| Theme | Intestinal ulcerations related to vascular disorders | |
|---|---|---|
| Title | Mesenteric arterial occlusion and mesenteric venous thrombosis | |
| Publish Date | 2012/09 | |
| Author | Koji Murono | Department of Surgical Oncology, Faculty of Medical Sciences, University of Tokyo |
| Author | Eiji Sunami | Department of Surgical Oncology, Faculty of Medical Sciences, University of Tokyo |
| Author | Toshiaki Watanabe | Department of Surgical Oncology, Faculty of Medical Sciences, University of Tokyo |
| [ Summary ] | Both superior mesenteric arterial occlusion and superior mesenteric venous thrombosis are life-threatening disorders, which may cause a wide range of bowel necrosis symptoms. Early diagnosis and rapid revascularization are important to prevent bowel necrosis. Both disorders are often diagnosed with computed tomography. Thrombosis or embolism are detected as filling defects in the superior mesenteric artery or vein. If ischemia in the bowel is irreversible, intramural gas in the small intestine or hepatic portal venous gas may be observed. Risk factors for superior mesenteric arterial occlusion include atherosclerosis and arrhythmia. Because necrosis may occur within 12 hours and the difficulties associated with early diagnosis, mortality rates range from 31 % to 78 % and have remained at this high level for decades. Thrombectomy or thrombolytic therapy are effective if early diagnosis is possible. Bowel ischemia is reversible at these times. If this is not possible necrotic bowels must be resected. Risk factors for superior mesenteric venous occlusion include hypercoagulable states such as protein C and S deficiencies, portal hypertension, previous abdominal surgery and pancreatitis. Unlike superior mesenteric arterial occlusion, necrosis does not occur for three to five days. The first choice of treatment is anticoagulant therapy. Necrotic bowels must be resected in cases with severe symptoms or irreversible bowel ischemia. |
|