II. Epidemiology

  1. Accounts for 20-30% of Acute Mesenteric Ischemia
  2. Age: 70 years is mean age

III. Pathophysiology

  1. Decreased perfusion to splenic flexure and distal sigmoid colon (watershed areas)

IV. Risk Factors

  1. More common in hospitalized patients
  2. Hypoperfusion due to Hypotension or shock state
    1. Sepsis
    2. Hemorrhagic blood loss
    3. Cardiogenic Shock
      1. Congestive Heart Failure exacerbation
      2. Myocardial Infarction or Myocardial Ischemia
  3. Post-Surgical status
  4. Dialysis
  5. Medications
    1. Pressor use
    2. Digitalis

V. Symptoms

  1. Gradual onset of symptoms over days in Nonocclusive Mesenteric Ischemia
    1. Contrast with sudden symptom onset of acute mesenteric Occlusion
  2. Abdominal Pain is absent in 25% of cases

VI. Signs

  1. Bleeding per Rectum is common (occult or grossly bloody stools)

VII. Imaging

  1. Abdominal Xray
    1. Early: Mild bowel dilation
    2. Late: Thumb printing, pneumatosis, portal venous gas
  2. Abdominal CT or Abdominal MRI
    1. Bowel ischemia may be present
  3. Colonoscopy with biopsy (gold standard)
  4. Angiography
    1. May show arterial narrowing

VIII. Management

  1. Papaverine infusion
  2. Consider Antiplatelet Therapy
  3. Surgery is only indicated if peritoneal signs are present

IX. Prognosis: Outcomes

  1. Reversible ischemia in 44% of cases
  2. Persistent colitis in 19% of cases
  3. Ischemic stricture in 13% of cases
  4. Perforation or gangrene in 19% of cases

X. References

  1. Fraboni (2012) Board Review Express, San Jose

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Ontology: Non-occlusive mesenteric ischemia (C0341422)

Concepts Disease or Syndrome (T047)
SnomedCT 235843005
English Non-occl mesenteric ischaemia, Non-occl mesenteric ischemia, NOMI - Non-occl mesent ischaem, Non-occlusive mesenteric ischaemia, Non-occlusive mesenteric ischemia, NOMI - Non-occlusive mesenteric ischaemia, NOMI - Non-occlusive mesenteric ischemia, Non-occlusive mesenteric ischemia (disorder)
Spanish isquemia mesentérica no oclusiva (trastorno), isquemia mesentérica no oclusiva