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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Vascular catastrophe resulting in a bowel infarction requiring massive resection is one of the most common indications for long-term total parenteral nutrition (TPN). The causes of mesenteric artery disease include embolic and thrombotic occlusions, nonocclusive mesenteric ischemia, and chronic mesenteric ischemia. This paper describes a case of a patient with chronic ischemia. The indication for TPN was intestinal angina limiting oral intake, not short-bowel syndrome as a result of bowel infarction and surgery. The patient had an extensive history of atherosclerotic disease and abdominal symptoms. Her nutritional status was maintained with TPN and oral intake as symptomatically tolerated. She eventually developed catheter sepsis. Her cardiopulmonary status deteriorated and she died. Progressive mesenteric ischemia and possible infarction may have contributed to her death. The patient had indicated she did not want surgery for a bowel infarction. She did consent to surgical correction of her disease, if feasible. Although TPN can maintain the nutritional and metabolic status of a patient with chronic mesenteric ischemia, the associated risk of catheter sepsis emphasizes the necessity for expedient treatment of the primary pathology.
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PMID:Parenteral nutrition support of a patient with chronic mesenteric artery occlusive disease. 832 26

The authors report the cases of two patients presenting a symptomatic intestinal angina caused by median arcuate ligament compression. Arteriography demonstrates severe coeliac artery stenosis in both of them and a retrograde filling of the coeliac axis from the superior mesenteric artery branch collateral vessels. The patients became asymptomatic after surgical release of the celiac trunk by section of the median arcuate ligament of the diaphragm. At 2 and 3 years follow-up, both patients report no further abdominal pain. Dunbar's syndrome is still a questionable subject; how can be a narrowing or an occlusion of the celiac artery semeiotically and clinically important? Some have proposed an ischemic base to explain the abdominal pain: the compression of the celiac trunk could be responsible of a celiac steal which results in shunting of blood from the superior mesenteric artery to the celiac distribution through the collateral system. There are very strong proofs that partial or even complete obstruction of the celiac artery should not lead to visceral ischemia such as: the rich collateral anastomosis of the celiac axis, the surgical ligation of the celiac axis performed without untoward consequences, the finding of asymptomatic celiac stenosis in the 49% of an arteriographic study, impossibility to formulate a consistent and rational for the surgical results. Shearing this view, few authors would prove that a stenotic type of the celiac artery is only a normal anatomic variant, refuting the existence of this syndrome.
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PMID:[Dunbar's syndrome: clinical reality or physiopathologic hypothesis?]. 900 67

We describe a case of intestinal angina caused by spontaneous dissection of the celiac artery and thrombosis of the superior mesenteric artery. Spontaneous dissection of a visceral artery is an uncommon occurrence that is usually diagnosed after fatal hemorrhage or ischemia. The underlying mechanism is unclear but the frequent association with multiple arterial lesions suggests general arterial disease. In symptomatic forms, surgical reconstruction is mandatory, to treat the lesion and allow definitive histological diagnosis.
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PMID:Spontaneous dissection of the celiac artery. 923

Chronic ischemia of the small bowel is classically described as presenting with abdominal pain associated with eating (intestinal angina). Here we describe the cases of two patients with chronic small bowel ischemia who presented atypically with painless watery diarrhea and weight loss. These cases suggest that the clinical spectrum of chronic small bowel ischemia may be wider than previously appreciated. Chronic ischemia of the small bowel should be included in the differential diagnosis for painless watery diarrhea in the context of weight loss.
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PMID:Painless small bowel ischemia presenting with diarrhea and weight loss. 957 68

Intestinal vasculitis is a rare cause of mesenteric ischemia. It results in chronic arterial insufficiency in most cases, sometimes in acute mesenteric ischemia. Abdominal symptoms like postprandial intestinal angina, diarrhea, anorexia, and perforation are nonspecific and do not allow for differentiation between vasculitic and noninflammatory causes of mesenteric ischemia. Conventional radiography and endoscopy can not prove the underlying process either. Therefore, extraintestinal symptoms of vasculitis must be observed carefully for diagnosing a systemic vasculitis with potential involvement of intestinal arteries. Extraintestinal manifestations are multifacetted including malaise, rheumatic symptoms and more specific findings like cutaneous efflorescences and organ-specific vasculitic damages due to ischemia of inner organs, nerves and sensory organs. While some vasculitic disorders are characterized by specific laboratory markers (ANCA, anti-ds-DNA antibodies), others appear with less specific signs. Prior to treatment, the diagnosis should be established by biopsy of suspect tissue and subsequent histologic analysis. Angiography can be helpful in diagnosis of syndromes involving medium-sized or larger vessels. The treatment of choice is glucocorticoids, while in patients with extensive visceral, especially renal involvement, cyclophosphamide should be added. When glucocorticoids can not be tapered or the disease can not be controlled other immunosuppressive agents should be employed. In difficult diagnostics with mere suspicion of vasculitis glucocorticoids may be given ex juvantibus and fairly often prove effective.
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PMID:[Intestinal vasculitis--a diagnostic-therapeutic challenge]. 1072 Nov 76

Abdominal pain is by far the most serious symptom in attacks of acute intermittent porphyria (AIP). Its cause is unknown. This case suggests visceral ischemia as a possible cause of the abdominal pain. A 31-year-old woman with recurrent bouts died during an attack; the autopsy revealed a 20 cm necrotic gangrene in the ileum. A protracted intestinal vasospasm could have been the immediate cause of death. The question as to whether intestinal angina could be the cause of abdominal pain in acute intermittent porphyria is discussed.
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PMID:[Unsatisfactory pain treatment in attacks of acute intermittent porphyria. Vasodilation an alternative if the pain is shown to be the pain of intestinal angina]. 1129 73

Chronic mesenteric ischemia often called intestinal angina too, is the clinical syndrome that originates as a result of chronic obstruction of the splanchnic arteries. Intestinal angina is defined by the clinical triad of postprandial abdominal pain, sitophobia (fear of eating) and chronic weight loss. Postprandial abdominal pain is analogous to angina pectoris and calf claudication, two more common manifestations of episodic tissue hypoxia. The authors present the case-history of a 50-year-old woman with intestinal angina due to obliteration of the all three main splanchnic arteries. The authors describe the course of the disease and point out new diagnostic approaches in the diagnosis of chronic mesenteric ischemia (Doppler ultrasound of the splanchnic arteries, helical CT angiography of the splanchnic vasculature). In the discussion they point out the possible atypical clinical manifestation of chronic mesenteric ischemia and existence of gastric ulceration and chronic ischemic gastritis caused by chronic mesenteric ischemia.
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PMID:[Chronic mesenteric ischemia]. 1563 5

Intestinal ischemia has been classified into three major categories based on its clinical features, namely, acute mesenteric ischemia (AMI), chronic mesenteric ischemia (intestinal angina), and colonic ischemia (ischemic colitis). Acute mesenteric ischemia is not an isolated clinical entity, but a complex of diseases, including acute mesenteric arterial embolus and thrombus, mesenteric venous thrombus, and nonocclusive mesenteric ischemia (NOMI). These diseases have common clinical features caused by impaired blood perfusion to the intestine, bacterial translocation, and systemic inflammatory response syndrome. Reperfusion injury, which exacerbates the ischemic damage of the intestinal microcirculation, is another important feature of AMI. There is substantial evidence that the mortality associated with AMI varies according to its cause. Nonocclusive mesenteric ischemia is the most lethal form of AMI because of the poor understanding of its pathophysiology and its mild and nonspecific symptoms, which often delay its diagnosis. Mesenteric venous thrombosis is much less lethal than acute thromboembolism of the superior mesenteric artery and NOMI. We present an overview of the current understanding of AMI based on reported evidence. Although AMI is still lethal and in-hospital mortality rates have remained high over the last few decades, accumulated knowledge on this condition is expected to improve its prognosis.
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PMID:Acute mesenteric ischemia: the challenge of gastroenterology. 1577 87

Chronic mesenteric ischemia is an unusual but important cause of abdominal pain. Although this condition accounts for only 5% of all intestinal ischemic events, it can have significant clinical consequences. Among its many causes, atherosclerotic occlusion or severe stenosis is the most common. This disorder has an indolent course that results in extensive collateral vascular formation. Thus, symptoms occur when at least two of the three main splanchnic vessels are affected. Intestinal angina, weight loss, and sitophobia are common clinical features. Diagnosis can often be made by noninvasive methods such as computerised axial tomographic angiography, magnetic resonance angiography, and duplex ultrasonography as well as by invasive catheter angiography. Therapy of chronic mesenteric ischemia depends on the extent and location of vascular disease. Alternatives to traditional surgical bypass are becoming more common including embolectomy, thrombolysis, and percutaneous angioplasty with vascular stenting. Early intervention is vital as the natural course of this illness can be debilitating. Furthermore, this has potential to develop into life-threatening acute mesenteric ischemia with subsequent bowel infarction and death. Long-term studies have shown that the risk of developing symptoms from asymptomatic but significant mesenteric vascular disease is 86% with overall 40% mortality rate. The recognition and management of this unusual but important cause of abdominal pain is discussed in detail in this review.
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PMID:Chronic mesenteric ischemia. 1583 94

Abdominal angina and fear of eating are manifestations of mesenteric ischemia. This infrequent cause of abdominal pain was diagnosed in a 60-year-old female smoker. We performed a novel side-to-side aorto-mesenteric anastomosis for mesenteric revascularization, with good short-term (6 months) result.
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PMID:Side-to-side aorto-mesenteric anastomosis for management of abdominal angina. 1642 23


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