Ischemia bowel . Ischemia bowel . "Occlusion of the mesenteric vessels is apt to be regarded as one of those conditions of which the diagnosis is impossible, the prognosis hopeless, and the treatment almost useless " (Cokkinis, 1926). . Ischemia bowel .
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1.atheromatous plaque with intimal calcifications
2.embolic from cardiac disease
3. abdominal aortic aneurysms with dissection into SMA
4. hypoperfusion secondary to hypovolemic shock or low-flow cardiac failure.
Both occlusive and nonocclusive subtypes can occur .
2. recent abdominal surgery
4. hypercoagulable states.
4. antiphospholipid antibody syndrome (APS).
APS is associated with hypercoagulable states secondary to circulating immunoglobulins that interact with phospholipids in cell membranes.
In a recent study by Kaushik et al, 13 (31%) of 42 patients with APS had CT findings of bowel ischemia.
is divided into:
1.Embolic acute mesenteric ischemia
2.thrombolic acute mesenteric ischemia
4. mesenteric venous thrombosis
all types of AMI share many similarities and a final common pathway ( bowel infarction and death, if not properly treated),they are discussed together
1. a sudden drop in C.O. ( MI or CHF or a ruptured plaque). 2.Dehydration.
gradual progression and frequently have a better collateral supply. Bowel viability is better preserved.
in a much younger patient population than other types .
( D / D with diverticulitis, appendicitis, Crohn disease, peptic ulcer disease, or pelvic inflammatory disease. )
1. the timing of the event. 2.localizing signs and symptoms 3.vascular distribution of the pain.
should be requested first to evaluate for free air, obstruction, ileus, intussusception, or volvulus.
may be needed if the cause is not apparent on plain radiographs.
Typically, if additional imaging are needed, ultrasound or angiography is the next step in the workup.
MRA is occasionally used to evaluate the patency of the SMA and IMA. It plays a limited role in the diagnosis.
Appendicitis Trauma Pseudomembranous colitis Adenocarcinoma
Diverticulitis Crohn Disease Necrotizing Enterocolitis Pneumatosis Intestinalis Typhlitis Ulcerative Colitis
usually surgical resection of the infarcted bowel segment.
not a surgical emergency and may be treated conservatively.
usually nonsurgically. Depending on the cause