The acute abdomen. Part II: Acute abdomen arising from vascular disorders in the elderly

The frequency of the "acute abdomen" has increased with the ageing of the population. In this chapter, we have examined syndromes of primary vascular origin, caused by vascular dysfunction, such as alterations in the vascular walls or haemodynamic disorders. We have left aside secondary vascular problems such as strangulation, obstruction or compression of vessels by tumours, which are easier to treat and diagnose and have a better prognosis. The symptoms of acute ischaemia caused by intrinsic vascular deficiency are not specific and clinical tests are untrustworthy. Despite progress in our knowledge of splanchnic haemodynamics, in radiology, vascular surgery and endoscopy, the prognosis remains poor. In view of the cataclysmic nature of the haemorrhage or the damage to the intestinal walls which evolves swiftly towards gangrenous necrosis, very rapid diagnosis of any of these various syndromes is essential if the patient is to be saved.