Mesenteric ischemia
Pathophysiology
4 distinct entities:
- Mesenteric arterial embolism
- Mesenteric arterial thrombosis
- Nonocclusive mesenteric ischemia
- Mesenteric venous thrombosis
Epidemiology
- Mean age: 70yo
- 2/3 women
Risk Factors
- CAD
- Valvular heart disease
- Dysrhythmia
- Hypovolemia / hypotension
- Meds
- Diuretics
- Vasoconstrictive
- Digoxin
- Dialysis
Signs/Symptoms
- Pain out of proportion to exam
- Severe, poorly localized, colicky
Work Up
- Labs
- Lactate (higher later)
- WBC (often >15K)
- Chemistry (metabolic acidosis)
- CTA
- Angiography
Treatment
- IVF
- IV Abx
- Narcotic analgesia
Acute arterial embolus
- Papaverine infusion (30-60 mg/h IV) OR
- surgical embolectomy OR
- intra-arterial thrombolysis
Nonocclusive mesenteric ischemia
- Papaverine infusion
Mesenteric venous thrombosis
- Heparin/warfarin either alone or in combination with surgery
- Immediate heparinization should be started even when surgical intervention is indicated
- Decreases progression of thrombosis and improves survival
Chronic mesenteric ischemia
- Angioplasty with or without stent placement or surgical revascularization
Consultation
- IR
- Vascular
- Surgery
Source
6/06 MISTRY, Rosen's, Tintinalli