.google.com/books?id=7GRnoeg6aZEC&pg=PA621|archive-date=2017-09-08}}</ref> In those with chronic disease bypass surgery is the treatment of choice.<ref name=Surg2013/> Those who have thrombosis of the vein may be treated with anticoagulation such as heparin and warfarin, with surgery used if they do not improve.<ref name=Ye2014/><ref>{{cite book|last1=Liapis|first1=C.D.|title=Vascular surgery|date=2007|publisher=Springer|location=Berlin|isbn=9783540309567|page=420|url=https://books.google.com/books?id=FRW3mzt2dZ4C&pg=PA420|url-status=live|archive-url=https://web.archive.org/web/20170908171423/https://books.google.com/books?id=FRW3mzt2dZ4C&pg=PA420|archive-date=2017-09-08}}</ref>
<!-- Epidemiology and history --> Acute intestinal ischemia affects about five per hundred thousand people per year in the developed world.<ref name=Geo2012>{{cite book|author1=Geoffrey D. Rubin|title=CT and MR Angiography: Comprehensive Vascular Assessment|date=2012|publisher=Lippincott Williams & Wilkins|isbn=9781469801834|page=318|url=https://books.google.com/books?id=xPwG17yFkzcC&pg=PA318|url-status=live|archive-url=https://web.archive.org/web/20170908171423/https://books.google.com/books?id=xPwG17yFkzcC&pg=PA318|archive-date=2017-09-08}}</ref> Chronic intestinal ischemia affects about one per hundred thousand people.<ref name=Gus2014>{{cite book|author1=Gustavo S. Oderich|title=Mesenteric Vascular Disease: Current Therapy|date=2014|publisher=Springer|isbn=9781493918478|page=105|url=https://books.google.com/books?id=nL2PBQAAQBAJ&pg=PA105|url-status=live|archive-url=https://web.archive.org/web/20170908171423/https://books.google.com/books?id=nL2PBQAAQBAJ&pg=PA105|archive-date=2017-09-08}}</ref> Most people affected are over 60 years old.<ref name=Britt2012/> Rates are about equal in males and females of the same age.<ref name=Britt2012/> Intestinal ischemia was first described in 1895.<ref name=Surg2013/>
==Signs and symptoms== While not always present and often overlapping, three progressive phases of intestinal ischemia have been described:<ref>{{cite journal |vauthors=Boley, SJ, Brandt, LJ, Veith, FJ |year=1978 |title=Ischemic disorders of the intestines |journal=Curr Probl Surg |volume=15 |pages=1–85 |doi=10.1016/S0011-3840(78)80018-5 |issue=4 |pmid=365467}}</ref><ref>{{cite journal |vauthors=Hunter G, Guernsey J | title = Mesenteric ischemia | journal = Med Clin North Am | volume = 72 | issue = 5 | pages = 1091–115 | year = 1988 | pmid = 3045452| doi = 10.1016/S0025-7125(16)30731-3 }}</ref> * A ''hyperactive'' stage occurs first, in which the primary symptoms are severe abdominal pain and the passage of bloody stools. Many patients get better and do not progress beyond this phase. * A ''paralytic'' phase can follow if ischemia continues; in this phase, the abdominal pain becomes more widespread, the belly becomes more tender to the touch, and bowel motility decreases, resulting in abdominal bloating, no further bloody stools, and absent bowel sounds on exam. * Finally, a ''shock'' phase can develop as fluids start to leak through the damaged colon lining. This can result in shock and metabolic acidosis with dehydration, low blood pressure, rapid heart rate, and confusion. Patients who progress to this phase are often critically ill and require intensive care.
===Clinical findings=== Symptoms of intestinal ischemia vary and can be acute (especially if embolic),<ref name="pmid15159262">{{cite journal |vauthors=Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD |title=Acute mesenteric ischemia: a clinical review |journal=Arch. Intern. Med. |volume=164 |issue=10 |pages=1054–62 |year=2004 |pmid=15159262 | doi=10.1001/archinte.164.10.1054|doi-access=free }}</ref> subacute, or chronic.<ref name="pmid2691119">{{cite journal |vauthors=Font VE, Hermann RE, Longworth DL |title=Chronic mesenteric venous thrombosis: difficult diagnosis and therapy |journal=Cleveland Clinic Journal of Medicine |volume=56 |issue=8 |pages=823–8 |year=1989 |pmid=2691119 |doi=10.3949/ccjm.56.8.823}}</ref>
Case series report prevalence of clinical findings and provide the best available, yet biased, estimate of the sensitivity of clinical findings.<ref name="pmid2321134">{{cite journal |vauthors=Levy PJ, Krausz MM, Manny J |title=Acute mesenteric ischemia: improved results—a retrospective analysis of ninety-two patients |journal=Surgery |volume=107 |issue=4 |pages=372–80 |year=1990 |pmid=2321134}}</ref><ref name="pmid11877691">{{cite journal |vauthors=Park WM, Gloviczki P, Cherry KJ, Hallett JW, Bower TC, Panneton JM, Schleck C, Ilstrup D, Harmsen WS, Noel AA |title=Contemporary management of acute mesenteric ischemia: Factors associated with survival |journal=J. Vasc. Surg. |volume=35 |issue=3 |pages=445–52 |year=2002 |pmid=11877691|doi=10.1067/mva.2002.120373 |doi-access=free }}</ref> In a series of 58 patients with intestinal ischemia due to mixed causes:<ref name="pmid11877691"/> * abdominal pain was present in 95% (median of 24 hours duration). The other three patients presented with shock and metabolic acidosis. * nausea in 44% * vomiting in 35% * diarrhea in 35% * heart rate > 100 in 33% * rectal bleeding in 16% (not stated if this number also included occult blood – presumably not) * constipation in 7%
===Diagnostic heuristics=== In the absence of adequate quantitative studies to guide diagnosis, various heuristics help guide diagnosis: * Intestinal ischemia "should be suspected when individuals, especially those at high risk for acute intestinal ischemia, develop severe and persisting abdominal pain that is disproportionate to their abdominal findings",<ref name=AGA2000>{{cite journal|title=American Gastroenterological Association Medical Position Statement: guidelines on intestinal ischemia|journal=Gastroenterology|date=May 2000|volume=118|issue=5|pages=951–3|pmid=10784595|doi=10.1016/s0016-5085(00)70182-x|doi-access=free}}</ref> or simply, pain out of proportion to exam. * Regarding intestinal arterial thrombosis or embolism: "early symptoms are present and are relatively mild in 50% of cases for three to four days before medical attention is sought".<ref name="isbn9780195175455"> {{cite book| last1 = Cope| first1 = Zachary| author-link = Zachary Cope| last2 = Silen| first2 = William|date=April 2005| title = Cope's Early Diagnosis of the Acute Abdomen| publisher = Oxford University Press| location = New York| edition = 21st| isbn = 978-0-19-517545-5| oclc = 56324163| url = https://archive.org/details/copesearlydiagno00sile| url-access = registration| lccn = 2004058138}}</ref> * Regarding intestinal arterial thrombosis or embolism: "Any patient with an arrhythmia such as atrial fibrillation who complains of abdominal pain is highly suspected of having embolization of the superior mesenteric artery until proven otherwise."<ref name="isbn9780195175455"/> * Regarding nonocclusive intestinal ischemia: "Any patient who takes digitalis and diuretics and who complains of abdominal pain must be considered to have nonocclusive ischemia until proven otherwise."<ref name="isbn9780195175455"/>
==Diagnosis== It is difficult to diagnose intestinal ischemia early.<ref>{{cite journal |vauthors=Evennett NJ, Petrov MS, Mittal A, Windsor JA |title=Systematic review and pooled estimates for the diagnostic accuracy of serological markers for intestinal ischemia |journal=World J Surg |volume=33 |issue=7 |pages=1374–83 |date=July 2009 |pmid=19424744 |doi=10.1007/s00268-009-0074-7 |s2cid=20115312 }}</ref>
===Blood tests=== In a series of 58 patients with intestinal ischemia due to mixed causes:<ref name="pmid11877691"/> * White blood cell count >10.5 in 98% (probably an overestimate as only tested in 81% of patients) * Lactic acid elevated 91% (probably an overestimate as only tested in 57% of patients)
In very early or very extensive acute intestinal ischemia, elevated lactate and white blood cell count may not yet be present. In extensive mesenteric ischemia, bowel may be ischemic but separated from the blood flow such that the byproducts of ischemia are not yet circulating.<ref name=Rutherford8thEd>{{cite book |title=Rutherford's vascular surgery |isbn=978-1455753048 |edition=Eighth|last1=Cronenwett |first1=Jack L. |last2=Wayne Johnston |first2=K. |year=2014 |publisher=Elsevier Saunders }}</ref>
===During endoscopy=== A number of devices have been used to assess the sufficiency of oxygen delivery to the colon. The earliest devices were based on tonometry, and required time to equilibrate and estimate the pHi, roughly an estimate of local CO<sub>2</sub> levels. The first device approved by the U.S. FDA (in 2004) used visible light spectroscopy to analyze capillary oxygen levels. Use during aortic aneurysm repair detected when colon oxygen levels fell below sustainable levels, allowing real-time repair. In several studies, specificity has been 83% for chronic intestinal ischemia and 90% or higher for acute colonic ischemia, with a sensitivity of 71–92%. This device must be placed using endoscopy, however.<ref>{{cite journal |vauthors=Lee ES, Bass A, Arko FR, etal | title = Intraoperative colon mucosal oxygen saturation during aortic surgery | volume = 136 | issue = 1 | pages = 19–24 | year = 2006| pmid = 16978651 | doi = 10.1016/j.jss.2006.05.014 | journal = The Journal of Surgical Research}}</ref><ref>{{cite journal |vauthors=Friedland S, Benaron D, Coogan S, etal | title = Diagnosis of chronic mesenteric ischemia by visible light spectroscopy during endoscopy | journal = Gastrointest Endosc | volume = 65| issue = 2 | pages = 294–300 | year = 2007| pmid = 17137857 | doi = 10.1016/j.gie.2006.05.007 }}</ref><ref>{{cite journal |vauthors=Lee ES, Pevec WC, Link DP, etal | title = Use of T-stat to Predict Colonic Ischemia during and after Endovascular Aneurysm Repair: A case report | journal = J Vasc Surg | volume = 47| issue = 3 | pages = 632–634 | year = 2008| pmid = 18295116 | doi = 10.1016/j.jvs.2007.09.037 | pmc = 2707776}}</ref>
Findings on gastroscopy may include edematous gastric mucosa,<ref>{{Cite journal|last1=Clair|first1=Daniel G.|last2=Beach|first2=Jocelyn M.|date=2016-03-10|editor-last=Campion|editor-first=Edward W.|title=Mesenteric Ischemia|journal=New England Journal of Medicine|language=en|volume=374|issue=10|pages=959–968|doi=10.1056/NEJMra1503884|pmid=26962730|s2cid=3952010 |issn=0028-4793}}</ref> and hyperperistalsis.<ref>{{Cite book|title=Mayo Clinic gastroenterology and hepatology board review|date=2008|publisher=Mayo Clinic Scientific Press|author1=Hauser, Stephen C.|author2=Pardi, Darrell S.|author3=Poterucha, John J.|author4=Mayo Clinic|isbn=978-1-4200-9224-0|edition=3rd|location=Rochester [Minn.]|oclc=285067394}}</ref>
Finding on colonoscopy may include: fragile mucosa,<ref>{{Cite book|last=Cotton|first=Peter B.|title=Practical gastrointestinal endoscopy: the fundamentals|date=2003|publisher=Blackwell Pub|editor=Williams, Christopher B.|isbn=1-4051-0235-7|edition=5th|location=Malden, Mass.|oclc=50731401}}</ref> segmental erythema,<ref>{{Cite book|title=Schwartz's principles of surgery|author=Schwartz, Seymour I.|editor1=Brunicardi, F. Charles|editor2=Andersen, Dana K.|editor3=Billiar, Timothy R.|editor4=Dunn, David L.|editor5=Hunter, John G.|date = 16 July 2014|isbn=978-0-07-179675-0|edition=Tenth|publisher=McGraw-Hill Education|location=New York|oclc=855332914}}</ref> longitudinal ulcer,<ref>{{Cite book|title=Corman's colon and rectal surgery|editor=Corman, Marvin L.|date=October 2012 |isbn=9781451111149|edition=Sixth|publisher=Lippincott Williams & Wilkins|location=Philadelphia|oclc=820121142}}</ref> and loss of haustrations.<ref>{{Cite book|title=Sabiston textbook of surgery: the biological basis of modern surgical practice|author1=Townsend, Courtney M.|author2=Beauchamp, R. Daniel|author3=Evers, B. Mark|author4=Mattox, Kenneth L.|year = 2017|isbn=978-0-323-29987-9|edition=20th|publisher=Elsevier Saunders|location=Philadelphia, PA|oclc=921338900}}</ref>
===Plain X-ray=== Plain X-rays are often normal or show non-specific findings.<ref>{{cite journal |vauthors=Smerud M, Johnson C, Stephens D | title = Diagnosis of bowel infarction: a comparison of plain films and CT scans in 23 cases | journal = AJR Am J Roentgenol | volume = 154 | issue = 1 | pages = 99–103 | year = 1990 | pmid = 2104734 | doi=10.2214/ajr.154.1.2104734| doi-access = free }}</ref>
===Computed tomography=== [[File:Mesenteriale Ischaemie mit Pneumatosis intestinalis und Gas in Mesenterial- und Lebervenen 80M - CT - 001.jpg|thumb|400px|CT image showing mesenteric ischemia with pneumatosis intestinalis and gas in mesenterial and liver veins]] Computed tomography (CT scan) is often used.<ref name="pmid3336673">{{cite journal |vauthors=Alpern M, Glazer G, Francis I | title = Ischemic or infarcted bowel: CT findings | journal = Radiology | volume = 166 | issue = 1 Pt 1 | pages = 149–52 | year = 1988 | pmid = 3336673 | doi=10.1148/radiology.166.1.3336673}}</ref><ref>{{cite journal | vauthors = Taourel P, Deneuville M, Pradel J, Régent D, Bruel J | title = Acute mesenteric ischemia: diagnosis with contrast-enhanced CT | journal = Radiology | volume = 199 | issue = 3 | pages = 632–6 | year = 1996 | pmid = 8637978 | doi = 10.1148/radiology.199.3.8637978 | url = http://radiology.rsnajnls.org/cgi/reprint/199/3/632.pdf | url-status = dead | archive-url = https://web.archive.org/web/20080227142554/http://radiology.rsnajnls.org/cgi/reprint/199/3/632.pdf | archive-date = 2008-02-27 | access-date = 2007-09-27 }}</ref> The accuracy of the CT scan depends on whether a small bowel obstruction (SBO) is present.<ref name="pmid15835585">{{cite journal |vauthors=Staunton M, Malone DE |title=Can acute mesenteric ischemia be ruled out using computed tomography? Critically appraised topic | |journal=Canadian Association of Radiologists Journal |volume=56 |issue=1 |pages=9–12 |year=2005 |pmid=15835585 }}</ref>
'''SBO absent''' * prevalence of intestinal ischemia 23% * sensitivity 64% * specificity 92% * positive predictive value (at prevalence of 23%) 79% * negative predictive value (at prevalence of 23%) 95% '''SBO present''' * prevalence of intestinal ischemia 62% * sensitivity 83% * specificity 93% * positive predictive value (at prevalence of 62%) 93% * negative predictive value (at prevalence of 62%) 61%
Early findings on CT scan include: * Intestinal mesenteric edema<ref name="pmid3336673"/> * Bowel dilatation<ref name="pmid3336673"/> * Bowel wall thickening<ref name="pmid3336673"/> * Intestinal mesenteric stranding<ref name="pmid15143223">{{cite journal |vauthors=Pereira JM, Sirlin CB, Pinto PS, Jeffrey RB, Stella DL, Casola G |title=Disproportionate fat stranding: a helpful CT sign in patients with acute abdominal pain |journal=Radiographics |volume=24 |issue=3 |pages=703–15 |year=2004 |pmid=15143223 |doi=10.1148/rg.243035084}}</ref> * Evidence of adjacent solid organ infarctions to the kidney or spleen, consistent with a cardiac embolic shower phenomenon
In embolic acute intestinal ischemia, CT-Angiography can be of great value for diagnosis and treatment. It may reveal the emboli itself lodged in the superior mesenteric artery, as well as the presence or absence of distal mesenteric branches.<ref name ="Rutherford8thEd"/>
Late findings, which indicate dead bowel, include: * Intramural bowel gas<ref name="pmid3336673"/> * Portal venous gas * Free abdominal air
===Angiography=== As the cause of the ischemia can be due to embolic or thrombotic occlusion of the mesenteric vessels or nonocclusive ischemia, the best way to differentiate between the etiologies is through the use of mesenteric angiography. Though it has serious risks, angiography provides the possibility of direct infusion of vasodilators in the setting of nonocclusive ischemia.<ref>Kao, Lillian S., and Tammy Lee. PreTest Surgery: PreTest Self-assessment and Review. New York: McGraw-Hill Medical, 2009.</ref>
==Treatment== The treatment of intestinal ischemia depends on the cause and can be medical or surgical. However, if bowel has become necrotic, the only treatment is surgical removal of the dead segments of bowel.<ref>{{cite web |url= https://www.lecturio.com/concepts/intestinal-ischemia/| title=Intestinal Ischemia |website=The Lecturio Medical Concept Library |access-date= 27 July 2021}}</ref>
In non-occlusive disease, where there is no blockage of the arteries supplying the bowel, the treatment is medical rather than surgical. People are admitted to the hospital for resuscitation with intravenous fluids, careful monitoring of laboratory tests, and optimization of their cardiovascular function. NG tube decompression and heparin anticoagulation may also be used to limit stress on the bowel and optimize perfusion, respectively.{{cn|date=February 2021}}
Surgical revascularisation remains the treatment of choice for intestinal ischaemia related to an occlusion of the vessels supplying the bowel, but thrombolytic medical treatment and vascular interventional radiological techniques have a growing role.<ref name="pmid12816826">{{cite journal |author=Sreenarasimhaiah J |title=Diagnosis and management of intestinal ischaemic disorders |journal=BMJ |volume=326 |issue=7403 |pages=1372–6 |year=2003 |pmid=12816826 | doi=10.1136/bmj.326.7403.1372 |pmc=1126251}}</ref>
If the ischemia has progressed to the point that the affected intestinal segments are gangrenous, a bowel resection of those segments is called for. Often, obviously dead segments are removed at the first operation, and a second-look operation is planned to assess segments that are borderline that may be savable after revascularization.<ref>{{cite journal|last1=Meng|first1=X|last2=Liu|first2=L|last3=Jiang|first3=H|title=Indications and procedures for second-look surgery in acute mesenteric ischemia.|journal=Surgery Today|date=August 2010|volume=40|issue=8|pages=700–5|pmid=20676851|doi=10.1007/s00595-009-4140-4|s2cid=9926212}}</ref>
===Methods for revascularization=== * Open surgical thrombectomy * Intestinal bypass * Trans-femoral antegrade intestinal angioplasty and stenting * Open retrograde intestinal angioplasty stenting * Trans-catheter thrombolysis<ref name ="Rutherford8thEd"/>
==Prognosis== The prognosis depends on prompt diagnosis (less than 12–24 hours and before gangrene)<ref name=AGA200b>{{cite journal |last1=Brandt |first1=LJ |last2=Boley |first2=SJ |title=AGA technical review on intestinal ischemia. American Gastrointestinal Association. |journal=Gastroenterology |date=May 2000 |volume=118 |issue=5 |pages=954–968 |pmid=10784596 |doi=10.1016/s0016-5085(00)70183-1}}</ref> and the underlying cause:<ref name="pmid">{{cite journal |vauthors=Schoots IG, Koffeman GI, Legemate DA, Levi M, van Gulik TM |title=Systematic review of survival after acute mesenteric ischaemia according to disease aetiology |journal=The British Journal of Surgery |volume=91 |issue=1 |pages=17–27 |year=2004 |pmid=14716789 |doi=10.1002/bjs.4459|s2cid=23812099 |doi-access=free }}</ref> * venous thrombosis: 32% mortality * arterial embolism: 54% mortality * arterial thrombosis: 77% mortality * non-occlusive ischemia: 73% mortality. In the case of prompt diagnosis and therapy, acute intestinal ischemia can be reversible.<ref>{{cite journal|last1=Nuzzo|first1=Alexandre|last2=Corcos|first2=Olivier|title=Reversible Acute Mesenteric Ischemia|journal=New England Journal of Medicine|date=13 October 2016|volume=375|issue=15|pages=e31|doi=10.1056/NEJMicm1509318|pmid=27732829}}</ref>
==History== Acute intestinal ischemia was first described in 1895, while chronic disease was first described in the 1940s.<ref name=Surg2013/> Chronic disease was initially known as angina abdominis.<ref name=Surg2013/>
==Terminology== The related term '''mesenteric ischemia''' or '''small intestine ischemia''' generally defined as ischemia of the small bowel specifically.<ref>{{cite web|url=https://www.mayoclinic.org/diseases-conditions/mesenteric-ischemia/symptoms-causes/syc-20374989|title=Mesenteric ischemia|website=Mayo Clinic|date=2019-04-24}}</ref> It has also been defined as poor circulation in the vessels supplying blood flow to any or several of the mesenteric organs, including the stomach, liver, colon and intestine. The terms '''colonic ischemia''', '''large intestine ischemia''', or '''ischemic colitis''' refers to ischemia of the large bowel.<ref>{{cite web|url=https://vascular.org/patients/vascular-conditions/mesenteric-ischemia|author=Dr. Rabih A. Chaer|title=Mesenteric Ischemia|website=Society for Vascular Surgery}}</ref><ref>{{Citation |last=Amini |first=Afshin |title=Bowel Ischemia |date=2023 |url=https://www.ncbi.nlm.nih.gov/books/NBK554527/ |work=StatPearls |access-date=2023-12-21 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32119414 |last2=Nagalli |first2=Shivaraj}}</ref>
===In the large intestine=== {{Main|Ischemic colitis}}
Ischemia of the large intestine (colon) is termed ischemic colitis. Although uncommon in the general population, ischemic colitis occurs with greater frequency in the elderly, and is the most common form of bowel ischemia.<ref name="pmid15043513">{{cite journal |vauthors=Higgins P, Davis K, Laine L | title = Systematic review: the epidemiology of ischaemic colitis. | journal = Aliment Pharmacol Ther | volume = 19 | issue = 7 | pages = 729–38 | year = 2004 | pmid = 15043513 | doi = 10.1111/j.1365-2036.2004.01903.x| hdl = 2027.42/74164 | s2cid = 9575677 | url = https://deepblue.lib.umich.edu/bitstream/2027.42/74164/1/j.1365-2036.2004.01903.x.pdf | hdl-access = free }}</ref><ref name="pmid10784596">{{cite journal |vauthors=Brandt LJ, Boley SJ |title=AGA technical review on intestinal ischemia. American Gastrointestinal Association |journal=Gastroenterology |volume=118 |issue=5 |pages=954–68 |year=2000 |pmid=10784596 |doi=10.1016/S0016-5085(00)70183-1}}</ref><ref name="pmid10784595">{{cite journal |author=American Gastroenterological Association |title=American Gastroenterological Association Medical Position Statement: guidelines on intestinal ischemia |journal=Gastroenterology |volume=118 |issue=5 |pages=951–3 |year=2000 |pmid=10784595 |doi=10.1016/S0016-5085(00)70182-X|doi-access=free }} http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3069&nbr=2295 {{Webarchive|url=https://web.archive.org/web/20070927212511/http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3069&nbr=2295 |date=2007-09-27 }}</ref> Causes of the reduced blood flow can include changes in the systemic circulation (e.g. low blood pressure), or local factors such as constriction of blood vessels or a blood clot. In most cases, no specific cause can be identified.<ref name="textp2332">Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., 2002 Saunders, p. 2332.</ref>
Ischemic colitis is usually suspected on the basis of the clinical setting, physical examination, and laboratory test results; the diagnosis can be confirmed by endoscopy or by using sigmoid or endoscopic placement of a visible light spectroscopic catheter (see Diagnosis). Ischemic colitis can span a wide spectrum of severity; most patients are treated supportively and recover fully, while a minority with very severe ischemia may develop sepsis and become critically,<ref>{{cite journal |vauthors=Medina C, Vilaseca J, Videla S, Fabra R, Armengol-Miro J, Malagelada J | title = Outcome of patients with ischemic colitis: review of fifty-three cases. | journal = Dis Colon Rectum | volume = 47 | issue = 2 | pages = 180–4 | year = 2004 | pmid = 15043287 | doi = 10.1007/s10350-003-0033-6| s2cid = 24204840 }}</ref> sometimes even fatally, ill.<ref>{{cite news | url=https://www.theguardian.com/uk-news/2013/aug/28/brighton-marathon-runner-died-bowel-disease | title=Brighton marathon runner died from bowel failure | work=The Guardian newspaper | date=28 August 2013 | agency=Press Association | access-date=29 August 2013}}</ref>
Patients with mild to moderate ischemic colitis are usually treated with IV fluids, analgesia, and bowel rest (that is, no food or water by mouth) until the symptoms resolve. Those with severe ischemia who develop complications such as sepsis, intestinal gangrene, or bowel perforation may require more aggressive interventions, such as surgery and intensive care. Most patients make a full recovery; occasionally, after severe ischemia, patients may develop long-term complications such as a stricture<ref>{{cite journal |vauthors=Simi M, Pietroletti R, Navarra L, Leardi S | title = Bowel stricture due to ischemic colitis: report of three cases requiring surgEsophageal dilatationery. | journal = Hepatogastroenterology | volume = 42 | issue = 3 | pages = 279–81 | year = 1995 | pmid = 7590579}}</ref> or chronic colitis.<ref name="Cappell M 1998 827–60, vi">{{cite journal | author = Cappell M | title = Intestinal (mesenteric) vasculopathy. II. Ischemic colitis and chronic mesenteric ischemia. | journal = Gastroenterol Clin North Am | volume = 27 | issue = 4 | pages = 827–60, vi | year = 1998 | pmid = 9890115 | doi = 10.1016/S0889-8553(05)70034-0}}</ref>
==References== {{Reflist}}
==External links== {{Medical resources | DiseasesDB = 29034 | ICD10 = {{ICD10|K|55|9|k|55}} | ICD9 = {{ICD9|557.9}} | ICDO = | OMIM = | MedlinePlus = 001156 | eMedicineSubj = radio | eMedicineTopic = 2726
}}
{{Gastroenterology}} {{Hemodynamics}}
Category:Diseases of intestines Category:Ischemia Category:Wikipedia medicine articles ready to translate Category:Wikipedia emergency medicine articles ready to translate