When is surgery indicated in ischemic bowel disease

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 to the operating room for:

  • • Assessment of the degree and extent of injury
  • • Identification of the site of and relief of arterial occlusion
  • • Resection of irreversibly damaged bowel (Short gut syndrome is a possible consequence of resection)
  • • Revascularization
  • • Indications for revascularization include typical disabling signs of angina or angiographic evidence of occlusion of at least two major mesenteric arteries, one being the SMA. There is still controversy regarding whether or not only the SMA should be revascularized.
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