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Acute Mesenteric Ischemia

Acute mesenteric ischemia is a syndrome caused by inadequate blood flow to the small intestine, resulting in bowel damage. It can be classified as arterial, with the majority being embolic or thrombotic, or non-arterial. Signs include severe abdominal pain, urgent need to defecate, fever, nausea and vomiting. Risk factors include smoking, high cholesterol, and high blood pressure. Without prompt treatment, it can lead to sepsis, irreversible bowel damage, and death. Diagnosis involves imaging tests and bloodwork. Treatment requires resuscitation, antibiotics, and revascularization of the bowel through surgery or radiology.

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121 views20 pages

Acute Mesenteric Ischemia

Acute mesenteric ischemia is a syndrome caused by inadequate blood flow to the small intestine, resulting in bowel damage. It can be classified as arterial, with the majority being embolic or thrombotic, or non-arterial. Signs include severe abdominal pain, urgent need to defecate, fever, nausea and vomiting. Risk factors include smoking, high cholesterol, and high blood pressure. Without prompt treatment, it can lead to sepsis, irreversible bowel damage, and death. Diagnosis involves imaging tests and bloodwork. Treatment requires resuscitation, antibiotics, and revascularization of the bowel through surgery or radiology.

Uploaded by

solysan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Acute Mesenteric

Ischemia

Presented by :Dr.Ahmed Elbagir


Definition

 Acute mesenteric ischemia (AMI) is a syndrome
caused by inadequate blood flow through the
mesenteric vessels, resulting in ischemia and
eventual gangrene of the bowel wall.
CLASSIFICATION OF MI

 Arterial:(most common)
 Occlusive MI
 *Acute:(surgical emergency)
 Embolic 40-50% or thrombotic 20-35
 *Chronic
 Atherosclerotic 90% or non atherosclerotic

 Non occlusive MI:colonic ischemia after aortoiliac surgery


and abdominal compartment syndrome .
 MI due to Venous thrombosis
Signs and symptoms

 Abrupt, severe abdominal pain
 Urgent need to have a bowel movement
 Fever
 Nausea and vomiting
CAUSES

 1. Arterial embolic disease
 2. Arterial thrombotic disease
 3. Low flow status.non-occlusive disease.
 4. Venous thrombotic disease
 5. Atherosclerosis. (chronic)
Risk Factors

 The risk factors for acute mesenteric ischaemia
depend on the underlying cause.

 Specifically, however for AMAE, the main reversible


risk factors are smoking, hyperlipidaemia, and
hypertension, much the same as for chronic
mesenteric ischaemia.
Complications

 If not treated promptly, acute mesenteric ischemia
can lead to:
 1/ Sepsis: This potentially life-threatening condition
is caused by the body releasing chemicals into the
bloodstream to fight infection.
 2/ Irreversible bowel damage: Insufficient blood
flow to the bowel can cause parts of the bowel to die.
 3/Death: Both of the above complications can lead to
death.
Principles of Treatment

Diagnosis

 Angiography: Your doctor might recommend a CT
scan, MRI or X-ray of your abdomen to determine if
the arteries to your small intestine have narrowed.
Adding a contrast dye (mesenteric angiogram, CT
angiography or magnetic resonance angiography)
can help pinpoint the narrowing.
Aortogram showing narrowing of superior mesenteric artery

 Doppler ultrasound.
CT and CTA


 MRI and MRA.
 Ultrasonography.
 Other Tests:
 ECG may show myocardial infarction or atrial
fibrillation.
Laboratory Studies

 Prothrombin time (PT)
 Activated partial thromboplastin time (aPTT)
 International normalized ratio (INR)
 Complete blood count (CBC), which may reveal
leukocytosis (bandemia) or hemoconcentration
 Chemistry studies that may show metabolic acidosis,
increased amylase levels, or increased lactate
dehydrogenase (LDH) levels
 Inpatient medications that may be used include the
following:
 Papaverine.

 Heparin/low-molecular-weight heparin (LMWH).
 Warfarin.
 Broad-spectrum antibiotics and pain medications.
 Thrombolytics.
Management

 Initial Management:
 Acute mesenteric ischaemia is a surgical emergency,
requiring urgent resuscitation with early senior
involvement. Ensure the patient receives IV fluids, a
catheter inserted, and a fluid balance chart started.
For confirmed cases, broad-spectrum antibiotics
should be given, due to the risk of faecal
contamination in case of perforation of the ischaemic
(and potentially necrotic) bowel and bacterial
translocation.

 Definitive Management:
 Excision of necrotic or non-viable bowel, if not
suitable for (or able to access) revascularisation .
 Revascularisation of the bowel ,involving removal of
any thrombus or embolism via radiological
intervention
Differential Diagnosis

 Mesenteric ischaemia should always be considered
in cases of acute abdomen, especially where there is
no other obvious cause. Other causes of acute
abdomen that may have similar presentations
include peptic ulcer disease, bowel perforation, and
symptomatic AAA .
Case

 A patient with acute on chronic mesenteric
ischaemia who had first undergone an
exploratory laparotomy and resection of the
distal small bowel and proximal large bowel
due to mesenteric ischaemia .
 Post - operative CT angiography identified a
7 cm long thrombotic occlusion from the
origin of the SMA •
 The arrow indicates the calcified SMA
mixed with thrombotic clots ( a ) .

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