Mesenteric ischemia

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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 / hypotension
  • Meds
  • 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