Makindo Medical Notes

Related Subjects: | Metabolic acidosis | Lactic acidosis

Mortality is up to 80%, even if the diagnosis is made and treatment performed.

About

• Acute to chronic presentation depending on underlying cause.
• Symptoms often outweigh clinical signs until later stages.
• Can result from thrombosis, embolism, non-occlusive ischaemia, or venous occlusion.

Anatomy

Aetiology

• Atherosclerosis: Thrombosis in the superior mesenteric artery.
• Thrombophilia: Hyperviscosity and dehydration increase risk.
• Trauma: Direct cause of gut ischaemia.
• Embolism: Commonly from atrial fibrillation or sickle cell disease.
• Progression to ischemic necrosis may result in perforation.

Clinical Presentation

• Chronic episodic abdominal pain, especially post-meal.
• Weight loss, diarrhoea (may be watery or bloody).
• Early symptoms may be minimal until ischaemia and perforation occur.
• Peritonitis with bowel infarction; pain often disproportionate to findings.

Investigations

• FBC: Elevated WCC and creatinine levels.
• ABG: Metabolic acidosis and raised lactate indicate ischaemia.
• AXR: May show calcified atheroma in mesenteric vessels and dilated gas-filled bowel loops.
• ECG: Evaluate for MI or AF; consider troponin if indicated.
• Contrast CT: Diagnostic; shows edematous bowel, ischaemia, vasodilatation, or pneumatosis in later stages.
• Angiography: May be used for definitive vascular imaging.

Management

• Immediate resuscitation with oxygen, IV fluids, antibiotics, and NG tube insertion.
• Emergency Surgery: Laparotomy with resection of necrotic bowel.
• Angiography with Thrombectomy/Embolectomy: May be considered in select cases.
• Short and long-term anticoagulation may be necessary if embolic origin is suspected.
• Consider palliative approach in patients unlikely to survive surgery.

References

• Relevant clinical guidelines and studies