TY  - CHAP
M1  - Book, Section
TI  - Mesenteric Ischemia
A1  - Al-Zahrani, Hassan A.
A1  - Lindsay, Thomas
A2  - Hall, Jesse B.
A2  - Schmidt, Gregory A.
A2  - Kress, John P.
PY  - 2015
T2  - Principles of Critical Care, 4e
AB  - Acute  mesenteric  ischemia  is  an  infrequent  but  deadly  clinical  entity.  When  diagnosis  is  delayed,  it  is  almost  always  fatal;  therefore,  a  high  index  of  suspicion  is  required,  especially  in  those  at  high  risk:  the  elderly,  those  with  cardiac  dysfunction,  patients  with  diffuse  atherosclerosis,  and  those  following  aortic  and  cardiac  surgery  or  arterial  catheterization.The  etiology  of  acute  mesenteric  ischemia  may  be  embolic,  thrombotic,  primary  vasoconstrictive,  or  secondary  to  venous  thrombosis.  Chronic  ischemia  is  usually  due  to  flow-limiting  lesions  (mesenteric  stenosis  or  occlusions)  in  the  presence  of  inadequate  collateralization.Classic  symptoms  of  acute  intestinal  ischemia  are  central  abdominal  pain  (often  out  of  proportion  to  the  benign  abdominal  examination),  weight  loss  (an  important  clue  even  in  the  acute  presentation),  bowel  emptying,  and  altered  bowel  function  (vomiting,  bloating,  constipation,  or  diarrhea).  Once  signs  of  peritonitis  or  bloody  diarrhea  are  present,  shock,  sepsis,  and  death  almost  always  follow.Arterial  phase  abdominal  and  pelvic  computed  tomographic  (CT)  mesenteric  angiography  is  the  investigation  of  choice,  offering  accurate  diagnostic  evaluation.  However,  selective  mesenteric  angiography  offers  therapeutic  options,  whereas  duplex  ultrasonography  may  not  be  definitive.  Frequently,  the  diagnosis  is  confirmed  only  at  laparotomy.Treatment  is  most  commonly  surgical,  with  restoration  of  flow  by  embolectomy,  bypass,  or  angioplasty  (antegrade  or  retrograde);  vasodilator  infusion  therapy;  thrombolysis  and  resection  of  nonviable  intestine;  and  liberal  use  of  “second  look”  laparotomy.Nonocclusive  mesenteric  ischemia  (NOMI)  has  a  high  mortality  rate,  and  early  diagnosis  and  treatment  are  important  for  improving  survival  in  patients  with  this  condition.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1107712084
ER  -