II. Epidemiology
- Accounts for 20-30% of Acute Mesenteric Ischemia
- Age: 70 years is mean age
III. Pathophysiology
- Decreased perfusion to splenic flexure and distal sigmoid colon (watershed areas)
- Results from hypoperfusion or shock state
- Low Cardiac Output (shock)
- Mesenteric arterial Vasoconstriction (severe and prolonged)
IV. Causes
- Septic Shock
- Myocardial Infarction or Myocardial Ischemia
- Congestive Heart Failure exacerbation
- Hypovolemia
- Vascular compression from intraabdominal compression
-
Bowel Obstruction with Strangulation
- Internal Hernia or closed loop obstruction
- Volvulus
V. Risk Factors
- Hospitalized patients
- Post-Surgical status
- Hemodialysis
- Medications
VI. Symptoms
- Gradual onset of symptoms over days in Nonocclusive Mesenteric Ischemia
- Contrast with sudden symptom onset of acute mesenteric Occlusion
- Abdominal Pain is absent in 25% of cases
VII. Signs
- Bleeding per Rectum is common (occult or grossly bloody stools)
VIII. Imaging
-
Abdominal CT or Abdominal MRI
- Bowel ischemia may be present
- Colonoscopy with biopsy (gold standard)
- Angiography
- May show arterial narrowing
- Abdominal Xray
- Listed for historical reasons only (all other advanced imaging is preferred)
- Early: Mild bowel dilation
- Late: Thumb printing, pneumatosis, portal venous gas
IX. Management
- Targeted Papaverine infusion via angiography
- Risk of Hypotension if catheter migrates into aorta
- Consider Antiplatelet Therapy
- Surgery is only indicated if peritoneal signs are present
X. Prognosis: Outcomes
- Reversible ischemia in 44% of cases
- Persistent colitis in 19% of cases
- Ischemic stricture in 13% of cases
- Perforation or gangrene in 19% of cases
XI. References
- Fraboni (2012) Board Review Express, San Jose
- Mastoraki (2021) World J Gastrointest Pathophysiol 7(1): 125-30 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| 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 |
