(Clinical Imaging) (Surgery)

Overview

• Obstruction of mesenteric vessel leading to bowel ischaemia and necrosis
• Three types → Ischaemic Colitis, Acute Mesenteric Ischaemia & Chronic Mesenteric Ischaemia
  • Acute Mesenteric Ischaemia → acute inadequate blood flow to the small intestine (superior mesenteric artery). Associated with arterial thrombosis and embolus (Atrial Fibrillation).
  • Chronic Mesenteric Ischaemia → constant or episodic hypoperfusion of the small intestine, usually due to atherosclerosis
  • Ischaemic Colitis → hypoperfusion of the large bowel (inferior mesenteric artery)
    • Area near splenic flexure (2/3 transverse colon) is at high risk of colonic ischaemia due to being watershed areas
• Risk Factors → increasing age, AF, other causes of emboli (endocarditis, malignancy), CVD risk factors (smoking, hypertension, diabetes), cocaine use
• Venn Diagram

Making Diagnosis

Clinical Features:

• Colicky abdo pain
  • Acute Mesenteric Ischaemia ⇒ sudden, severe abdominal pain out of keeping with physical exam findings
• Rectal bleeding → most common in ischaemic colitis
• Diarrhoea
• Fever
• Chronic Mesenteric Ischaemia ⇒ ‘intestinal angina’ due to atherosclerosis
  • Post-prandial abdominal pain

Investigations:

• VBG → increased lactate (acidosis)
  • Metabolic Acidosis