The spectrum of Gl ischemia 2

Published on February 27, 2022   31 min

A selection of talks on Gastroenterology & Nephrology

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In the first part of my talk, I discussed colon ischemia and now in the second part of my talk, I'm going to discuss a variety of topics including acute mesenteric ischemia, focal segmental ischemia, mesenteric arterial occlusive disease, mesenteric venous thrombosis, and chronic mesenteric ischemia or intestinal angina.
I'm now going to talk about acute mesenteric ischemia, which also is a spectrum of disease. Most common is what used to be called superior mesenteric arterial thrombus. It is now called, more accurately, mesenteric arterial occlusive disease. The next most common is a superior mesenteric artery embolus. Next most common is non-exclusive mesenteric ischemia. Now this may be a term unfamiliar to some of you. How can you have ischemic disease and have non-occluded vessels? Well, this is a very old term dating back to the 1920s and 30s, where a patient would die, would have an autopsy, would have gangrenous bowel, and when the blood vessels were opened, there was no inclusion. The blood vessels were relatively normal and it was, therefore, called non-inclusive mesenteric ischemia. What this was, was a blood vessel spasm, and with death, the spasm resolved and the vessels normalized. I'll show you an example of this. Superior mesenteric venous thrombosis accounts for 5 - 10 percent of patients with acute mesenteric ischemia and focal segmental ischemia, probably another 5 percent.