Blackwell Science, LtdOxford, UKJGHJournal of Gastroenterology and ... Department of Gastroenterology, The Queen Elizabeth Hospital, Woodville South, ...
Blackwell Science, LtdOxford, UKJGHJournal of Gastroenterology and Hepatology0815-93192005 Blackwell Publishing Asia Pty LtdSeptember 200520914571457Images of InterestGastrointestinalGastrointestinal
Journal of Gastroenterology and Hepatology (2005) 20, 1457
DOI: 10.1111/j.1440-1746.2005.04077.x
IMAGES OF INTEREST
Gastrointestinal: Acute mesenteric ischemia The first description of acute mesenteric ischemia has been attributed to Dr R Virchow in 1852. The most common cause is impaction of an embolus close to the origin of the superior mesenteric artery. This occurs in approximately 40–50% of patients. Other causes include the development of a thrombus on an atheromatous plaque in the superior mesenteric artery, non-occlusive mesenteric ischemia (largely associated with hypotension) and mesenteric venous thrombosis. Almost all patients with acute mesenteric ischemia have abdominal pain and some have additional symptoms such as nausea, vomiting, abdominal distension and gastrointestinal bleeding. Initially, abnormalities on physical examination are relatively minor but signs of peritonitis eventually develop in those with intestinal infarction. In patients with suspected acute mesenteric ischemia, investigations can include plain abdominal radiographs, computed tomography (CT) scans, selective mesenteric angiograms and laparotomy. The images illustrated below were from a 66-year-old man who was admitted to hospital with abdominal pain. He had hypertension and had been previously treated for peripheral vascular disease. Abnormal physical findings included lower abdominal guarding, tenderness, rebound tenderness and diminished bowel sounds. His white cell count was elevated and an abdominal radiograph showed dilated loops of small bowel with air-fluid levels. An enhanced abdominal CT scan showed mild dilatation of loops of small bowel, thickening of the small bowel wall (edema), and gas in the small bowel wall and in the mesentery (Fig. 1). In the liver, gas was noted throughout the portal venous system including the hepatic venous radicals (Fig. 2). The presence of gas in the bowel wall, mesentery and mesenteric vessels (pneumatosis) is a late sign of ischemic injury and indicates bowel infarction and necrosis. In large series, patients with occlusive mesenteric infarction have a high mortality (80–90%) but this is lower (10%) when infarction results from non-occlusive mesenteric ischemia. Contributed by FM Gonzalez Valverde, F Menarguez Pina, M Molto Aguado, MJ Gomez Ramos, F Mauri Barbera, NM Torregrosa and JL Vazquez Rojas Department of Surgery and Intensive Care Unit, Hospital General De La Vega Baja, Servicio De Cirugia GeneralY Del Aparato Digestivo, Ctra. Orihuela-Almoradi s/n, Alicante, Spain.
Figure 1
Figure 2
Contributions to the Images of Interest Section are welcomed and should be submitted to Professor IC Roberts-Thomson, Department of Gastroenterology, The Queen Elizabeth Hospital, Woodville South, South Australia 5011, Australia. © 2005 Blackwell Publishing Asia Pty Ltd
