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General Reference

Bmj 2003;326:1372

Pathophys and Cause

Cause:Atherosclerotic disease w low-flow states; embolic

Pathophys:Typically, low-flow state; acutely partial or full inferior mesenteric artery occlusion

Signs and Symptoms

Sx:Crampy and often bloody diarrhea

Si:Guaiac-positive stool

Course

After initial acute illness, gradual scarring with lumen narrowing, which gradually normalizes, some progress to chronicity due to microscopic damage to vessels

Complications

Strictures sometimes, although most heal

Lab and Xray

Lab: Noninv:Endoscopy w bx quite specif

Xray:Abdominal xray typically nonspecific, segmental dilation, pneumatosis. CT preferred; shows thromboembolism of mesenteric vessels, intramural or portal venous gas, segmental thickening of the bowel wall, absence of bowel wall enhancement with contrast-enhanced CT, mucosal edema (thumbprinting), possibly bowel dilatation proximal to the ischemic segment of the bowel

Treatment

Rx:Surgery usually not necessary; watch for stricture later