Intestinal Ischemia
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Intestinal Ischemia

Mesenteric ischemia or infarction occurs in a variety of conditions that result in interruption or reduction of the blood supply of the intestine. Regardless of the causes of the ischemic insult, the end results are similar and range from transient alteration of bowel activity to transmural hemorrhagic necrosis. Mesenteric ischemia is classified into four categories that are distinct conditions with different causes, clinical manifestations, therapy, and prognoses.

Mesenteric ischemia or infarction occurs in a variety of conditions that result in interruption or reduction of the blood supply of the intestine. Regardless of the causes of the ischemic insult, the end results are similar and range from transient alteration of bowel activity to transmural hemorrhagic necrosis. Mesenteric ischemia is classified into four categories that are distinct conditions with different causes, clinical manifestations, therapy, and prognoses. These four categories are:

- acute mesenteric ischemia, an acute ischemia of the small bowel with or without colonic involvement;

-focal mesenteric ischemia, an acute ischemia of localized segments of small intestine exemplified by strangulating small-bowel obstruction;

- chronic mesenteric ischemia, or ischemia without loss of tissue viability;

- colonic ischemia.

Early diagnosis is crucial because critical intestinal ischemia progresses to fatal infarction unless promptly diagnosed and treated.

The initial signs and symptoms of acute mesenteric ischemia are often nonspecific. Patients at risk include

those with the following: a history of prior mesenteric ischemia, vasculopathy, atrial fibrillation, nontherapeutic

anticoagulation therapy, hypotension (trauma, sepsis, cardiogenic shock), a history of recent myocardial

infarction, congestive heart failure, or hypercoagulable states (cancer, etc) . Intestinal infarction ac-counts for 1% of the patients presenting with an acute abdomen. Acute mesenteric ischemia is a life-threatening condition, with mortality rates that range from 59% to 93% . Findings from studies have shown that early diagnosis and treatment have a substantial effect on the outcome in a patient.

Abdominal Computer Tomography (CT) has been considered of limited use in the diagnosis of acute mesenteric ischemia, except in patients suspected of having superior mesenteric vein thrombosis. Perceptive errors in the diagnosis of venous thrombosis result from focusing on a more common abnormality that explains the clinical manifestation.

Specific findings of bowel ischemia are relatively uncommon in patients evaluated with CT. As such,

radiologists are most often required to rely on secondary CT findings, such as bowel wall thickening, pneumatosis

intestinalis, portomesenteric venous gas, or ascites, as indirect signs of bowel ischemia. Any of these findings alone or in combination may raise suspicion for this diagnosis, but they can be subtle and lack specificity, particularly in the absence of a clinical manifestation suggestive of ischemia . These findings result in interpretive errors . Although these secondary findings are important in the CT evaluation and clinical management of acute abdominal pain, the pitfalls of CT imaging merit special consideration.

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