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Periumbilical pain out of proportion to tenderness; nausea, vomiting, distention, GI bleeding, altered bowel habits. Abdominal x-ray shows bowel distention, air-fluid levels, thumbprinting (submucosal edema), but may be normal early in course. Peritoneal signs indicate infarcted bowel requiring surgical resection. Early celiac and mesenteric arteriography is recommended in all cases following hemodynamic resuscitation (avoid vasopressors, digitalis). Intra-arterial vasodilators (e.g., papaverine) can be administered to reverse vasoconstriction. Laparotomy indicated to restore intestinal blood flow obstructed by embolus or thrombosis or to resect necrotic bowel. Postoperative anticoagulation indicated in mesenteric venous thrombosis, controversial in arterial occlusion.

Outline

Section 11. Gastroenterology