Small Bowel Ischemia

Small bowel ischemia is a relatively uncommon disorder requiring prompt recognition and aggressive management if significant morbidity and mortality are to be averted. The pathophysiology of the ischemic event usually will determine the management approach used. Factors to be considered include whether the ischemia is the consequence of arterial or venous occlusive disease; the cause and nature of the ischemia (ie, a consequence of arterial spasm, inflammation, complete or incomplete occlusion); whether the occlusion is the result of an embolus or thrombosis; the preexistence and degree of development of arterial collateral channels; and the existence and extent of comorbid conditions. Established and experimental therapeutic interventions have varied in efficacy and include 1) correction of physiologic alterations predisposing to the ischemic event, 2) angiography with arterial infusion of vasodilators; 3) embolectomy or thrombectomy, and resection of necrotic bowel; 4) anticoagulation (veno-occlusive disease); and 5) selective application of thrombolytic agents. The overall success of any therapeutic intervention depends upon the early recognition and management of ischemia, as the incidence of morbidity and mortality rises after infarction occurs.