Acute mesenteric ischemia
| Mesenteric ischemia | |
|---|---|
| Synonyms | mesenteric ischaemia, mesenteric vascular disease |
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| Computer tomography (CT) showing dilated loops of small bowel with thickened walls (black arrow), findings characteristic of ischemic bowel due to thrombosis of the superior mesenteric vein. | |
| Classification and external resources | |
| Specialty | gastroenterology |
| ICD-10 | K55.9 |
| ICD-9-CM | 557.9 |
| DiseasesDB | 29034 |
| MedlinePlus | 001156 |
| eMedicine | radio/2726 |
Mesenteric ischemia is a medical condition in which injury of the small intestine occurs due to not enough blood supply. It can come on suddenly, known as acute mesenteric ischemia, or gradually, known as chronic mesenteric ischemia. Acute disease often presents with sudden severe pain. Symptoms may come on more slowly in those with acute on chronic disease. Signs and symptoms of chronic disease include abdominal pain after eating, unintentional weight loss, vomiting, and being afraid of eating.
Risk factors include atrial fibrillation, heart failure, chronic renal failure, being prone to forming blood clots, and previous myocardial infarction. There are four mechanisms by which poor blood flow occurs: a blood clot from elsewhere getting lodged in an artery, a new blood clot forming in an artery, a blood clot forming in the , and insufficient blood flow due to low blood pressure or spasms of arteries. Chronic disease is a risk factor for acute disease. The best method of diagnosis is angiography, with computer tomography (CT) being used when that is not available.
Treatment of acute ischemia may include stenting or medications to break down the clot provided at the site of obstruction by interventional radiology.Open surgery may also be used to remove or bypass the obstruction and may be required to remove any intestines that may have died. If not rapidly treated outcomes are often poor. Among those affected even with treatment the risk of death is 70% to 90%. In those with chronic disease bypass surgery is the treatment of choice. Those who have thrombosis of the vein may be treated with anticoagulation such as heparin and warfarin, with surgery used if they do not improve.
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