Modern Trends in Management of Mesenteric Ischemia
Mohamed Emam Al Sayed Ezzat Fakhr;
Abstract
Mesenteric ischemia occurs when perfusion of the visceral organs fails to meet normal metabolic requirements. This disorder is categorized as either acute or chronic, based on the duration of symptoms. Acute mesenteric ischemia (AMI) occurs rapidly over hours to days and frequently leads to acute intestinal infarction requiring resection. The most common causes are embolization to the mesenteric arteries or acute thrombosis related to a preexisting plaque. Chronic mesenteric ischemia (CMI) is a more insidious process and progresses over weeks to several months. The most common cause is progressive occlusive disease of the visceral arteries, usually related to atherosclerosis. It is often unrecognized by physicians and is frequently misdiagnosed as a gastrointestinal disorder (Jimenez et al., 2010).
The disorders of the visceral circulation are infrequent mainly because of the very extensive and efficient collateral system connecting the celiac, superior mesenteric, and inferior mesenteric arteries. However, there is a lot of interest in the optimal management of these conditions, because of their catastrophic outcomes that are usually associated with a high morbidity and mortality (Geroulakos et al., 2006).
The differential diagnosis of AMI includes intestinal obstruction, perforated viscus, pancreatitis, cholecystitis, appendicitis and diverticulitis. Diagnosis is often delayed due to the nonspecific presentation, and extensive infarction may develop. Therefore, this diagnosis should be considered and investigated in any patient with acute, severe, persistent (> 2 hours) and unexplained abdominal pain (Gardiner et al., 2013).
The sine qua non of CMI is postprandial abdominal pain (Schwartz et al., 2013), which some authors have described as intestinal angina. The pain is characteristically dull and crampy, occurring primarily in the epigastrium or midabdomen. The temporal relationship between pain and food ingestion often leads to ''food fear", another classic but not invariable complaint. The lack of specificity of the signs and symptoms of this syndrome often leads to a delay in diagnosis, and it is common for affected patiens to have undergone myriad interventions, including antacid or antireflux therapy, cholecystectomy, hysterectomy, and adhesiolysis (Schwartz et al., 2013). These patients have other stigmata of peripheral vascular disease such as a history of cardiac disease, stroke, claudication, or previous vascular operative procedures (Freischlag et al., 2004).
Plain abdominal radiographs may provide helpful information to exclude other causes of abdominal pain such as intestinal obstruction, perforation, or volvulus, which
The disorders of the visceral circulation are infrequent mainly because of the very extensive and efficient collateral system connecting the celiac, superior mesenteric, and inferior mesenteric arteries. However, there is a lot of interest in the optimal management of these conditions, because of their catastrophic outcomes that are usually associated with a high morbidity and mortality (Geroulakos et al., 2006).
The differential diagnosis of AMI includes intestinal obstruction, perforated viscus, pancreatitis, cholecystitis, appendicitis and diverticulitis. Diagnosis is often delayed due to the nonspecific presentation, and extensive infarction may develop. Therefore, this diagnosis should be considered and investigated in any patient with acute, severe, persistent (> 2 hours) and unexplained abdominal pain (Gardiner et al., 2013).
The sine qua non of CMI is postprandial abdominal pain (Schwartz et al., 2013), which some authors have described as intestinal angina. The pain is characteristically dull and crampy, occurring primarily in the epigastrium or midabdomen. The temporal relationship between pain and food ingestion often leads to ''food fear", another classic but not invariable complaint. The lack of specificity of the signs and symptoms of this syndrome often leads to a delay in diagnosis, and it is common for affected patiens to have undergone myriad interventions, including antacid or antireflux therapy, cholecystectomy, hysterectomy, and adhesiolysis (Schwartz et al., 2013). These patients have other stigmata of peripheral vascular disease such as a history of cardiac disease, stroke, claudication, or previous vascular operative procedures (Freischlag et al., 2004).
Plain abdominal radiographs may provide helpful information to exclude other causes of abdominal pain such as intestinal obstruction, perforation, or volvulus, which
Other data
| Title | Modern Trends in Management of Mesenteric Ischemia | Other Titles | الإتجاهات الحديثة فى علاج قصور الدورة الدموية المساريقية | Authors | Mohamed Emam Al Sayed Ezzat Fakhr | Issue Date | 2014 |
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