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Doença intestinal isquêmica

Last reviewed: 7 Aug 2025
Last updated: 05 Jan 2024

Summary

Definition

History and exam

Key diagnostic factors

  • dor abdominal
  • desconforto abdominal
Full details

Other diagnostic factors

  • hematoquezia/melena
  • diarreia
  • perda de peso
  • sopro abdominal
  • vasculite
  • tontura, palidez, dispneia
  • fobia alimentar (sitofobia)
Full details

Risk factors

  • pacientes de idade avançada
  • história de tabagismo
  • estados hipercoaguláveis
  • fibrilação atrial
  • infarto do miocárdio
  • defeitos estruturais do coração
  • história de vasculite
  • aterosclerose
  • cirurgia cardiovascular recente
  • choque
  • insuficiência cardíaca congestiva
  • síndrome do intestino irritável
  • carcinoma colônico
  • constipação
  • uso prolongado de laxantes
  • uso de vasopressores, digitálicos e cocaína
Full details

Diagnostic investigations

1st investigations to order

  • angiotomografia
  • Hemograma completo
  • perfil bioquímico incluindo proteína C-reativa
  • painel da coagulação, tipo e rastreamento, prova cruzada
  • gasometria arterial/nível de lactato
  • eletrocardiograma (ECG)
  • radiografia torácica ortostática
  • radiografias abdominais
  • sigmoidoscopia ou colonoscopia
  • endoscopia digestiva alta
Full details

Investigations to consider

  • angiografia por ressonância magnética
  • angiografia mesentérica
  • ultrassonografia duplex mesentérica
Full details

Emerging tests

  • espectroscopia de infravermelho próximo abdominal

Treatment algorithm

ACUTE

evidência de infarto, perfuração ou peritonite

sem evidência de infarto, perfuração ou peritonite

ONGOING

isquemia mesentérica crônica

isquemia colônica não aguda

Contributors

Authors

Monjur Ahmed, AGAF, FACG, FACP, FASGE, FRCP, MD, MRCP

Professor of Medicine

Thomas Jefferson University

Gastroenterologist

Thomas Jefferson University Hospital

Philadelphia

PA

Disclosures

MA declares that he has no competing interests.

Acknowledgements

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.

Disclosures

AVR, JL, AB, JHM, and AF declare that they have no competing interests.

Peer reviewers

Eli D. Ehrenpreis, MD

Professor of Medicine

Rosalind Franklin University Medical School

Chicago

IL

Disclosures

EDE declares that he has no competing interests.

Andrew Poullis, BSc, MBBS, MD, FRCP

Consultant Gastroenterologist

St George’s Hospital

London

UK

Disclosures

AP declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Brandt LJ, Feuerstadt P, Longstreth GF, et al. ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI). Am J Gastroenterol. 2015 Jan;110(1):18-44.Full text  Abstract

Bala M, Catena F, Kashuk J, et al. Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. World J Emerg Surg. 2022 Oct 19;17(1):54.Full text  Abstract

Björck M, Koelemay M, Acosta S, et al. Editor's choice - management of the diseases of mesenteric arteries and veins: clinical practice guidelines of the European Society of Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2017 Apr;53(4):460-510.Full text  Abstract

American College of Radiology. ACR appropriateness criteria: radiologic management of mesenteric ischemia. 2022 [internet publication].Full text

Tilsed JV, Casamassima A, Kurihara H, et al. ESTES guidelines: acute mesenteric ischaemia. Eur J Trauma Emerg Surg. 2016 Apr;42(2):253-70.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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