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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Feham Tariq, MD [2]


Overview

Mesenteric ischemia is a type of intestinal ischemia primarily affecting the small intestine. It is one of the life-threatening gastrointestinal vascular emergencies which requires prompt surgical/medical intervention depending upon the underlying cause.

Common causes in the development of mesenteric ischemia can be divided into occlusive/non-occlusive, arterial or venous, localized/generalized and superficial or transmural.[1]

Risk Factors

  • Mesenteric ischemia can be caused by any factor that can compromise the blood supply to the affected organ; either by reducing the perfusion( low blood pressure or vasoconstriction) or by promoting the formation of thromboemboli(blood clots). It can be broadly classified as modifiable and non-modifiable.

Common Risk Factors

Risk factors
Occlusive Embolic Atrial fibrillation
Cardiac arrhythmia
Valvular heart disease
Infective endocarditis
Recent myocardial infarction
Ventricular aneurysm
Aortic atherosclerosis
Aortic aneurysm
Thrombotic Advanced age
Low cardiac output states
Peripheral arterial disease
Traumatic injury
Inherited thrombophilia-
Acquired thrombophilia- malignancy, oral contraceptives intake.
Non-occlusive Heart failure
Aortic insufficiency
Septic shock
Vasoconstrictive drugs:
Cocaine abuse or ergot poisoning
Hemodialysis
  • Common risk factors in the development of mesenteric ischemia include:
    • Non-modifiable causes**
      • Age >60 years
      • High cholesterol levels
      • History of smoking
    • Occlusive causes
      • Embolic causes:[2]
      • Atrial fibrillation
      • Cardiac arrhythmias
      • Valvular heart diseases
      • Infective endocarditis
      • Recent myocardial infarction
      • Ventricular aneurysm
      • Aortic atherosclerosis
      • Aortic aneurysm
    • Thrombotic causes:[3]
      • Advanced age
      • Low cardiac output states
      • Traumatic injury
      • Peripheral artery disease
  • Non-occlusive causes:[4]
    • Heart failure
    • Aortic insufficiency
    • Septic shock
    • Vasoconstrictive drugs(e.g. Digoxin, alpha-adrenergic agonists)
    • Cocaine abuse/ergot poisoning
    • Hemodialysis

Less Common Risk Factors

  • Less common risk factors in the development of [disease name] include:
    • [Risk factor 1]
    • [Risk factor 2]
    • [Risk factor 3]

References

  1. Corcos O, Nuzzo A (2013). "Gastro-intestinal vascular emergencies". Best Pract Res Clin Gastroenterol. 27 (5): 709–25. doi:10.1016/j.bpg.2013.08.006. PMID 24160929.
  2. Fitzgerald T, Kim D, Karakozis S, Alam H, Provido H, Kirkpatrick J (2000). "Visceral ischemia after cardiopulmonary bypass". Am Surg. 66 (7): 623–6. PMID 10917470.
  3. Martinelli I, Mannucci PM, De Stefano V, Taioli E, Rossi V, Crosti F; et al. (1998). "Different risks of thrombosis in four coagulation defects associated with inherited thrombophilia: a study of 150 families". Blood. 92 (7): 2353–8. PMID 9746774.
  4. Acosta S, Ogren M, Sternby NH, Bergqvist D, Björck M (2006). "Fatal nonocclusive mesenteric ischaemia: population-based incidence and risk factors". J Intern Med. 259 (3): 305–13. doi:10.1111/j.1365-2796.2006.01613.x. PMID 16476108.

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References