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[Nonobstructive mesenteric ischemia--a diagnostic problem in internal intensive care]

W Scheppach1, H Langenfeld, G Schultz

  • 1Medizinische Klinik, Universität Würzburg.

Zeitschrift Fur Gastroenterologie
|April 1, 1995
PubMed
Summary

Non-occlusive disease (NOD) can cause acute gut ischemia and bowel necrosis in elderly patients, often masked by other conditions. Early surgical intervention is crucial, even if angiography shows no major vessel occlusion.

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Area of Science:

  • Gastroenterology
  • Vascular Surgery
  • Geriatric Medicine

Background:

  • Acute gut ischemia is a critical condition often caused by arterial occlusion.
  • Non-occlusive disease (NOD) presents a diagnostic challenge, particularly in elderly patients with comorbidities.

Observation:

  • This study presents four cases of acute gut ischemia in elderly patients attributed to NOD.
  • Patients experienced bowel necrosis following hypotensive episodes linked to myocardial infarction, arrhythmias, or sepsis.
  • Clinical presentation was often obscured by underlying systemic illnesses.

Findings:

  • Angiography revealed atherosclerosis but not major celiac or mesenteric vessel occlusion in these cases.
  • Laparotomy or autopsy confirmed extensive small and large bowel necrosis.

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  • NOD should be suspected in elderly patients with acute abdominal symptoms and hypotension, even with normal angiography.

    • Implications:

    • Early surgical exploration, potentially via laparoscopy, is recommended for suspected acute gut ischemia due to NOD.
    • Timely intervention can improve outcomes in this high-risk patient population.
    • This highlights the importance of considering non-occlusive causes of mesenteric ischemia.