Embolic from Afib or MI; thrombosis from atherosclerosis, low flow hypotensive states, rarely birth control pills (Nejm 1968;279:1213)

Sx:

Acute: sudden onset, pain disproportionate to physical findings

Chronic: h/o weight loss, pc abdominal pain for days to weeks; pain, often radiating to back; abdominal distention within 24 h

Si:Decreased bowel tones; stool guaiac-positive

In acute ischemia, w/o surgery, nearly all die (Nejm 1969;281:309); some survive with surgery, esp those embolic in origin

r/o mesenteric venous thrombosis(Nejm 2001;345:1683) w abdominal pain and pos guaiac (50%), then bowel infarction; dx w abdom CT (90% sens); rx w anticoagulation and surgery if clinically forced

Lab:

Hem:Elevated wbc

Paracentesis:Rbc's, wbc's; and bacteria late in course

Xray:Mesenteric arteriogram

Rx:

of acute syndrome: endarterectomy and limited bowel resection, angioplasty.

of abdominal angina, frequent small feedings; surgery, preferably in anginal stage before infarction