Summary
Definition
Ischaemic bowel disease encompasses a heterogeneous group of disorders caused by acute or chronic processes, arising from occlusive or non-occlusive aetiologies, which result in decreased blood flow to the gastrointestinal tract. The clinical course may range from transient and reversible to fulminant.
[Figure caption and citation for the preceding image starts]:
Histopathology of intestinal ischaemia
From the collection of Dr Jennifer Holder-Murray; used with permission
[Citation ends].
History and exam
Other diagnostic factors
- haematochezia/melaena
- diarrhoea
- abdominal tenderness
- weight loss
- abdominal bruit
- vasculitis
- light headedness, pallor, dyspnoea
- food fear (sitophobia)
Risk factors
- old age
- history of smoking
- hyper-coagulable states
- atrial fibrillation
- myocardial infarction
- structural heart defects
- history of vasculitis
- recent cardiovascular surgery
- shock
- congestive heart failure
- atherosclerosis
- previous ileostomy
- irritable bowel syndrome
- colonic carcinoma
- constipation
- long-term laxative use
- use of vasopressors, digitalis, cocaine
Diagnostic investigations
1st investigations to order
- FBC
- chemistry panel
- arterial blood gas/lactate level
- ECG
- erect CXR
- abdominal x-rays
- sigmoidoscopy or colonoscopy
Investigations to consider
- mesenteric angiography
- CT scan with contrast/CT angiogram
- barium enema
- mesenteric duplex ultrasound
- magnetic resonance angiograph (MRA)
Treatment algorithm
Contributors
Authors VIEW ALL
Medical Director
Swedish Colon and Rectal Clinic
Program Director
Swedish Colon and Rectal Surgery Training Program
Swedish Medical Center
Seattle
WA
Disclosures
AB declares that he has no competing interests.
Dr Amir Bastawrous would like to gratefully acknowledge Dr Jennifer Holder-Murray and Dr Alessandro Fichera, the previous contributors to this monograph. JHM and AF declare that they have no competing interests.
Peer reviewers VIEW ALL
Assistant Professor of Surgery
Department of Surgery
University of California, Los Angeles
Los Angeles
CA
Disclosures
FC declares that she has no competing interests.
Assistant Professor of Surgery
Division of Colon and Rectal Surgery
University Hospital Case Medical Center
Cleveland
OH
Disclosures
SS received a fee for educational courses on laparoscopic surgery, paid for in part by Covidien, Olympus, and Applied Medical.
Associate Professor of Colon and Rectal Surgery
Department of Surgery
David Geffen School of Medicine at UCLA
Los Angeles
CA
Disclosures
CK declares that he has no competing interests.
General Surgeon
General Surgery Department
Istanbul Training and Research Hospital
Istanbul
Turkey
Disclosures
GC is an author of a number of references cited in this monograph.
Consultant Gastroenterologist
St George’s Hospital
London
UK
Disclosures
AP declares that he has no competing interests.
Use of this content is subject to our disclaimer