Related Subjects:
|Metabolic acidosis|Lactic acidosis
Mortality is up to 80%, even if the diagnosis is made and treatment performed.
About
- Can cause acute to chronic presentation depending on aetiology
- Symptoms often exceed signs until late
- Thrombosis, Embolism, Non occlusive, Venous Occlusion
Anatomy
Aetiology
- Atherosclerosis and thrombosis of Superior mesenteric artery
- Thrombophilia, hyperviscosity, dehydration
- Gut ischaemia related to trauma
- Arterial embolism from AF, Sickle cell disease
- Ischaemic necrosis can lead to perforation
Clinical
- Chronic episodic abdominal pain with meals
- Weight loss, diarrhoea (watery or bloody)
- There are few early signs until ischaemia and perforation
- Peritonitis with bowel infarction
- Pain may exceed clinical findings
Investigations
- FBC: raised WCC, Raised Creatinine
- ABG: Metabolic Acidosis and raised lactate suggests bowel ischaemia
- AXR: calcified atheroma in mesenteric vessels. Dilated gas filled small bowel loops
- ECG: MI, AF and consider Troponin if needed
- Contrast CT: usually diagnostic depending on extent but may show oedematous bowel due to ischaemia and vasodilatation. Later pneumatosis.
- Angiography may be considered
Management
- Resuscitation, Oxygen, IV fluids, Antibiotics, NG tube
- Emergency laparotomy and resection of gangrenous bowel
- Occasionally Angiography and thrombectomy/embolectomy
- May need post op short term and long term anticoagulation if embolic
- Those that survive may have short gut syndrome.
- Palliative for those who would not survive surgery
References