Chapter: Intestinal Ischemia
McMaster Section Editor(s): Peter Lovrics
Section Editor(s) in Interna Szczeklika: Witold Bartnik†, Władysław Januszewicz
McMaster Author(s): Hyea Min Yoon, Cagla Eskicioglu
How to Cite This Chapter: Yoon HM, Eskicioglu C. Intestinal Ischemia. McMaster Textbook of Internal Medicine. Kraków: Medycyna Praktyczna. https://empendium.com/mcmtextbook/chapter/B31.II.4.19 Accessed December 06, 2019.
Last Updated: January 7, 2017
Last Reviewed: June 10, 2019
Main Documents Taken Into Account:
Tilsed JV, Casamassima A, Kurihara H, et al. ESTES guidelines: acute mesenteric ischaemia.
Eur J Trauma Emerg Surg. 2016 Apr;42(2):253-70. doi: 10.1007/s00068-016-0634-0. PubMed PMID: 26820988; PubMed Central PMCID: PMC4830881.
Clair DG, Beach JM. Mesenteric Ischemia.
N Engl J Med. 2016 Mar 10;374(10):959-68. doi: 10.1056/NEJMra1503884. Review. PubMed PMID: 26962730.
Brandt LJ, Feuerstadt P, Longstreth GF, Boley SJ; American College of Gastroenterology. ACG clinical guideline: epidemiology, risk factors, patterns of presentation, diagnosis, and management of colon ischemia (CI).
Am J Gastroenterol. 2015 Jan;110(1):18-44; quiz 45. doi: 10.1038/ajg.2014.395. Epub 2014 Dec 23. PubMed PMID: 25559486.
Definition and EtiologyTop
Intestinal ischemia refers to reversible and irreversible bowel injury that results from a decrease in blood flow to the small or large intestine. Any process that reduces intestinal blood flow, with or without subsequent reperfusion injury, can cause intestinal ischemia. Causes may be occlusive (arterial embolism, arterial thrombosis, or venous thrombosis) or nonocclusive (eg, due to shock or vasospasm). Intestinal ischemia varies widely in presentation and outcome depending on the time course of disease, degree of blood flow compromise, presence of collateralization, and segment of the bowel affected. Serious consequences such as bowel infarction, perforation, sepsis, and death can occur.
There is variation in terminology in the literature that can cause confusion. Mesenteric ischemia refers to small bowel ischemia. Ischemic colitis and colonic ischemia refer to large bowel ischemia representing variable clinical presentations across the spectrum of severity of the disease. The terms intestinal ischemia and ischemic bowel can apply to either the small or large bowel.