Bowel blood supply can be compromised in four ways
- Strangulation
- Acute thrombotic or embolic obstruction – usually of the superior
mesenteric artery
- Transient Ischaemia (
ischaemic colitis )
- Chronic Mesenteric Artery insufficiency
Acute Bowel Ischaemia Presentation
- Can be difficult diagnosis
- Diffuse tenderness
- Abdominal distension
- Absent Bowel sounds
- May be vomiting and/or bloody diarrhoea
- Disproportionate degree of pain and cardiovascular collapse
- May be history of ‘mesenteric claudication’, AF, oral contraceptive,
sepsis, portal hypertension
Investigations
- FBC,
- WCC,
- HCO3,
- Plain AXR,
- Serum amylase may be raised,
- Duplex,
- Laparotomy
Treatment
- Laporotomy performed on clinical suspicion for diagnosis
- May be able to restore blood supply through embolectomy or vascular bypass
- If infarcted section not too extensive - resect
- If too extensive, leave patient with minimum of interference (terminal)
Chronic Mesenteric Artery Insufficiency Presentation
- Gross weight loss
- Abdominal pain following eating (about 20 mins)
- May lead to a ‘fear of food’
- Sometimes there is an epigastric bruit
Cause
- Gross insufficiency of coeliac, superior mesenteric and inferior
mesenteric arteries usually due to arteriosclerosis
Investigations
- Duplex scanning
- Lateral projection arteriography
Treatment
- Surgical reconstruction of one or more of the arteries involved
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