Intestinal Ischaemia

Question 1

Define

Answer 1

Obstruction of a mesenteric vessel leading to bowel ischaemia and necrosis

Question 2

Causes

Answer 2

Embolus (60%)

Thrombosis (40%)

Can be a consequence of:

• Volvulus
• Intussusception
• Bowel strangulation
• Failed surgical resection

Question 3

Risk factors

Answer 3

• AF
• Endocarditis (can throw emboli)
• Arterial Thrombosis: hypercholesterolaemia, hypertension, diabetes mellitus, smoking
• Venous Thrombosis: portal hypertension, splenectomy, septic thrombophlebitis, OCP, thrombophilia

Question 4

Epidemiology

Answer 4

UNCOMMON

More common in the ELDERLY

Question 5

Symptoms

Answer 5

Severe acute colicky abdominal pain

Vomiting

Rectal bleeding

History of chronic mesenteric artery insufficiency

• Gross weight loss
• Post-prandial abdominal pain

History of heart or liver disease

Question 6

Signs

Answer 6

• Diffuse abdominal tenderness
• Abdominal distension
• Tender palpable mass (ischaemic bowel)
• Bowel sounds may be absent
• Disproportionate degree of cardiovascular collapse

Question 7

Investigations

Answer 7

Diagnosis based on clinical suspicion or after laparotomy

AXR - thickening of small bowel folds and signs of obstruction

Bloods

ABG - lactic acidosis

FBC

U&Es

LFTs

Clotting

Cross-match

Mesenteric Angiography

Only if stable

NOTE: the ‘watershed zone’ (the area between the supply of the superior and inferior mesenteric arteries - near the splenic flexure) is most vulnerable to intestinal ischaemia