The spectrum of mesenteric infarction

Abstract

Over the last ten years, 140 cases of mesenteric infarction were treated at the King County Hospital. In half of these cases no anatomic vascular obstruction was demonstrated. In the other half, atheroma, thrombus, or embolus obstructed a major mesenteric artery. In only a few cases could infarction be attributed to isolated venous thrombosis. A comparison of the clinical and autopsy data revealed only a few significant differences between those patients with functional and those with anatomic obstructions. Of possible importance was the finding that significantly more of the patients with functional obstruction were taking digitalis. Over 90 per cent of the patients in both groups had significant cardiac disease and many had congestive failure. It is very likely that low cardiac output is one of the most important etiologic factors in both groups. Splanchnic vasoconstriction in response to low cardiac output further diminishes mesenteric flow. Intimal proliferation of the vasa recta may have been present in some of those who were assumed to have no anatomic obstruction. Mesenteric ischemia should be suspected in all elderly cardiac patients with unexplained gastrointestinal symptoms. Improved medical management may prevent some cases of infarction. Mesenteric arteriography will reveal atherosclerotic lesions in certain cases and infarction may be prevented in some of these by endarterectomy or bypass procedures. When pain becomes constant and progressively intense, prompt celiotomy is recommended. All questionably involved bowel must be resected and every effort made to improve blood flow to the remaining areas.