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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bowel ischemia and infarction are diseases primarily of, but not confined to, the elderly. Insidiously developing bowel ischemia may mimic more common gastrointestinal disturbances, such as peptic ulcer disease or malignancy, and go undiagnosed for long periods. Bowel infarction is a catastrophic event: Mortality rates approach 90%. Chronic intestinal ischemia may precede infarction, or infarction may occur with no warning. Laboratory and radiologic studies have minimal value in diagnosis of these disorders. A high index of suspicion must be maintained in patients complaining of abdominal pain if these diagnoses are to be made promptly.
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PMID:Bowel ischemia and infarction. Chronic and acute causes of abdominal pain. 368 21

Chronic intestinal ischemia is usually caused by atherosclerosis of the visceral branches of the abdominal aorta. It classically presents with severe postprandial abdominal pain, weight loss due to fear of eating, and altered intestinal motility. Aortography is the definitive diagnostic study and usually reveals occlusive disease of at least two major visceral vessels. Revascularization is indicated in symptomatic patients but should be undertaken in asymptomatic patients only when aortic reconstruction is indicated that would threaten intestinal collateral blood flow. Refinements in operative technique and perioperative management have improved the safety and effectiveness of visceral reconstruction procedures.
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PMID:Chronic visceral ischemia. An often overlooked cause of abdominal pain. 687 83

Chronic mesenteric ischaemia is often difficult to diagnose. A high level of clinical suspicion is needed and further investigation requires invasive procedures. We present a case where weight loss and abdominal pain were dominant features and initial interpretation of a labelled leucocyte scan suggested inflammatory bowel disease. Subsequent investigations excluded this possibility and chronic ischaemia was confirmed at autopsy. Positive small bowel images using 99Tcm-HMPAO labelled leucocytes may indicate chronic ischaemia.
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PMID:Case report: chronic mesenteric ischaemia as a cause of abnormal bowel uptake of labelled leucocytes. 749 19

A review of chronic intestinal ischaemia with special emphasis on symptoms, clinical findings, diagnostic procedures and treatment is given. Chronic intestinal ischaemia is not a frequent disease and is often caused by arteriosclerosis. The symptoms are postprandial abdominal pain accompanied by weight loss. The weight loss is mainly caused by reduced food consumption. The diagnosis is traditionally based on angiography and it is recognised that two of the three arteries to the intestines must be affected before the symptoms are experienced. Recently, more functional tests have become available. Especially the measurements of splanchnic blood flow before and after a test meal are used. The lack of a postprandial rise in blood flow is taken as evidence for intestinal ischaemia. Noninvasive methods such as duplex scanning with measurement of portal flow and tonometry seem promising. The treatment is surgical reconstruction of the blood flow or, more recently, percutaneous transluminal angioplasty. The results are generally excellent, although percutaneous transluminal angioplasty in some cases needs to be repeated. The diagnosis and treatment are for a specialist with a special interest. The patients should be concentrated in just a few centres.
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PMID:[Intestinal ischemia. Clinical picture and examination methods]. 779 56

Chronic mesenteric ischemia is rare and commonly presents with abdominal pain and weight loss. Treatment options are limited to surgical or endovascular revascularization. In this report we describe in detail successful stent-supported angioplasty of a high-grade superior mesenteric artery stenosis utilizing a right brachial artery approach. A brief review of the literature is provided.
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PMID:Stenting of a superior mesenteric artery lesion via the right arm approach. 1074 84

The clinical presentation of mesenteric ischemia depends on the site, grade, and cause of vascular obstruction; the degree of collateralization; and the stage of disease. Patients in the early stages of ischemia typically have abdominal pain out of context with an unimpressive abdominal examination. It is during this stage that medical and endovascular techniques can be most effective. After signs of peritonitis are present (signaling bowel infarction), surgical exploration and bowel resection are necessary. Chronic mesenteric ischemia induced by stenotic arteriosclerosis should be treated with percutaneous transluminal angioplasty and stenting (PTAS). Chronic mesenteric arterial occlusions are better handled with bypass surgery. Acute embolic or thrombotic ischemia is surgically treated after medical resuscitation. Endovascular techniques may be applicable in selected patients (usually in those with subacute symptoms), but thrombolytic therapy should be avoided if intestinal infarction is suspected. Non-occlusive mesenteric ischemia requires a rapid correction of the predisposing hypotension or sepsis followed by papaverine infusion into the superior mesenteric artery. Celiac artery compression syndrome requiring treatment is best treated with surgical release of the median arcuate ligament; PTAS should not be performed. Mesenteric venous occlusion should be treated with anticoagulation. Surgical exploration and bowel resection is necessary in patients presenting with acute signs and symptoms, reserving thrombolytic therapy for early, mildly symptomatic, thromboses in whom there is no contraindication to thrombolysis.
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PMID:Mesenteric Vascular Disease. 1134 65

Chronic mesenteric ischemia (CMI) is rare and is often diagnosed late. Fatal malabsorption-related complications or acute ischemic events occur in the absence of treatment. Diagnosis depends on careful acquisition of a medical history and elimination of other conditions. No sensitive and specific tests are available for functional diagnosis of CMI. If other causes of abdominal pain and weight loss have been confidently ruled out, evidence of visceral artery occlusion at noninvasive imaging (Doppler ultrasonography, computed tomographic angiography, and magnetic resonance angiography) suggests CMI. Until the 1990s, open surgery was considered the treatment of choice; percutaneous transluminal angioplasty (PTA) was reserved for patients for whom surgery carried a high risk. However, open surgery carries a nonnegligible risk of morbidity and mortality. In recent years, PTA with stent placement has been recognized as a minimally invasive means of obtaining good long-term results with an acceptable recurrence rate and consequently has been suggested for primary treatment of CMI. New treatments including administration of fibrinolytic agents before PTA of chronic occlusions, routine revascularization of one or more arteries, and stent placement will probably be validated in the near future. Similarly, new data on selection of the best approach will become available soon.
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PMID:Chronic mesenteric ischemia: imaging and percutaneous treatment. 1211 Jul 15

Chronic intestinal ischaemia is characterized by postprandial abdominal pain and prominent weight loss, often leading to the first clinical suspicion of malignancy. After ruling out various gastrointestinal disorders, chronic intestinal ischaemia should be considered as a potential diagnosis. Besides the clinical picture, various non-invasive procedures are helpful in establishing the diagnosis. Whereas a plain abdominal radiography may show arterial calcifications, duplex ultrasonography is nowadays the leading diagnostic procedure for ruling out significant disease. Another promising and increasingly used technology is magnetic resonance angiography. Suspicious findings must be followed by the gold standard in diagnosis, namely splanchnic angiography. Since all these technologies provide only anatomical evidence of disease, functional imaging techniques assessing splanchnic blood flow after meal challenge using the invasive indocyanine green method may be helpful. However, further studies are needed in the use of this experimental technique in the workup of these patients.
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PMID:Splanchnic blood flow determination in patients with suspected chronic intestinal ischaemia. 1243 8

Mesenteric ischemia is an important clinical condition becoming more prevalent with aging of the population. Mesenteric ischemia may be manifest in an acute presentation, usually secondary to thromboembolism or cardiac insufficiency. Patients have abdominal pain, lactic acidosis, benign abdominal examination, and, often, coexistent multisystem organ dysfunction. Chronic mesenteric ischemia is secondary to proximal arterial stenosis or occlusions inadequately compensated by collateral flow. Clinical presentation may simulate occult malignancy. In this review article, the role of Doppler sonography and other diagnostic imaging tests in suspected acute mesenteric ischemia and mesenteric arterial insufficiency are evaluated with emphasis on diagnostic criteria and appropriate use in each clinical context.
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PMID:Mesenteric ischemia. 1297 81

Chronic mesenteric ischemia is an uncommon condition associated with a high morbidity and mortality. We reported a 36-year old women with postprandial abdominal pain due to chronic mesenteric ischemia caused by a fistula between superior mesenteric and common hepatic artery.
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PMID:Mesenteric ischemia: an unusual presentation of fistula between superior mesenteric artery and common hepatic artery. 1530 Sep 18


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