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Flashcards in Bowel Ischaemia Deck (11):

Acute bowel ischaemia

Acute occlusion of superior mesenteric artery


Causes of acute bowel ischaemia (ARTERIAL)

Embolism (commonly L.hearted side thrombus or iatrogenic rupture-interventional radiological procedure)

Thrombosis from SMA

Vasculitis ( Rheumatoid arthritis, polyarteritis nodosa, SLE)

External compression (commonly a mass)


Main types of bowel ischaemia

Acute mesenteric ischaemia

Chronic mesenteric ischaemia

Ischaemic colitis (colonic ischaemia)


Causes of acute bowel ischaemia (VENOUS)

Thrombosis (Superior Mesenteric Vein)
Hypo-perfusion due to:
HF, dialysis, Recent surgery, infection, drug related


Common type of patients to present with acute bowel ischaemia

Older patients with long-standing congestive heart failure, cardiac arrhythmias, recent MI, hypotension, or peripheral vascular disease.

Younger patients with history of collagen vascular disease, vasculitis, hyper-coagulable state, vasoactive medicine or cocaine use.

Patients with arterial embolus who describe sudden, severe abdominal pain with rapid, forceful bowel evacuation, possibly containing blood.


Presentation of acute bowel ischaemia

Sudden onset of diffuse abdo pain colicky or constant
Persists for more than 2-3 hours
Commonly peri-umbilical
Appear severely ill
Palpation to tenderness is a late sign


Presentation of chronic bowel ischaemia

Usually elderly
More common in female (3:1)
Often Hx of heavy smoker or other atherosclerotic factors

Insidious onset with repeated, mild, transient, episodes over many months, becoming progressively more severe
Pain occurs after meals, pain poorly localised
May be sitophobic (fear of eating)


Colonic ischaemia

Most common form of intestinal ischaemia
80% resolves without surgical intervention either spontaneous or conservative


Presentation of colonic ischaemia

Mild-mod pain felt laterally, over time becomes more continuous and intense.
Pain radiates to back
May be frequent bloody loose stools
Tenderness to palpation is an early sign
Abdomen becomes distended, loss of bowel sounds


Investigation for acute, chronic and colonic ischemia

Acute: AXR shows Thumbrinting, subdiaphragmatic air if perforated. Contrast CT to diagnose mesenteric venous thrombosis

Chronic: Angiography shows severe occlusion in at least 2 of the 3 splanchnic vessels (coeliac, IMA or SMA)

Colonic: Colonoscopy shows cobble stone appearance, thumbprinting and strictures. Barium enema can be used if no colonoscopy available.


Management of acute ischaemia

Fluid Resuscitation and adequate oxygen supply
Emprical Ab: Ceftriaxone or levofloxacin AND metranidazole

IF PERITONITIS OR PERFORATION: Exploratory laparotomy or laparoscopy

Papaverine infusion, embelectomy or bypass, bowel resection