MESENTERIC ISCHEMIA SURGERY
Mesenteric ischemia is a relatively rare disorder seen in the emergency department (ED); however, it is an important diagnosis to make because of its high mortality rate. Vague and nonspecific clinical findings and limitations of diagnostic studies make the diagnosis a significant challenge. Moreover, delays in diagnosis lead to increased mortality rates. Despite recent advances in diagnosis and treatment, mortality rates continue to remain high.
SYMPTOMS AND SIGNS SURGERY IN INDIA
The early hallmark of mesenteric ischemia is severe pain but minimal physical findings. The abdomen remains soft, with little or no tenderness. Mild tachycardia may be present. Later, as necrosis develops, signs of peritonitis appear, with marked abdominal tenderness, guarding, rigidity, and no bowel sounds. The stool may be heme-positive (increasingly likely as ischemia progresses). The usual signs of shock develop and are frequently followed by death.
Sudden onset of pain suggests but is not diagnostic of an arterial embolism, whereas a more gradual onset is typical of venous thrombosis. Patients with a history of postprandial abdominal discomfort (which suggests intestinal angina) may have arterial thrombosis.
Diagnosis
- Clinical diagnosis more important than diagnostic tests
- Mesenteric angiography if diagnosis unclear
Early diagnosis is particularly important because mortality increases significantly once intestinal infarction has occurred. Mesenteric ischemia must be considered in any patient > 50 with known risk factors or predisposing conditions who develops sudden, severe abdominal pain.
What causes mesenteric ischemia?
Atherosclerosis, which slows the amount of blood flowing through your arteries, is a frequent cause of chronic mesenteric ischemia. Your arteries are normally smooth and unobstructed on the inside, but as you age, a sticky substance called plaque forms in the walls of your arteries. Plaque is made of fats and other materials circulating in your blood. As more plaque builds up, your arteries can narrow and stiffen. Eventually, enough plaque builds up to reduce blood flow through your arteries.
A clot, called an embolus, which travels to one of the mesenteric arteries and suddenly blocks the blood flow, is a common cause for acute mesenteric ischemia. These clots often originate in the heart and are more common among patients with an irregular heartbeat or heart disease.
What tests will I need?
Your physician may perform several tests to rule out other conditions with similar symptoms. First your physician will ask you questions about your general health, medical history, and symptoms. In addition, your physician will conduct a physical examination. Together these are known as a patient history and exam. As part of your history and exam, your physician will ask you if you smoke or have high blood pressure. Your physician will also want to know when and how often your symptoms occur as well as how long you have been experiencing them.
Treatment in india
Acute mesenteric artery ischemia is an emergency. Surgery is usually performed to remove the clot. In some cases, the surgeon must also create a bypass around the blockage.
Surgery for chronic mesenteric artery ischemia involves removing the blockage and reconnecting the arteries to the aorta. A bypass around the blockage is another procedure. It is usually done with a plastic tube graft.
An alternative to surgery is a stent. It may be inserted to enlarge the blockage of the mesenteric artery or deliver medicine directly to the affected area. This is a new technique and should only be done by experienced health care providers.
List of other Mesenteric ischemia treatment
Stent Surgery
Arterial Bypass Surgery
