Ischemic Enteritis/Colitis

Small intestine hypoperfusion/cessation of arterial inflow results in acute mesenteric ischemia and is due to embolic obstruction of the superior mesenteric artery or acute thrombotic obstruction (usually of an already diseased mesenteric vessel). Morbidity and mortality of this condition are high. Treatment involves conservative measures (oxygen, anticoagulation, i.v. fluids) as well as surgical (bowel resection, embolectomy, bypass) and endovascular (embolectomy, balloon dilatation, stent) intervention. Not all patients require surgery, but peritonitis or full-thickness necrosis mandates surgery in good-risk candidates. In poor-risk patients, palliation may be justified. Ischemic colitis is the most common form of gastrointestinal ischemia, and more than 40 cases per 100,000 population are observed annually. The pathophysiology of this condition is poorly understood, and the presenting clinical signs are non-specific. Symptomatic treatment requires hospital admission, with surgery only for perforation as an early complication or stricture as a late complication. Chronic mesenteric ischemia usually results from atherosclerotic narrowing of the celiac or superior mesenteric arteries.