Excel Hospital
  • What is Mesentric Ischemia?

    • A medical condition in which inflammation and injury of the small intestine occurs due to inadequate blood supply.

  • Types

    • Acute
    • Chronic

  • Acute Mesentric Ischemia

    • Acute Mesentric Ischemia is a syndrome caused by inadequate blood flow through the mesenteric vessels, resulting in ischemia and eventual gangrene of the bowel wall

    • Classification
    • Arterial-
    a) Non occlusive mesenteric ischemia (NOMI) due to spasm of artery
    b) Occlusive mesenteric arterial ischemia (OMAI) Subdivision – Acute mesenteric arterial thrombosis (AMAT) , Acute mesenteric arterial embolism (AMAE)

    • Venous - mesenteric venous thrombosis (MVT)

  • Chronic Mesentric Ischemia

    • Occurs gradually as the main visceral arteries narrow
    • It also can occur suddenly as a result of a blood clot severely restricting blood flow (acute on chronic mesenteric ischemia)
    • Lack of oxygen-rich blood can permanently damage the intestines

  • Risk Factors

    • Smoking
    • Hypertension
    • Diabetes mellitus
    • Hypercholesterolemia

  • Symptoms

    • Abdominal pain
    • Bloody stools
    • Bloating
    • Nausea/Vomiting
    • Diarrhoea/Constipation
    • Weight loss

  • Complications

    • Gangrene of intestine
    • Multi organ failure

  • Diagnosis

    • CT / MR Angiography
    • Mesenteric angiography

  • Medical Treatment

    • After initial medical or surgical stabilization, patients with AMI typically have a prolonged inpatient recovery time.
    • Inpatient medications:
    - Papaverine
    - Heparin/low-molecular-weight heparin
    - Warfarin
    - Broad-spectrum antibiotics and pain medications & Supportive medicines
    - Thrombolytics

    • Note: Treat any predisposing cause(s) of AMI

    • Acute mesenteric arterial embolism (AMAE) - Papaverine infusion, surgical embolectomy, and intra-arterial thrombolysis.
    • Acute mesenteric arterial thrombosis (AMAT) - Papaverine infusion and arterial.
    reconstruction, either through aortosuperior mesenteric arterial bypass grafting or through re implantation of the superior mesenteric artery (SMA) into the aorta.
    • Non occlusive mesenteric ischemia (NOMI) - Papaverine infusion.
    • Mesenteric venous thrombosis (MVT) - Anticoagulation with heparin or warfarin, either alone or in combination with surgery; immediate heparinization should be started even when surgical intervention is indicated.

  • Surgery

    • All cases of mesenteric ischemia with signs of peritonitis or possible bowel infarction, regardless of etiology, generally warrant immediate surgical intervention for the resection of ischemic or necrotic intestines.
    • Hemodynamic instability can also be an indication for surgery
    • Surgical treatment may be contraindicated if the risks from comorbid conditions preclude survival after general anesthesia
    • If the ischemia is thought to be caused by vasospasm, surgery is not indicated. Medical management with anticoagulants and intra-arterial vasodilators is appropriate
    • A second-look procedure is indicated whenever bowel of questionable viability is not resected

  • Percutaneous Endovascular Interventions (in selected cases)

    • Especially in isolated spontaneous dissection of the SMA, stent placement may be the preferred option.

  • Long Term Monitoring

    • Cardiac and renal status
    • Carotid duplex studies - if diffuse atherosclerotic disease
    • Outpatient medications –
    - antiarrhythmics for patients with atrial fibrillation (AF)
    - warfarin for MVT or AF ( for at least 6 months or for life if a hypercoagulable state was dis covered during treatment )
    - Treatment of predisposing factors
    - Periodic evaluation of coagulation status -the international normalized ratio (INR)