Mesenteric ischemia
Pathophysiology
4 distinct entities:
1. Mesenteric arterial embolism
2. Mesenteric arterial thrombosis
3. Nonocclusive mesenteric ischemia
4. Mesenteric venous thrombosis
Epidemiology
Mean age: 70yo; 2/3 women
Risk Factors
CAD, valvular heart disease, dysrhythmia, hypovolemia or hypotension, diuretic or vasoconstrictive meds, dig, dialysis
Si/Symptoms
Pain out of proportion to exam
Severe, poorly localized, colicky
W/U
Lactate (higher later)
CTA
Angiography
Treatment
IV Abx
IVF
Narcotic analgesia
Acute arterial embolusPapaverine infusion (30-60 mg/h IV), surgical embolectomy, or intra-arterial thrombolysis
Acute arterial thrombosisPapaverine infusion and arterial reconstruction either through aortosuperior mesenteric arterial bypass grafting or
reimplantation of the SMA to the aorta
Nonocclusive mesenteric ischemiaPapaverine infusion
Mesenteric venous thrombosisAnticoagulation with heparin/warfarin either alone or in combination with surgery. Immediate heparinization should be started even when surgical intervention is indicated, as it decreases progression of thrombosis and improves survival
Chronic mesenteric ischemiaAngioplasty with or without stent placement or surgical revascularization.
Consultation
IR
Vascular
Surgery
Source
6/06 MISTRY, Rosen's, Tintinalli