Can ischemia be isolated to the colon? Ischemic colitis is the most common form of non-occlusive intestinal ischemia occurring in older adult patients with impaired cardiac output via a nonocclusive mechanism. In younger patients, however, the cause can be occlusive (sickle cell disease, hypercoagulable states) or nonocclusive (cocaine use, vasculitis, long-distance running).
What is meant by a second look operation? During initial surgery (whether or not revascularization has been attempted), some bowel may be left intentionally intact as the status of its viability may not be clear. Patients may undergo a second operation 24 to 48 hours later to assess viability.
When should a patient with ischemic bowel disease be sent to the operating room? Initial clinical suspicion of acute ischemic bowel disease when other diagnoses have been excluded should prompt angiography. If findings are amenable to nonsurgical intervention and there is no sign of bowel necrosis, patients can be managed medically. Patients should be sent …
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What is the role of angioplasty and stenting in the management of ischemic bowel disease? Percutaneous transluminal angioplasty with or without stent placement can be considered as an alternative to surgery in patients with more distal lesions. Lesions located at the aortic orifices of mesenteric arteries may not be as amenable to dilation and angioplasty …
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Is there any medical treatment for mesenteric ischemia? Various measures can be employed to treat mesenteric ischemia: A. Management of the underlying disease process, including antiplatelet agents for vascular disease B. Anticoagulation for arterial thrombotic and venous occlusive disease C. Adequate pain control (avoiding opiates as they decrease peristalsis and aggravate ischemia) D. Theoretical treatments: small meals, smoking cessation, …
Invasive mesenteric angiographic studies When the diagnosis and treatment of ischemic bowel disease is delayed and peritoneal signs and acidosis ensue, the mortality rate increases significantly. Angiography is the gold standard for diagnosis of mesenteric arterial occlusion and can help to differentiate between embolic and thrombotic etiologic factors. The cutoff of a major artery in …
What is the diagnostic role of endoscopy (sigmoidoscopy, colonoscopy, enteroscopy) and laparoscopy? In spite of the fact that a small number of published case reports describe diagnostic findings of mesenteric ischemia via enteroscopy, this approach can be extremely dangerous because of the high risk of bowel perforation. Lower endoscopy, however, has been shown to be …
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