Materiały źródłowe

• #1 Acute Mesenteric Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431068/

  Acute mesenteric ischemia is caused by a sudden decline in blood flow through the mesenteric vessels. […] Embolic patients commonly have a positive medical history of cardiovascular diseases including recent myocardial infarction, congestive heart failure, and atrial fibrillation. Causes include peripheral arterial emboli, cardiac emboli, and an atheromatous plaque that ruptured or dislodged after surgery. […] The typical thrombotic patient experiences a history of postprandial abdominal pain, leading to food avoidance and weight loss. Causes include atheromatous vascular disease (e.g., atherosclerosis, aortic aneurysm, aortic dissection) and decreased cardiac output due to a secondary cause (e.g., dehydration, myocardial infarction, congestive heart failure). […] The NOMI patient is typically critically ill, presents with several severe comorbidities, and is hemodynamically unstable. Causes include drugs that reduce blood flow (e.g., vasopressors and ergotamines), hypotension from severe medical conditions (e.g., myocardial infarction, sepsis, CHF, and renal disease), and patients that recently received major surgery (e.g., cardiac and abdominal surgery).

• #1 Acute Mesenteric Ischemia: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/189146-overview

  Acute mesenteric ischemia (AMI) is a syndrome caused by inadequate blood flow through the mesenteric vessels, resulting in ischemia and eventual gangrene of the bowel wall. […] The four types of AMI have somewhat different predisposing factors, clinical pictures, and prognoses. […] A secondary clinical entity of mesenteric ischemia occurs as a consequence of mechanical obstruction (eg, from internal hernia with strangulation, volvulus, or intussusception). Tumor compression, aortic dissection and postangiography thrombosis are other reported causes. […] Causes of AMAE (embolic AMI) include the following: Cardiac emboli – Mural thrombus after MI, auricular thrombus associated with mitral stenosis and atrial fibrillation, or septic emboli from valvular endocarditis (less frequent). […] Causes of AMAT (thrombotic AMI) include the following: Atherosclerotic vascular disease (most common), Aortic aneurysm, Aortic dissection, Arteritis, Decreased cardiac output from MI or CHF (thrombotic AMI may cause acute decompensation), Dehydration from any cause.

• #1 Mesenteric Ischemia

  https://mobile.fpnotebook.com/Surgery/GI/MsntrcIschm.htm

  Sudden interruption of Small Bowel perfusion resulting in Intestinal Ischemia, infarction and necrosis. […] Atrial Fibrillation causes 50% of Mesenteric Artery Embolism, and 25% of all Mesenteric Ischemia cases. […] Mesenteric Artery Embolism (50%) is the most common embolism source of cardiac origin. […] Mesenteric Artery Thrombosis (15-25%) typically occurs at proximal SMA and is often preceded by Chronic Mesenteric Ischemia. […] Nonocclusive Mesenteric Ischemia – NOMI (20-30%) results from Low Cardiac Output and mesenteric arterial Vasoconstriction or vasospasm. […] Mesenteric Venous Thrombosis – MVT (5-10%) occurs in Hypercoagulable State or localized intraabdominal inflammation. […] Diffuse atherosclerotic disease is present in 95% of cases of Primary Chronic Mesenteric Ischemia. […] Secondary Mesenteric Ischemia can be caused by adhesions, herniation, volvulus, intussusception, tumor, trauma, or retroperitoneal fibrosis.

• #1 Bowel Ischaemia | Doctor

  https://patient.info/doctor/bowel-ischaemia

  Bowel ischaemia has been classified into three main types: Acute mesenteric ischaemia, Chronic mesenteric ischaemia, Ischaemic colitis (colonic ischaemia). […] This is an umbrella term covering a number of conditions, including acute mesenteric arterial embolus and thrombus, mesenteric venous thrombus and non-occlusive mesenteric ischaemia (NOMI). […] Conditions causing arterial emboli – eg, mural thrombus following myocardial infarction, auricular thrombus associated with mitral stenosis and AF, septic emboli from valvular endocarditis, fragments of proximal aortic thrombus, arterial catheterisation dislodging bits of plaque. […] Conditions causing arterial thrombosis – atherosclerosis (most common), aortic aneurysm or dissection, arteritis, decreased cardiac output (eg, from myocardial infarction or chronic heart failure), dehydration.

• #1 Acute mesenteric ischemia: A review of the main imaging techniques and signs | Radiología (English Edition)

  https://www.elsevier.es/en-revista-radiologia-english-edition–419-articulo-acute-mesenteric-ischemia-a-review-S2173510720300501?newsletter=true

  The most common cause of AMI is arterial, such as mesenteric artery embolism (MAE) and mesenteric artery thrombosis (MAT); other less common causes are venous, such as mesenteric vein thrombosis (MVT), and low-output states such as non-occlusive mesenteric ischaemia (NOMI). There are other causes of AMI that should also be borne in mind, such as vasculitis, arterial dissection, internal hernias, adhesions, volvulus and mesenteric trauma. […] Arterial embolism is the most common cause of AMI and accounts for 40-50% of all cases. The main risk factors include atrial fibrillation, recent myocardial infarction, congestive heart failure, cardiomyopathies and embolisms due to aortic lesion or atherosclerosis. Arterial thrombosis accounts for approximately 25-30% of cases of AMI. The main risk factors are atherosclerotic disease and dyslipidaemia, followed by hypertension, diabetes, dehydration, antiphospholipid syndrome and oestrogen therapy. MVT accounts for 5-10% of all cases of AMI. It may occur in younger populations compared to other causes.

• #1 Mesenteric Ischaemia • LITFL • CCC General surgery

  https://litfl.com/mesenteric-ischaemia/

  Mesenteric ischaemia = inadequate blood flow through mesenteric circulation – ischaemia – gangrene […] Arterial disease […] embolism: MI, mitral stenosis, AF, endocarditis, mycotic aneurysm, prosthetic grafts, myxoma […] thrombosis: plaque rupture […] occlusive disease: atherosclerosis, vasculitis, autoimmune disease […] non-occlusive disease: decreased perfusion (septic shock, hypovolaemia, vasopressors, pancreatitis) […] Venous disease […] intra-abdominal infection with portal pyemia […] hypercoagulable states […] portal hypertension/mass effect from tumours – stasis […] direct trauma from surgery […] band adhesions.

• #1 Mesenteric Ischemia

  https://errolozdalga.com/medicine/pages/mesentericischemia.cr.5.16.11.html

  Mesenteric Ischemia can be divided into Acute vs Chronic, and Small Bowel vs Colonic Ischemia. Acute Mesenteric Ischemia can be further divided into Occlusive vs Non-occlusive etiologies. […] Etiologies: A. Occlusive: Mesenteric Artery Embolism ~50% of cases, e.g. from A-fib, endocarditis, LV thrombus, etc. The SMA is most anatomically predisposed, due to its large caliber and narrow take-off angle from the aorta. The IMA is rarely affected due to its small caliber. The most commonly involved segment is the middle of the jejunum, as this is the most distant from collateral circulation of the celiac axis and IMA. […] Mesenteric Artery Thrombosis 15-25% of cases – this pathogenesis resembles that of plaque stenosis and/or rupture as in MI. They have bad preexisting atherosclerosis, and often have a history of Intestinal Angina representing chronic mesenteric ischemia where they have postprandial pain, nausea/vomiting, early satiety, and weight loss.

• #1 Chronic Mesenteric Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430748/

  Several factors predispose mesenteric vessels to atherosclerosis, including diabetes, hypertension, smoking, and hyperlipidemia. Smoking and hyperlipidemia are particularly significant risk factors for the development of SMA atherosclerosis. This condition underscores the critical importance of recognizing and addressing these risk factors to mitigate the progression of vascular compromise and its associated symptoms.

• #1 Acute Mesenteric Ischemia: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/189146-overview

  Causes of NOMI include the following: Hypotension from CHF, MI, sepsis, aortic insufficiency, severe liver or renal disease, or recent major cardiac or abdominal surgery. […] Causes of MVT include the following (80% of patients with MVT are found to have predisposing conditions): Hypercoagulability from protein C and S deficiency, antithrombin III deficiency, dysfibrinogenemia, abnormal plasminogen, polycythemia vera (most common), thrombocytosis, sickle cell disease, factor V Leiden mutation, pregnancy, and oral contraceptive use.

• #1 Bowel Ischaemia | Doctor

  https://patient.info/doctor/bowel-ischaemia

  NOMI – hypotension, vasopressive drugs, ergotamines, cocaine, digitalis. […] MVT can be caused by: Hypercoagulability disorders (eg, protein C and S deficiency). […] Tumour causing venous compression or hypercoagulability. […] Infection – usually intra-abdominal such as appendicitis, diverticulitis, or abscess, venous congestion from cirrhosis (portal hypertension). […] Venous trauma from accidents or surgery, especially portocaval surgery, pancreatitis, decompression sickness. […] Chronic mesenteric ischaemia has a very low incidence, accounting for less than 1 in 1,000 hospital admissions for abdominal pain. […] This is generally caused by factors predisposing to atherosclerosis – eg, smoking, hypertension, diabetes mellitus and hyperlipidaemia. […] Chronic mesenteric ischaemia symptoms include moderate-to-severe colicky or constant and poorly localised pain.

• #1 Mesenteric ischaemia | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/gastrointestinal-intensive-care/Chapter-26/mesenteric-ischaemia

  Venous mesenteric ischaemia due to mesenteric venous thrombosis has risk factors which resemble the risk factors for DVT and VTE in general. Additionally, there are a few risk factors unique to the mesenteric venous circulation which are probably of interest to the intensivist. […] Atherosclerosis of mesenteric vessels leads to chronically diminished flow through the mesenteric circulation. […] The collateral circulation allows a major visceral arterial occlusion to be clinically silent, and to go virtually unnoticed. […] The mesenteric circulation is a vascular bed with highly variable vascular resistance. Any increase in mesenteric vascular resistance can lead to mesenteric hypoperfusion. […] Risk factors include portal hypertension, hypercoagulability, thrombocytosis and any sort of local inflammation (eg. pancreatitis or diverticulitis).

• #1 Mesenteric ischemia: what the radiologist needs to know – Olson – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/21705/html

  Non-occlusive mesenteric ischemia (NOMI) is caused by intestinal hypoperfusion in the absence of vascular occlusion. […] Causes of arterial occlusion include emboli to the mesenteric vasculature, which commonly originate from the left atrium, left ventricle, or left-sided cardiac valves, and arterial thrombosis. […] Secondary causes of venous occlusion include inflammatory and infectious conditions such as diverticulitis, appendicitis, inflammatory bowel disease, and pancreatitis or neoplasia. […] In low-flow states caused by conditions such as cardiogenic or hemorrhagic shock, sepsis, or arrhythmia, reflex splanchnic vasoconstriction occurs to divert blood flow to critical organs such as the heart and brain. […] Mesenteric ischemia can occur in the aftermath of invasive procedures, particularly in patients with severe atherosclerosis or poor cardiopulmonary function.

• #1 Acute mesenteric ischemia: A review of the main imaging techniques and signs | Radiología (English Edition)

  https://www.elsevier.es/en-revista-radiologia-english-edition–419-articulo-acute-mesenteric-ischemia-a-review-S2173510720300501?newsletter=true

  NOMI is often seen in patients of advanced age, and is responsible for approximately 20-30% of cases of AMI. Unlike the above-mentioned disorders, it is an acute disorder of the mesenteric circulation not caused by organic occlusion of the blood vessels that often persists even after the precipitating event is corrected. In terms of pathogenesis, NOMI is believed to arise from a combination of low cardiac output and vasoconstriction. Underlying diseases and risk factors include shock, dialysis, heart disorders, long-term extracorporeal circulation, postoperative stress, use of certain drug treatments (catecholamines, digitalis drugs and diuretics), arrhythmias, burns, diabetes, pancreatitis, dehydration and hypovolaemia. This condition is characterised by high rates of morbidity and mortality, due to patients’ advanced age and diagnostic delay.

• #1 Acute mesenteric ischaemia: a pictorial review | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-018-0641-2

  Mesenteric venous thrombosis may be caused by infiltrative, neoplastic or inflammatory/infectious conditions. […] VAMI appears in younger patients, over 40, sometimes with several days of mild symptoms. […] In the setting of non-occlusive causes such as septic, haemorrhagic or cardiogenic shock, a profound drop of systemic blood pressure results in a reflexive mesenteric arterial vasoconstriction with diversion of blood flow to the brain and heart. […] Risk factors for NOMI include age over 50, history of acute myocardial infarction, congestive heart failure, aortic insufficiency, cardiopulmonary bypass, kidney or liver disease or major abdominal surgery.

• #1 Chronic Mesenteric Ischemia Causes, Symptoms, and Treatments

  https://www.upmc.com/services/heart-vascular/conditions/chronic-mesenteric-ischemia

  Chronic mesenteric ischemia occurs when plaque builds up in the major arteries that supply blood to the small intestine or small bowel. […] Atherosclerosis (hardening of the arteries) causes chronic mesenteric ischemia. […] In atherosclerosis, fatty deposits and calcium can build up along the inner artery walls and form plaque. Over time, the buildup of plaque causes the arteries to narrow. This limits the amount of oxygen-rich blood that flows to the intestines.

• #1 Chronic Mesenteric Ischemia: Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/183683-overview

  Chronic mesenteric ischemia (CMI) usually results from long-standing atherosclerotic disease of two or more mesenteric vessels. […] Other nonatheromatous causes of CMI include the vasculitides, such as Takayasu arteritis. […] Factors that predispose to atherosclerosis are associated with increased risk for chronic mesenteric ischemia (CMI). These include the following: Smoking, Hypertension, Diabetes mellitus, Hypercholesterolemia (although patients may present with hypocholesterolemia because of their chronic malnourished state). […] When the arterial lumen is narrowed secondary to atherosclerosis, any increase in intestinal demand (as in eating) or decrease in intestinal supply (as in hypovolemia) can result in severe abdominal pain and possibly infarction. The risk factors for atherosclerosis are therefore pertinent to the development of CMI.

• #1 Mesenteric ischemia – USZ

  https://www.usz.ch/en/disease/mesenteric-ischemia/

  Mesenteric ischemia is a reduced blood supply to the intestine due to an obstruction or narrowing of the intestinal vessels. […] The most common cause of acute mesenteric ischemia is a blood clot (thrombus) that occludes an intestinal vessel. […] In chronic mesenteric ischemia, however, the narrowing of the intestinal vessels develops slowly and insidiously the blood vessels become increasingly calcified and constrict. […] Chronic mesenteric ischemia is the result of a prolonged, insidious process. The most common cause is vascular calcification (arteriosclerosis). […] Other and rarer causes include vascular inflammation, changes to the abdominal aorta or constriction by structures outside the vessels. […] The main risk factors are: High blood pressure, Elevated blood lipids, Diabetes mellitus, Obesity, Unhealthy diet, Smoking, Lack of exercise.

• #1 Advancements in Treatment Strategies for Chronic Mesenteric Ischemia: A Comprehensive Review

  https://www.mdpi.com/2077-0383/12/22/7112

  Notably, unlike most other atherosclerotic diseases, chronic mesenteric ischemia is observed more frequently in women. […] The diagnosis of CMI relies on a combination of specific clinical symptoms and the presence of hemodynamically significant MAOD. […] The classic symptoms of CMI typically include postprandial abdominal pain, weight loss, and food fear, it is important to acknowledge that this triad may not always be present, even at the time of revascularization. […] In a series of patients who underwent mesenteric revascularization, abdominal pain was present in 96% of cases but only occurred after eating in 74% of patients. […] Malnutrition has been found to have a notable impact on the outcomes of patients undergoing revascularization for CMI. […] The estimated prevalence for peripheral artery disease (PAD) ranges from 3% to 10%, while coronary artery disease (CAD) has a prevalence of 4.5% and cardiovascular disease (CVD) has a prevalence of 2.4%.

• #1 Chronic mesenteric ischemia | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/chronic-mesenteric-ischaemia?lang=us

  Chronic mesenteric ischemia is often multifactorial in etiology. The most common cause is atherosclerosis involving the proximal portions of the celiac artery, superior mesenteric artery (SMA), or inferior mesenteric artery (IMA). […] Less common etiologies include dissection, vasculitis, e.g. Buerger disease, Takayasu arteritis, fibromuscular dysplasia, radiation, and cocaine abuse.

• #1 Mesenteric ischemia: what the radiologist needs to know – Olson – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/21705/html

  A relatively rare cause of bowel ischemia, acute gastrointestinal vaso-occlusive ischemia (GVOI) should be considered in patients with sickle cell disease who present with acute abdominal pain. […] A complication of abdominal radiation, radiation enteritis develops secondary to obliterative arteritis affecting the microvascular circulation in the small bowel mucosa and submucosa.

• #1 Advancements in Treatment Strategies for Chronic Mesenteric Ischemia: A Comprehensive Review

  https://www.mdpi.com/2077-0383/12/22/7112

  Chronic mesenteric ischemia (CMI) arises from the inability to achieve adequate intestinal blood flow after meals, leading to an imbalance between oxygen and metabolite supply and demand. […] This hemodynamic disturbance is typically the result of atherosclerotic occlusive disease occurring at the entrances of the mesenteric vessels, such as the celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery (IMA), which accounts for 35–75% of cases. […] Other authors stated that atherosclerotic narrowing of the mesenteric arteries is responsible for more than 95% of cases of mesenteric arterial stenosis. […] Furthermore, nonatherosclerotic causes include vasculitis, fibromuscular dysplasia, segmental arterial mediolysis, and median arcuate ligament syndrome. […] The occurrence of mesenteric artery occlusive disease (MAOD) is relatively common among the elderly population, particularly among individuals with occlusive disease observed in other vascular areas.

• #1 Mesenteric ischemia: Recognizing an uncommon disorder and distinguishing among its causes | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/9/545

  Mesenteric ischemia occurs because of inadequate intestinal blood flow. Its severity depends on the vessels involved and whether collateral blood vessels are available to prevent malperfusion. Mesenteric ischemia is classified into acute or chronic subtypes according to the timing of vessel occlusion and onset of symptoms. Mesenteric arterial occlusion from embolism or thrombosis is the most common cause of acute mesenteric ischemia (49% and 29%, respectively), followed by nonocclusive mesenteric ischemia (20%22%) from splanchnic hypoperfusion and vasoconstriction and venous thrombosis (10%). Chronic mesenteric ischemia describes intermittent or continuous intestinal hypoperfusion caused by occlusive disease of the mesenteric vessels. Most cases of chronic mesenteric ischemia are due to atherosclerosis. Less common causes include fibromuscular dysplasia, vasculitis, and retroperitoneal fibrosis. More than 90% of cases of chronic mesenteric ischemia result from atherosclerotic disease affecting the proximal segments of the visceral vessels.

• #1

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-gastrointestinal/mesenteric-ischemia

  Recognize the importance of early consideration for mesenteric ischemia in the differential diagnosis of abdominal pain. […] Identify the four different causes of mesenteric ischemia and their clinical presentations. […] The main goal is to identify mesenteric ischemia early in undifferentiated abdominal pain patients so that rapid revascularization to the mesentery can be achieved preventing bowel infarction and its subsequent complications. […] Mesenteric ischemia is a time-sensitive disease process as delays in diagnosis will lead to increased morbidity and mortality, especially in elderly patients. […] The classic presentation for mesenteric ischemia will be in a patient over the age of 60. […] One of the distinctive findings in mesenteric ischemia is that the abdominal pain is out of proportion to their physical exam.

• #1 Mesenteric Ischemia: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23246-mesenteric-ischemia

  Narrowed and blocked arteries in the mesentery can cause ischemia, depriving your digestive tract of vital blood and oxygen. […] This usually happens because of a blockage in your blood vessels that provide blood to those areas. […] Mesenteric ischemia is more common as people age. It usually happens along with heart and circulation conditions, especially ones that can cause blood clots. […] Risk factors for mesenteric ischemia include: Atrial fibrillation (a type of irregular heart rhythm), Coronary artery disease, Diabetes, Heart failure, High blood pressure (hypertension), High cholesterol (hyperlipidemia), Hypercoagulation disorders (conditions that make your blood clot too easily), Recent surgery, Peripheral vascular diseases (such as peripheral artery disease), Tobacco use (past or present).

• #1 Diagnosing Mesenteric Ischemia | NYU Langone Health

  https://nyulangone.org/conditions/mesenteric-ischemia/diagnosis

  The condition may be caused by atherosclerosis, a buildup of plaquea hard, waxy substance made of fat, cholesterol, and calciumin the arteries. […] Another cause is a blood clot, which cuts off blood supply to the mesenteric arteries and may be life threatening. […] Certain lifestyle habits, such as being sedentary and eating a diet high in fatty foods, can lead to mesenteric ischemia because they can cause plaque to accumulate in the arteries. […] In addition, smoking has been proven to harm blood vessels, causing them to narrow and increasing the risk for the condition. […] People with chronic conditions that increase the risk for blood clots or narrowing of the arteries are also at increased risk for mesenteric ischemia. […] A tear in the aorta, called aortic dissection, also increases a persons risk for the condition. […] People who use drugs such as cocaine and methamphetamine are at increased risk for mesenteric ischemia.

• #1 Mesenteric Ischemia

  https://johnshopkinshealthcare.staywellsolutionsonline.com/Library/Wellness/Dental/134,203

  Risk factors for mesenteric ischemia include: Older age, Low blood pressure, High blood pressure, Heart disease, including coronary artery disease, heart failure, heart valve disease, and atrial fibrillation, High cholesterol and triglycerides in the blood, Tobacco use and cigarette smoke, Blood that easily clots, Inflammatory conditions, such as pancreatitis and diverticulitis, Rheumatologic conditions called vasculitis, Injury, Kidney failure, Decompression sickness, a deep-water diving injury, Recent heart attack, Recent catheter studies of the blood vessels, Use of cocaine, Dialysis. […] Mesenteric ischemia is decreased or blocked blood flow to your large or small intestine. It can be chronic, due to plaque buildup over time. Or it can be acute and happen suddenly, due to a blood clot. It can also happen from using certain illegal drugs like cocaine.

• #1 Chronic Mesenteric Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430748/

  Chronic mesenteric ischemia (CMI) is a manifestation of peripheral vascular disease caused by insufficient blood supply to meet the metabolic demands of visceral organs. CMI is typically due to atherosclerotic narrowing of mesenteric vessels, most commonly the superior mesenteric artery. Risk factors include smoking, hyperlipidemia, diabetes, and hypertension. […] Atherosclerosis is the leading cause of chronic mesenteric ischemia, resulting in a narrowing of the mesenteric vessels and a reduction in blood flow to the gastrointestinal tract. This narrowing, often involving the ostia of the mesenteric vessels, particularly the SMA, creates an imbalance between the oxygen supply to and consumption by the intestine. When increased blood flow is required, eg, during digestion, the compromised vessels fail to meet the demand, leading to severe abdominal pain and, in some cases, mesenteric ischemia.

• #1 Chronic mesenteric ischemia – UpToDate

  https://www.uptodate.com/contents/chronic-mesenteric-ischemia

  In one autopsy series, 29 of 120 individuals showed atherosclerotic disease within 2 cm of the origins of the celiac or mesenteric arteries, and 18 of 120 had at least two stenotic vessels; only one patient had evidence of bowel necrosis. The occurrence of disease was strongly associated with aging and correlated with atherosclerotic disease of cerebral arteries at the skull base.

• #1 Mesenteric Ischemia – North Texas Vascular Center

  http://ntxvascular.com/mesenteric-ischemia/

  Mesenteric ischemia is poor circulation in the vessels supplying blood flow to your mesenteric organs: your stomach, liver, colon and intestine. […] ACUTE mesenteric ischemia is commonly caused by a blood clot, which travels to one of the mesenteric arteries and suddenly blocks blood flow. These clots often originate in the heart and are more common among patients with an irregular heartbeat or heart disease. CHRONIC mesenteric ischemia is frequently due to atherosclerosis (hardening of the arteries), which slows the amount of blood flowing through the arteries. An artery becomes blocked by plaque, which is formed by fats and other materials circulating in your blood. As more plaque builds up along the blood vessel wall, the artery can narrow and stiffen. Eventually, enough plaque builds up to reduce blood flow or even completely block the arteries.

• #1 Intestinal ischemia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/intestinal-ischemia/symptoms-causes/syc-20373946

  Intestinal ischemia happens when the blood flow through the major blood vessels that send blood to and from the intestines slows or stops. The condition has many possible causes. Causes may include: […] Acute mesenteric ischemia is the result of a sudden loss of blood flow to the small intestine. It may be due to: […] Chronic mesenteric ischemia is due to the buildup of fatty deposits on an artery wall, called atherosclerosis. […] Ischemia due to mesenteric venous thrombosis happens when blood can’t leave the small intestine. This can be due to a blood clot in a vein that drains blood from the intestines.

• #1 Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0150-5

  Acute mesenteric ischemia (AMI) may be defined as a sudden interruption of the blood supply to a segment of the small intestine, leading to ischemia, cellular damage, intestinal necrosis, and eventually patient death if untreated. AMI may be non-occlusive (NOMI) or occlusive, with the primary etiology further defined as mesenteric arterial embolism (50%), mesenteric arterial thrombosis (15-25%), or mesenteric venous thrombosis (5-15%). […] Roughly, 50% of all cases of AMI are due to acute mesenteric embolism. Mesenteric emboli can originate from the left atrium, associated with cardiac dysrhythmias such as atrial fibrillation, left ventricle with global myocardial dysfunction associated with poor ejection fraction, or cardiac valves due to endocarditis. […] Thrombosis of the SMA (approximately 25% of cases) is usually associated with pre-existing chronic atherosclerotic disease leading to stenosis.

• #1 Mesenteric Ischemia

  https://errolozdalga.com/medicine/pages/mesentericischemia.cr.5.16.11.html

  Mesenteric Venous Thrombosis 5% of cases – causes increased resistance which backflows causing bowel wall edema, decreased arterial flow, and bowel infarction. This usually occurs in patients with hypercoagulable states, as well as portal hypertension, abdominal infections, malignancy, trauma, and pancreatitis. […] Nonocclusive Ischemia: 20-30% of cases – Pathogenesis involves splanchnic hypoperfusion and vasoconstriction, often with vasospasm. This occurs in patients with bad atherosclerotic disease who are hypotensive (i.e. sepsis, CHF, etc), often on pressors, or other meds that cause decreased intestinal blood flow or vasoconstriction (Digoxin, Cocaine, Diuretics).

• #1 Chronic mesenteric ischemia – UpToDate

  https://www.uptodate.com/contents/chronic-mesenteric-ischemia

  Chronic mesenteric ischemia is caused by a reduction in intestinal blood flow and is classified as acute (sudden onset of intestinal hypoperfusion) or chronic, depending on the time course of symptoms. Chronic mesenteric ischemia, also called intestinal angina, refers to episodic or continuous hypoperfusion of the small intestine that typically occurs in patients with multivessel mesenteric artery stenosis or occlusion. […] The majority of cases of chronic mesenteric ischemia are caused by atherosclerotic narrowing of the origins of the celiac or superior mesenteric arteries. […] While atherosclerosis of the mesenteric vessels is common, clinical manifestations as a consequence of mesenteric arterial disease are rare. […] Up to 18 percent of individuals over 65 years of age in the general population have significant stenosis of the celiac or superior mesenteric artery without any known prior symptoms.

• #1 Bowel Ischaemia | Doctor

  https://patient.info/doctor/bowel-ischaemia

  The history is typically one of weight loss, postprandial pain (’intestinal angina’) and a fear of eating. […] The condition may be difficult to diagnose, with nonspecific symptoms of an 'acute abdomen’, such as acute-onset abdominal pain. […] The pain is most frequently located in the left iliac fossa. […] Ischaemic colitis may also be caused by venous occlusion. […] The incidence of ischaemic colitis rose from 6.1 cases/100000 person-years in 1976-80 to 22.9/100000 in 2005-09. […] Because the most common cause is atheroma of the mesenteric vessels it is mainly a disease of the elderly and is rare before the age of 60. […] The average age for diagnosis is 70. […] Thrombosis: Inferior mesenteric artery thrombosis. […] Emboli: Mesenteric arterial emboli. […] The ischaemia may be transient and resolve once the cause of the hypoperfusion has been alleviated.

• #1 Advancements in Treatment Strategies for Chronic Mesenteric Ischemia: A Comprehensive Review

  https://www.mdpi.com/2077-0383/12/22/7112

  In contrast, CMI has a prevalence of only 0.03% (30 per 100,000 individuals), indicating its rarity. […] The understanding of the natural progression of CMI has largely been shaped by studying the clinical course of patients before they undergo intervention, which is often influenced by the duration of symptoms or the occurrence of acute mesenteric ischemia (AMI). […] Reports suggest that the 5-year mortality rate for untreated CMI patients approaches 86%. […] Interestingly, up to 50% of patients with AMI present with thrombosis of an existing lesion and exhibit prior symptoms consistent with CMI. […] Revascularization procedures, whether open surgeries or endovascular interventions, have demonstrated excellent outcomes in terms of relieving symptoms and achieving long-term graft or mesenteric vessel patency. […] However, it is worth noting that there can be a considerable delay in the diagnosis of CMI, with the average time from initial presentation to diagnosis spanning 15 to 35 months.

• #1 Acute Mesenteric Ischemia – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/acute-abdomen-and-surgical-gastroenterology/acute-mesenteric-ischemia

  Acute mesenteric ischemia is interruption of intestinal blood flow by embolism, thrombosis, or a low-flow state. […] Etiology of Acute Mesenteric Ischemia […] Mesenteric blood flow may be disrupted on either the venous or arterial sides. In general, patients 50 are at greatest risk and have the types of occlusions and risk factors shown in table Causes of Acute Mesenteric Ischemia. However, many patients have no identifiable risk factors. […] Causes of Acute Mesenteric Ischemia […] Arterial embolus ( 40%) […] Arterial thrombosis (30%) […] Venous thrombosis (15%) […] Nonocclusive ischemia (15%) […] If diagnosis and treatment take place before infarction occurs, mortality is low; after intestinal infarction, mortality is high and varies depending on the etiology. […] For this reason, clinical diagnosis of mesenteric ischemia should supersede diagnostic tests, which may delay treatment.

• #1 Intestinal Ischemia (Acute Mesenteric Ischemia) | Time of Care

  https://www.timeofcare.com/intestinal-ischemia-acute-mesenteric-ischemia/

  Diagnosis History and Physical. -Risk Factors: -DDx and Etiology: -A very high index of suspicion is needed for timely diagnosis. […] -For AMI caused mesenteric artery occlusion: SMA embolism: consider fibrinolytic; if no quick improvement, proceed to surgical embolectomy if possible, o/w aortomesenteric bypass SMA thrombosis: percutaneous or surgical revascularization -For AMI 2/2 to nonocclusive causes: correct underlying cause (especially cardiac) -Consider angioplasty/stent vs. surgical revascularization in cases of chronic mesenteric ischemia if: 2 vessels or occlusion of SMA, supportive clinical hx, other etiologies for abd pain excluded […] Prognosis: Mortality 20 to 70% if bowel infarcted; dx prior to infarction strongest predictor of survival.

• #1 Acute mesenteric ischemia: A review of the main imaging techniques and signs | Radiología (English Edition)

  https://www.elsevier.es/en-revista-radiologia-english-edition–419-articulo-acute-mesenteric-ischemia-a-review-S2173510720300501?newsletter=true

  Acute mesenteric ischaemia (AMI) is an uncommon condition that constitutes one of the abdominal emergencies with the worst prognosis. Its incidence increases with age and seems to be equal in men and women. It represents approximately one in every 1000 patients admitted to hospital for acute care. Its mortality rate is around 40-80%, due to the difficulty of early detection and the limited time that elapses between the decrease in vascular flow to the intestinal loops and the development of irreversible intestinal necrosis. The prognosis for these patients depends on the time to diagnosis and initiation of treatment. A delay in diagnosis of 24h decreases survival rates by up to 20%. Therefore, early diagnosis and rapid management are essential. In this regard, imaging tests play an important role, since, as shall be seen later on, neither symptoms nor laboratory tests are specific. At present, multidetector computed tomography (MDCT) is the initial imaging technique of choice for the diagnosis of suspected AMI and, in addition, enables other causes of acute abdominal pain to be ruled out.

• #1 Delayed Diagnosis of Mesenteric Ischemia | PSNet

  https://psnet.ahrq.gov/web-mm/delayed-diagnosis-mesenteric-ischemia

  In patients with acute abdominal pain, it is important to assess for atherosclerotic risk factors and arrhythmias, potential sources of embolus, and/or hypoperfusion, as this would increase clinical suspicion for this disorder. […] Symptoms of weight loss and dietary changes in the setting of atherosclerosis should increase suspicion for chronic mesenteric ischemia until proven otherwise. […] Once diagnosed, initial management consists of fluid resuscitation, broad spectrum antibiotics, anticoagulation in most cases, and urgent surgical consultation to General Surgery and Vascular Surgery for abdominal exploration. […] Outcomes of this disease process depend on the etiology, with higher mortality in arterial (50-70%) compared to venous ischemia (30%). […] Unfortunately, mortality rates exceed 60% in acute mesenteric ischemia and these high mortality rates have been unchanged in recent series.

• #1 Acute Mesenteric Ischaemia – Causes – Management – TeachMeSurgery

  https://teachmesurgery.com/vascular/peripheral/mesenteric-ischaemia/

  The main risks from mesenteric ischaemia are bowel necrosis and perforation. The mortality from the condition can be 50% in certain patient groups, even if the diagnosis is made and treatment performed promptly. Those that survive may have short gut syndrome if a significant amount of bowel needs to be resection.

• #2 Mesenteric ischemia: Recognizing an uncommon disorder and distinguishing among its causes | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/9/545

  Mesenteric ischemia occurs because of inadequate intestinal blood flow. Its severity depends on the vessels involved and whether collateral blood vessels are available to prevent malperfusion. Mesenteric ischemia is classified into acute or chronic subtypes according to the timing of vessel occlusion and onset of symptoms. Mesenteric arterial occlusion from embolism or thrombosis is the most common cause of acute mesenteric ischemia (49% and 29%, respectively), followed by nonocclusive mesenteric ischemia (20%22%) from splanchnic hypoperfusion and vasoconstriction and venous thrombosis (10%). Chronic mesenteric ischemia describes intermittent or continuous intestinal hypoperfusion caused by occlusive disease of the mesenteric vessels. Most cases of chronic mesenteric ischemia are due to atherosclerosis. Less common causes include fibromuscular dysplasia, vasculitis, and retroperitoneal fibrosis. More than 90% of cases of chronic mesenteric ischemia result from atherosclerotic disease affecting the proximal segments of the visceral vessels.

• #2 Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0150-5

  Acute mesenteric ischemia (AMI) may be defined as a sudden interruption of the blood supply to a segment of the small intestine, leading to ischemia, cellular damage, intestinal necrosis, and eventually patient death if untreated. AMI may be non-occlusive (NOMI) or occlusive, with the primary etiology further defined as mesenteric arterial embolism (50%), mesenteric arterial thrombosis (15-25%), or mesenteric venous thrombosis (5-15%). […] Roughly, 50% of all cases of AMI are due to acute mesenteric embolism. Mesenteric emboli can originate from the left atrium, associated with cardiac dysrhythmias such as atrial fibrillation, left ventricle with global myocardial dysfunction associated with poor ejection fraction, or cardiac valves due to endocarditis. […] Thrombosis of the SMA (approximately 25% of cases) is usually associated with pre-existing chronic atherosclerotic disease leading to stenosis.

• #2

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-gastrointestinal/mesenteric-ischemia

  The four causes of mesenteric ischemia are mesenteric artery embolism (commonly due to atrial fibrillation), mesenteric artery thrombosis (commonly due to atherosclerosis), mesenteric vein thrombosis (commonly due to hypercoagulability) and non-occlusive mesenteric ischemia (commonly due to low flow states). […] Mesenteric artery embolism is the most common cause of mesenteric ischemia accounting for 40-50% of cases. […] Mesenteric artery thrombosis generally occurs due to long standing atherosclerosis at the origin of the SMA. […] MVT occurs in younger patient populations and is most likely due to hypercoagulable states. […] Non-occlusive ischemia occurs in low flow states in the absence of an arterial or venous occlusion.

• #2 Mesenteric Artery Ischemia: Causes, Symptoms, and Treatment

  https://www.healthline.com/health/mesenteric-artery-ischemia

  Mesenteric artery ischemia is a condition that restricts blood flow to your intestines. […] The condition may occur with cardiovascular disease. […] The buildup of fatty deposits, called atherosclerosis, can lead to heart disease as well as ischemia. […] High cholesterol contributes to ischemia because it causes plaque to line your arteries. […] Blood clots can also block the mesenteric arteries and reduce blood flow to the digestive tract. […] A blood clot is a group of blood cells that stick together. […] The most common cause of blood clots that cause acute mesenteric ischemia is heart disease, especially atrial fibrillation. […] Chronic mesenteric ischemia is caused by a narrowing of more than one of the intestinal arteries. […] Cocaine and methamphetamine use can also lead to ischemia in some people. […] Previous blood vessel surgery is another possible cause of ischemia.

• #2 Acute mesenteric ischaemia: a pictorial review | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-018-0641-2

  Acute mesenteric ischaemia can be of acute (90%) or chronic type (10%). In acute type the causes are arterial embolism, arterial thrombosis, nonocclusive form or venous occlusion. […] Acute occlusions of the superior mesenteric artery due to thrombosis or embolisation are responsible for approximately 60%70% of cases of acute bowel ischaemia, whereas nonocclusive conditions account for approximately 20%30% of cases and mesenteric venous thromboses account for 5%10% of the total. […] Arterial inflow occlusion most commonly results from thromboembolism, where the embolus originates from the left atrium as a consequence of atrial fibrillation. […] The development of intestinal ischaemia from an arterially obstructing lesion depends upon the location of the obstruction, the patients collateral vasculature, acuity and degree of the obstruction.

• #2 Acute mesenteric ischemia: A review of the main imaging techniques and signs | Radiología (English Edition)

  https://www.elsevier.es/en-revista-radiologia-english-edition–419-articulo-acute-mesenteric-ischemia-a-review-S2173510720300501?newsletter=true

  The most common cause of AMI is arterial, such as mesenteric artery embolism (MAE) and mesenteric artery thrombosis (MAT); other less common causes are venous, such as mesenteric vein thrombosis (MVT), and low-output states such as non-occlusive mesenteric ischaemia (NOMI). There are other causes of AMI that should also be borne in mind, such as vasculitis, arterial dissection, internal hernias, adhesions, volvulus and mesenteric trauma. […] Arterial embolism is the most common cause of AMI and accounts for 40-50% of all cases. The main risk factors include atrial fibrillation, recent myocardial infarction, congestive heart failure, cardiomyopathies and embolisms due to aortic lesion or atherosclerosis. Arterial thrombosis accounts for approximately 25-30% of cases of AMI. The main risk factors are atherosclerotic disease and dyslipidaemia, followed by hypertension, diabetes, dehydration, antiphospholipid syndrome and oestrogen therapy. MVT accounts for 5-10% of all cases of AMI. It may occur in younger populations compared to other causes.

• #2 Chronic Mesenteric Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430748/

  Chronic mesenteric ischemia (CMI) is a manifestation of peripheral vascular disease caused by insufficient blood supply to meet the metabolic demands of visceral organs. CMI is typically due to atherosclerotic narrowing of mesenteric vessels, most commonly the superior mesenteric artery. Risk factors include smoking, hyperlipidemia, diabetes, and hypertension. […] Atherosclerosis is the leading cause of chronic mesenteric ischemia, resulting in a narrowing of the mesenteric vessels and a reduction in blood flow to the gastrointestinal tract. This narrowing, often involving the ostia of the mesenteric vessels, particularly the SMA, creates an imbalance between the oxygen supply to and consumption by the intestine. When increased blood flow is required, eg, during digestion, the compromised vessels fail to meet the demand, leading to severe abdominal pain and, in some cases, mesenteric ischemia.

• #2 Mesenteric Ischemia: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23246-mesenteric-ischemia

  Narrowed and blocked arteries in the mesentery can cause ischemia, depriving your digestive tract of vital blood and oxygen. […] This usually happens because of a blockage in your blood vessels that provide blood to those areas. […] Mesenteric ischemia is more common as people age. It usually happens along with heart and circulation conditions, especially ones that can cause blood clots. […] Risk factors for mesenteric ischemia include: Atrial fibrillation (a type of irregular heart rhythm), Coronary artery disease, Diabetes, Heart failure, High blood pressure (hypertension), High cholesterol (hyperlipidemia), Hypercoagulation disorders (conditions that make your blood clot too easily), Recent surgery, Peripheral vascular diseases (such as peripheral artery disease), Tobacco use (past or present).

• #2 Diagnosing Mesenteric Ischemia | NYU Langone Health

  https://nyulangone.org/conditions/mesenteric-ischemia/diagnosis

  The condition may be caused by atherosclerosis, a buildup of plaquea hard, waxy substance made of fat, cholesterol, and calciumin the arteries. […] Another cause is a blood clot, which cuts off blood supply to the mesenteric arteries and may be life threatening. […] Certain lifestyle habits, such as being sedentary and eating a diet high in fatty foods, can lead to mesenteric ischemia because they can cause plaque to accumulate in the arteries. […] In addition, smoking has been proven to harm blood vessels, causing them to narrow and increasing the risk for the condition. […] People with chronic conditions that increase the risk for blood clots or narrowing of the arteries are also at increased risk for mesenteric ischemia. […] A tear in the aorta, called aortic dissection, also increases a persons risk for the condition. […] People who use drugs such as cocaine and methamphetamine are at increased risk for mesenteric ischemia.

• #2 Bowel Ischaemia | Doctor

  https://patient.info/doctor/bowel-ischaemia

  Bowel ischaemia has been classified into three main types: Acute mesenteric ischaemia, Chronic mesenteric ischaemia, Ischaemic colitis (colonic ischaemia). […] This is an umbrella term covering a number of conditions, including acute mesenteric arterial embolus and thrombus, mesenteric venous thrombus and non-occlusive mesenteric ischaemia (NOMI). […] Conditions causing arterial emboli – eg, mural thrombus following myocardial infarction, auricular thrombus associated with mitral stenosis and AF, septic emboli from valvular endocarditis, fragments of proximal aortic thrombus, arterial catheterisation dislodging bits of plaque. […] Conditions causing arterial thrombosis – atherosclerosis (most common), aortic aneurysm or dissection, arteritis, decreased cardiac output (eg, from myocardial infarction or chronic heart failure), dehydration.

• #2 Mesenteric Ischemia

  https://errolozdalga.com/medicine/pages/mesentericischemia.cr.5.16.11.html

  Mesenteric Ischemia can be divided into Acute vs Chronic, and Small Bowel vs Colonic Ischemia. Acute Mesenteric Ischemia can be further divided into Occlusive vs Non-occlusive etiologies. […] Etiologies: A. Occlusive: Mesenteric Artery Embolism ~50% of cases, e.g. from A-fib, endocarditis, LV thrombus, etc. The SMA is most anatomically predisposed, due to its large caliber and narrow take-off angle from the aorta. The IMA is rarely affected due to its small caliber. The most commonly involved segment is the middle of the jejunum, as this is the most distant from collateral circulation of the celiac axis and IMA. […] Mesenteric Artery Thrombosis 15-25% of cases – this pathogenesis resembles that of plaque stenosis and/or rupture as in MI. They have bad preexisting atherosclerosis, and often have a history of Intestinal Angina representing chronic mesenteric ischemia where they have postprandial pain, nausea/vomiting, early satiety, and weight loss.

• #2 Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery | World Journal of Emergency Surgery | Full Text

  https://wjes.biomedcentral.com/articles/10.1186/s13017-017-0150-5

  NOMI occurs in approximately 20% of cases and is usually a consequence of SMA vasoconstriction associated with low splanchnic blood flow. […] Mesenteric venous thrombosis (MVT) accounts for less than 10% of cases of mesenteric infarction. Thrombosis is attributed to a combination of Virchows triad, i.e., stagnated blood flow, hypercoagulability, and vascular inflammation, but approximately 20% are idiopathic.

• #2 Acute Mesenteric Ischemia: Practice Essentials, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/189146-overview

  Causes of NOMI include the following: Hypotension from CHF, MI, sepsis, aortic insufficiency, severe liver or renal disease, or recent major cardiac or abdominal surgery. […] Causes of MVT include the following (80% of patients with MVT are found to have predisposing conditions): Hypercoagulability from protein C and S deficiency, antithrombin III deficiency, dysfibrinogenemia, abnormal plasminogen, polycythemia vera (most common), thrombocytosis, sickle cell disease, factor V Leiden mutation, pregnancy, and oral contraceptive use.

• #2 Bowel Ischaemia | Doctor

  https://patient.info/doctor/bowel-ischaemia

  NOMI – hypotension, vasopressive drugs, ergotamines, cocaine, digitalis. […] MVT can be caused by: Hypercoagulability disorders (eg, protein C and S deficiency). […] Tumour causing venous compression or hypercoagulability. […] Infection – usually intra-abdominal such as appendicitis, diverticulitis, or abscess, venous congestion from cirrhosis (portal hypertension). […] Venous trauma from accidents or surgery, especially portocaval surgery, pancreatitis, decompression sickness. […] Chronic mesenteric ischaemia has a very low incidence, accounting for less than 1 in 1,000 hospital admissions for abdominal pain. […] This is generally caused by factors predisposing to atherosclerosis – eg, smoking, hypertension, diabetes mellitus and hyperlipidaemia. […] Chronic mesenteric ischaemia symptoms include moderate-to-severe colicky or constant and poorly localised pain.

• #2 Mesenteric Ischaemia • LITFL • CCC General surgery

  https://litfl.com/mesenteric-ischaemia/

  Mesenteric ischaemia = inadequate blood flow through mesenteric circulation – ischaemia – gangrene […] Arterial disease […] embolism: MI, mitral stenosis, AF, endocarditis, mycotic aneurysm, prosthetic grafts, myxoma […] thrombosis: plaque rupture […] occlusive disease: atherosclerosis, vasculitis, autoimmune disease […] non-occlusive disease: decreased perfusion (septic shock, hypovolaemia, vasopressors, pancreatitis) […] Venous disease […] intra-abdominal infection with portal pyemia […] hypercoagulable states […] portal hypertension/mass effect from tumours – stasis […] direct trauma from surgery […] band adhesions.

• #2 Mesenteric ischemia: what the radiologist needs to know – Olson – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/21705/html

  Non-occlusive mesenteric ischemia (NOMI) is caused by intestinal hypoperfusion in the absence of vascular occlusion. […] Causes of arterial occlusion include emboli to the mesenteric vasculature, which commonly originate from the left atrium, left ventricle, or left-sided cardiac valves, and arterial thrombosis. […] Secondary causes of venous occlusion include inflammatory and infectious conditions such as diverticulitis, appendicitis, inflammatory bowel disease, and pancreatitis or neoplasia. […] In low-flow states caused by conditions such as cardiogenic or hemorrhagic shock, sepsis, or arrhythmia, reflex splanchnic vasoconstriction occurs to divert blood flow to critical organs such as the heart and brain. […] Mesenteric ischemia can occur in the aftermath of invasive procedures, particularly in patients with severe atherosclerosis or poor cardiopulmonary function.

• #2 Mesenteric Ischemia

  https://errolozdalga.com/medicine/pages/mesentericischemia.cr.5.16.11.html

  Mesenteric Venous Thrombosis 5% of cases – causes increased resistance which backflows causing bowel wall edema, decreased arterial flow, and bowel infarction. This usually occurs in patients with hypercoagulable states, as well as portal hypertension, abdominal infections, malignancy, trauma, and pancreatitis. […] Nonocclusive Ischemia: 20-30% of cases – Pathogenesis involves splanchnic hypoperfusion and vasoconstriction, often with vasospasm. This occurs in patients with bad atherosclerotic disease who are hypotensive (i.e. sepsis, CHF, etc), often on pressors, or other meds that cause decreased intestinal blood flow or vasoconstriction (Digoxin, Cocaine, Diuretics).

• #2 Acute mesenteric ischemia: A review of the main imaging techniques and signs | Radiología (English Edition)

  https://www.elsevier.es/en-revista-radiologia-english-edition–419-articulo-acute-mesenteric-ischemia-a-review-S2173510720300501?newsletter=true

  NOMI is often seen in patients of advanced age, and is responsible for approximately 20-30% of cases of AMI. Unlike the above-mentioned disorders, it is an acute disorder of the mesenteric circulation not caused by organic occlusion of the blood vessels that often persists even after the precipitating event is corrected. In terms of pathogenesis, NOMI is believed to arise from a combination of low cardiac output and vasoconstriction. Underlying diseases and risk factors include shock, dialysis, heart disorders, long-term extracorporeal circulation, postoperative stress, use of certain drug treatments (catecholamines, digitalis drugs and diuretics), arrhythmias, burns, diabetes, pancreatitis, dehydration and hypovolaemia. This condition is characterised by high rates of morbidity and mortality, due to patients’ advanced age and diagnostic delay.

• #2 Acute Mesenteric Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431068/

  Acute mesenteric ischemia is caused by a sudden decline in blood flow through the mesenteric vessels. […] Embolic patients commonly have a positive medical history of cardiovascular diseases including recent myocardial infarction, congestive heart failure, and atrial fibrillation. Causes include peripheral arterial emboli, cardiac emboli, and an atheromatous plaque that ruptured or dislodged after surgery. […] The typical thrombotic patient experiences a history of postprandial abdominal pain, leading to food avoidance and weight loss. Causes include atheromatous vascular disease (e.g., atherosclerosis, aortic aneurysm, aortic dissection) and decreased cardiac output due to a secondary cause (e.g., dehydration, myocardial infarction, congestive heart failure). […] The NOMI patient is typically critically ill, presents with several severe comorbidities, and is hemodynamically unstable. Causes include drugs that reduce blood flow (e.g., vasopressors and ergotamines), hypotension from severe medical conditions (e.g., myocardial infarction, sepsis, CHF, and renal disease), and patients that recently received major surgery (e.g., cardiac and abdominal surgery).

• #2 Mesenteric Ischemia: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23246-mesenteric-ischemia

  Different types of mesenteric ischemia have different causes. […] Acute mesenteric ischemia can happen in a similar way. This usually happens because of blood clots, which cause sudden and very severe symptoms. […] Chronic mesenteric ischemia often happens because of circulatory diseases that cause blood vessels to narrow. […] This narrowing, known as stenosis, means that blood flow to your mesentery drops over time. […] This condition can also happen because a blood clot forms in a mesenteric blood vessel. […] Non-occlusive mesenteric ischemia (NOMI), which happens without a blockage, makes up about 20% of all cases of acute mesenteric ischemia. […] Acute NOMI happens when blood vessels constrict, or there are spasms in the muscles lining those vessels. […] Problems like sepsis, heart attack, dehydration and allergic reactions can all contribute to acute mesenteric ischemia.

• #2 Mesenteric Ischemia : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/mesenteric-ischemia/

  Mesenteric ischemia is uncommon cause of abdominal pain: […] Etiology: […] Mesenteric arterial occlusion: […] Embolic source: 40-50% […] Thrombotic occlusion: 20-35% […] Dissection: <5% [...] Mesenteric venous thrombosis: 5-15% of cases [...] Primary (idiopathic) [...] Secondary causes: thrombophilia, trauma, local inflammatory changes from pancreatitis, diverticulitis, inflammation, or infection, etc. [...] Nonocclusive mesenteric ischemia: 5-15% of cases [...] Cardiac insufficiency or low-flow states. [...] Increasingly identified in patients undergoing hemodialysis.

• #2 Chronic mesenteric ischemia – UpToDate

  https://www.uptodate.com/contents/chronic-mesenteric-ischemia

  Chronic mesenteric ischemia is caused by a reduction in intestinal blood flow and is classified as acute (sudden onset of intestinal hypoperfusion) or chronic, depending on the time course of symptoms. Chronic mesenteric ischemia, also called intestinal angina, refers to episodic or continuous hypoperfusion of the small intestine that typically occurs in patients with multivessel mesenteric artery stenosis or occlusion. […] The majority of cases of chronic mesenteric ischemia are caused by atherosclerotic narrowing of the origins of the celiac or superior mesenteric arteries. […] While atherosclerosis of the mesenteric vessels is common, clinical manifestations as a consequence of mesenteric arterial disease are rare. […] Up to 18 percent of individuals over 65 years of age in the general population have significant stenosis of the celiac or superior mesenteric artery without any known prior symptoms.

• #2 Advancements in Treatment Strategies for Chronic Mesenteric Ischemia: A Comprehensive Review

  https://www.mdpi.com/2077-0383/12/22/7112

  Chronic mesenteric ischemia (CMI) arises from the inability to achieve adequate intestinal blood flow after meals, leading to an imbalance between oxygen and metabolite supply and demand. […] This hemodynamic disturbance is typically the result of atherosclerotic occlusive disease occurring at the entrances of the mesenteric vessels, such as the celiac artery (CA), superior mesenteric artery (SMA), and inferior mesenteric artery (IMA), which accounts for 35–75% of cases. […] Other authors stated that atherosclerotic narrowing of the mesenteric arteries is responsible for more than 95% of cases of mesenteric arterial stenosis. […] Furthermore, nonatherosclerotic causes include vasculitis, fibromuscular dysplasia, segmental arterial mediolysis, and median arcuate ligament syndrome. […] The occurrence of mesenteric artery occlusive disease (MAOD) is relatively common among the elderly population, particularly among individuals with occlusive disease observed in other vascular areas.

• #2 Chronic Mesenteric Ischemia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430748/

  Several factors predispose mesenteric vessels to atherosclerosis, including diabetes, hypertension, smoking, and hyperlipidemia. Smoking and hyperlipidemia are particularly significant risk factors for the development of SMA atherosclerosis. This condition underscores the critical importance of recognizing and addressing these risk factors to mitigate the progression of vascular compromise and its associated symptoms.

• #2 Delayed Diagnosis of Mesenteric Ischemia | PSNet

  https://psnet.ahrq.gov/web-mm/delayed-diagnosis-mesenteric-ischemia

  Risk factors for developing mesenteric ischemia vary by etiology but include any process that results in mesenteric hypoperfusion or increases the likelihood of intestinal embolism, thrombosis, or vasoconstriction. […] Acute arterial thrombosis is most common in patients with a history of chronic mesenteric ischemia due to atherosclerosis and peripheral artery disease. […] Given the potential for devastating outcomes when not diagnosed in a timely fashion, as in the presented case, mesenteric ischemia is an important diagnosis to consider in all patients with severe abdominal pain. […] Its chronic form most commonly affects women; more than 70% of patients with this disease are female. […] The most common universal presenting symptom is abdominal pain; for acute ischemia this is classically described as pain out of proportion to exam with an abdominal bruit on auscultation, although this is not present in all patients.

• #2 Chronic Mesenteric Ischemia: Background, Anatomy, Pathophysiology

  https://emedicine.medscape.com/article/183683-overview

  Chronic mesenteric ischemia (CMI) usually results from long-standing atherosclerotic disease of two or more mesenteric vessels. […] Other nonatheromatous causes of CMI include the vasculitides, such as Takayasu arteritis. […] Factors that predispose to atherosclerosis are associated with increased risk for chronic mesenteric ischemia (CMI). These include the following: Smoking, Hypertension, Diabetes mellitus, Hypercholesterolemia (although patients may present with hypocholesterolemia because of their chronic malnourished state). […] When the arterial lumen is narrowed secondary to atherosclerosis, any increase in intestinal demand (as in eating) or decrease in intestinal supply (as in hypovolemia) can result in severe abdominal pain and possibly infarction. The risk factors for atherosclerosis are therefore pertinent to the development of CMI.

• #2 Mesenteric Ischemia I Ohio State Medical Center

  https://wexnermedical.osu.edu/heart-vascular/heart-rhythm/mesenteric-ischemia

  Mesenteric ischemia occurs when one or more of your mesenteric arteries become obstructed. […] Acute mesenteric ischemia often occurs when a blood clot (embolus), which usually forms in the heart, travels into one of the mesenteric arteries and blocks the blood flow. […] Chronic mesenteric ischemia is commonly caused by atherosclerosis (hardening of the arteries). […] Other risk factors that contribute to mesenteric ischemia include: Aortic dissection (a tear in the aorta’s inner layer), Blood vessel disorders (such as fibromuscular dysplasia and arteritis), Coagulation disorders, Congestive heart failure, Low blood pressure, Obstruction of the veins in the bowel.

• #2 Small Bowel Ischemia – American College of Gastroenterology

  https://gi.org/topics/small-bowel-ischemia/

  Small bowel ischemia (also called mesenteric ischemia) is a potentially life-threatening group of conditions that reduce blood flow to the small intestine (e.g., duodenum, jejunum or ileum). […] Small bowel ischemia describes disorders that develop when blood flow to the small bowel is partially or completely blocked. The blockage usually occurs in one or more arteries that supply the small intestine. […] Small bowel ischemia occurs when a blockage prevents blood from flowing through the arteries to the intestines. The blockages can result from several possible causes: Atherosclerosis: Cholesterol builds up in the arteries leading to the intestines, reducing blood flow. Blood clots: Blood clots can partially or completely block arteries that supply blood to the intestines or, less commonly, the veins that carry blood from the intestines back to the heart. Hernia: Part of the intestine may protrude through a weak area of abdominal muscle, cutting off blood flow to the intestine. Low blood pressure: Extremely low blood pressure, which can result from trauma or heart failure (weakening of the heart’s ability to push blood forward), can reduce blood flow to the intestines, especially if arteries are already narrowed. Scar tissue: Tissue that grows after surgery or an injury can enlarge or obstruct the bowel, cutting off its blood supply.

• #2 Bowel Ischaemia | Doctor

  https://patient.info/doctor/bowel-ischaemia

  The history is typically one of weight loss, postprandial pain (’intestinal angina’) and a fear of eating. […] The condition may be difficult to diagnose, with nonspecific symptoms of an 'acute abdomen’, such as acute-onset abdominal pain. […] The pain is most frequently located in the left iliac fossa. […] Ischaemic colitis may also be caused by venous occlusion. […] The incidence of ischaemic colitis rose from 6.1 cases/100000 person-years in 1976-80 to 22.9/100000 in 2005-09. […] Because the most common cause is atheroma of the mesenteric vessels it is mainly a disease of the elderly and is rare before the age of 60. […] The average age for diagnosis is 70. […] Thrombosis: Inferior mesenteric artery thrombosis. […] Emboli: Mesenteric arterial emboli. […] The ischaemia may be transient and resolve once the cause of the hypoperfusion has been alleviated.

• #2 Mesenteric Ischemia

  https://mobile.fpnotebook.com/Surgery/GI/MsntrcIschm.htm

  Sudden interruption of Small Bowel perfusion resulting in Intestinal Ischemia, infarction and necrosis. […] Atrial Fibrillation causes 50% of Mesenteric Artery Embolism, and 25% of all Mesenteric Ischemia cases. […] Mesenteric Artery Embolism (50%) is the most common embolism source of cardiac origin. […] Mesenteric Artery Thrombosis (15-25%) typically occurs at proximal SMA and is often preceded by Chronic Mesenteric Ischemia. […] Nonocclusive Mesenteric Ischemia – NOMI (20-30%) results from Low Cardiac Output and mesenteric arterial Vasoconstriction or vasospasm. […] Mesenteric Venous Thrombosis – MVT (5-10%) occurs in Hypercoagulable State or localized intraabdominal inflammation. […] Diffuse atherosclerotic disease is present in 95% of cases of Primary Chronic Mesenteric Ischemia. […] Secondary Mesenteric Ischemia can be caused by adhesions, herniation, volvulus, intussusception, tumor, trauma, or retroperitoneal fibrosis.

• #2 Mesenteric Ischemia

  https://johnshopkinshealthcare.staywellsolutionsonline.com/Library/Wellness/Dental/134,203

  Risk factors for mesenteric ischemia include: Older age, Low blood pressure, High blood pressure, Heart disease, including coronary artery disease, heart failure, heart valve disease, and atrial fibrillation, High cholesterol and triglycerides in the blood, Tobacco use and cigarette smoke, Blood that easily clots, Inflammatory conditions, such as pancreatitis and diverticulitis, Rheumatologic conditions called vasculitis, Injury, Kidney failure, Decompression sickness, a deep-water diving injury, Recent heart attack, Recent catheter studies of the blood vessels, Use of cocaine, Dialysis. […] Mesenteric ischemia is decreased or blocked blood flow to your large or small intestine. It can be chronic, due to plaque buildup over time. Or it can be acute and happen suddenly, due to a blood clot. It can also happen from using certain illegal drugs like cocaine.

• #2 Mesenteric Ischemia | UCSF Department of Surgery

  https://surgery.ucsf.edu/condition/mesenteric-ischemia

  Visceral artery disease is the narrowing of the arteries that supply blood to the intestines, spleen and liver. The narrowing is caused by atherosclerosis, which results in a reduction of blood flow to these organs. […] Atherosclerosis: A narrowing or hardening of the arteries when plaque forms in the artery walls. Plaque, a sticky substance, consists of fats and other products circulating in the blood. As plaque builds up, arteries can narrow and stiffen. Eventually, plaque builds up and reduces blood flow through the arteries. […] Blood Clots: A clot or embolus travels to one of the mesenteric arteries and blocks blood flow. Such clots are more common in patients with heart disease an irregular heartbeat. […] Aortic dissection: A tear in the aorta’s inner layer. […] Coagulation disorders […] Congestive heart failure […] Low blood pressure […] Occlusion or blockage of the veins in the bowel […] Fibromuscular dysplasia and arteritits: Disorders of the blood.

• #2 Chronic mesenteric ischemia – UpToDate

  https://www.uptodate.com/contents/chronic-mesenteric-ischemia

  In one autopsy series, 29 of 120 individuals showed atherosclerotic disease within 2 cm of the origins of the celiac or mesenteric arteries, and 18 of 120 had at least two stenotic vessels; only one patient had evidence of bowel necrosis. The occurrence of disease was strongly associated with aging and correlated with atherosclerotic disease of cerebral arteries at the skull base.

• #2 Intestinal ischemia – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/intestinal-ischemia/

  Intestinal ischemia occurs if bowel perfusion cannot meet the metabolic demands of the intestine. This relative hypoperfusion may be the result of atherosclerosis, thromboembolic disease, or severe systemic hypotension. […] Acute mesenteric ischemia (AMI) has various etiologies, which manifest with similar clinical features despite having different underlying risk factors and pathology. […] AMI is most commonly caused by acute mesenteric artery embolism, which accounts for 50% of all cases. […] Nonocclusive mesenteric ischemia causes 20% of cases and most commonly occurs in critically ill patients with low cardiac output. […] Atherosclerosis is the main cause of chronic mesenteric ischemia (CMI). […] CMI is typically caused by slowly progressing stenosis of two or more of the main mesenteric arteries. […] Thrombus formation in addition to stenosis can lead to acute-on-chronic mesenteric ischemia, which leads to AMI. […] Older patients with risk factors for atherosclerosis are at especially high risk for developing colon ischemia.

• #2 Mesenteric artery ischemia: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001156.htm

  Mesenteric artery ischemia occurs when there is a narrowing or blockage of one or more of the three major arteries that supply the small and large intestines. These are called the mesenteric arteries. […] Hardening of the arteries occurs when fat, cholesterol, and other substances build up in the walls of arteries. This is more common in smokers and in people with high blood pressure or high blood cholesterol. […] The blood supply to the intestines may be suddenly blocked by a blood clot (embolus). The clots most often come from the heart or aorta. These clots are more commonly seen in people with abnormal heart rhythm. […] When the blood supply is suddenly cut off by a blood clot, it is an emergency. Treatment can include medicines to dissolve the blood clots and open up the arteries.

• #2 Delayed Diagnosis of Mesenteric Ischemia | PSNet

  https://psnet.ahrq.gov/web-mm/delayed-diagnosis-mesenteric-ischemia

  In patients with acute abdominal pain, it is important to assess for atherosclerotic risk factors and arrhythmias, potential sources of embolus, and/or hypoperfusion, as this would increase clinical suspicion for this disorder. […] Symptoms of weight loss and dietary changes in the setting of atherosclerosis should increase suspicion for chronic mesenteric ischemia until proven otherwise. […] Once diagnosed, initial management consists of fluid resuscitation, broad spectrum antibiotics, anticoagulation in most cases, and urgent surgical consultation to General Surgery and Vascular Surgery for abdominal exploration. […] Outcomes of this disease process depend on the etiology, with higher mortality in arterial (50-70%) compared to venous ischemia (30%). […] Unfortunately, mortality rates exceed 60% in acute mesenteric ischemia and these high mortality rates have been unchanged in recent series.

• #2 Advancements in Treatment Strategies for Chronic Mesenteric Ischemia: A Comprehensive Review

  https://www.mdpi.com/2077-0383/12/22/7112

  In contrast, CMI has a prevalence of only 0.03% (30 per 100,000 individuals), indicating its rarity. […] The understanding of the natural progression of CMI has largely been shaped by studying the clinical course of patients before they undergo intervention, which is often influenced by the duration of symptoms or the occurrence of acute mesenteric ischemia (AMI). […] Reports suggest that the 5-year mortality rate for untreated CMI patients approaches 86%. […] Interestingly, up to 50% of patients with AMI present with thrombosis of an existing lesion and exhibit prior symptoms consistent with CMI. […] Revascularization procedures, whether open surgeries or endovascular interventions, have demonstrated excellent outcomes in terms of relieving symptoms and achieving long-term graft or mesenteric vessel patency. […] However, it is worth noting that there can be a considerable delay in the diagnosis of CMI, with the average time from initial presentation to diagnosis spanning 15 to 35 months.

• #2

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-gastrointestinal/mesenteric-ischemia

  Recognize the importance of early consideration for mesenteric ischemia in the differential diagnosis of abdominal pain. […] Identify the four different causes of mesenteric ischemia and their clinical presentations. […] The main goal is to identify mesenteric ischemia early in undifferentiated abdominal pain patients so that rapid revascularization to the mesentery can be achieved preventing bowel infarction and its subsequent complications. […] Mesenteric ischemia is a time-sensitive disease process as delays in diagnosis will lead to increased morbidity and mortality, especially in elderly patients. […] The classic presentation for mesenteric ischemia will be in a patient over the age of 60. […] One of the distinctive findings in mesenteric ischemia is that the abdominal pain is out of proportion to their physical exam.

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