Ischemic bowel disease can be classified into three types: acute mesenteric ischemia, chronic mesenteric ischemia, and colonic ischemia. Acute mesenteric ischemia may also be further subdivided into embolic mesenteric ischemia, thrombotic mesenteric ischemia, and venous mesenteric ischemia. Colonic ischemia is the most common type and has the most favorable prognosis.
It may present clinically in a number of ways, including transient reversible ischemia, chronic irreversible ischemia, or acute fulminant ischemia.
Mesenteric venous thrombosis may lead to acute or subacute intestinal ischemia and may also present across a spectrum of severity.
Long-term complications of ischemic bowel disease depend on the location and nature of the underlying pathology. Possible complications include stricture formation, short bowel syndrome, and food fear leading to malnutrition.
Ischemic bowel disease encompasses a heterogeneous group of disorders caused by acute or chronic processes, arising from occlusive or nonocclusive etiologies, which result in decreased blood flow to the gastrointestinal tract. The clinical course may range from transient and reversible to fulminant.
History and exam
Key diagnostic factors
- abdominal pain
Other diagnostic factors
- abdominal tenderness
- weight loss
- abdominal bruit
- light headedness, pallor, dyspnea
- food fear (sitophobia)
- old age
- history of smoking
- hypercoagulable states
- atrial fibrillation
- myocardial infarction
- structural heart defects
- history of vasculitis
- recent cardiovascular surgery
- congestive heart failure
- previous ileostomy
- irritable bowel syndrome
- colonic carcinoma
- long-term laxative use
- use of vasopressors, digitalis, cocaine
1st investigations to order
- CT angiogram
- chemistry panel including serum lactate
- coagulation panel
- arterial blood gas/lactate level
- erect CXR
- abdominal x-rays
- sigmoidoscopy or colonoscopy
Investigations to consider
- magnetic resonance imaging/magnetic resonance angiography
- mesenteric angiography
- mesenteric duplex ultrasound
evidence of infarction, perforation, or peritonitis
no evidence of infarction, perforation, or peritonitis
chronic mesenteric ischemia
nonacute colonic ischemia
Monjur Ahmed, AGAF, FACG, FACP, FASGE, FRCP, MD, MRCP
Clinical Associate Professor
Thomas Jefferson University
Thomas Jefferson University Hospital
MA declares that he has no competing interests.
Dr Monjur Ahmed would like to gratefully acknowledge Dr Alex von Roon, Dr James Lewis, Dr Amir Bastawrous, Dr Jennifer Holder-Murray, and Dr Alessandro Fichera, previous contributors to this topic.
AVR, JL, AB, JHM, and AF declare that they have no competing interests.
Eli D. Ehrenpreis, MD
Professor of Medicine
Rosalind Franklin University Medical School
EDE declares that he has no competing interests.
Andrew Poullis, BSc, MBBS, MD, FRCP
St George’s Hospital
AP declares that he has no competing interests.
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