This document discusses acute mesenteric ischemia (AMI), a rare but life-threatening condition caused by sudden interruption of blood supply to the intestine. It can be caused by arterial embolism, thrombosis, or venous thrombosis. Clinical features include severe abdominal pain, nausea, vomiting, and bloody stools. Early diagnosis via CT angiography and prompt resuscitation, antibiotics, anticoagulation, and surgery are important, as delayed treatment can lead to bowel necrosis and death. Surgical management focuses on reestablishing blood flow and resecting non-viable bowel. Outcomes depend on how quickly treatment is initiated.

1. Dr.Asif Mian Ansari
DNB resident
Dept. of General Surgery
Max hospital, Mohali

2.  Sudden interruption of blood supply to segment of intestine
 Rare (0.09-0.2%) but life threatening (50-80% mortality)
Bowel ischemia
Cellular
damage
Bowel
necrosis

3. AMI
Occlusive
Embolism
(AMAE-50%)
Thrombosis
(AMAT-15-25%)
Venous thrombosis
(MVT-5-15%)
Non-occlusive

7. ACUTE MESENTRIC ARTERIAL EMBOLISM
Sources of embolism:
Left atrium-cardiac arrythmia
Left ventricle-global myocardial dysfunction
with poor EF
Endocarditis
Rarely-atherosclerotic aorta
3-10 cm distal to origin of SMA-sparing proximal jejunum
& colon

8. ACUTE MESENTRIC ARTERIALTHROMBOSIS
•Pre existing chronic atherosclerosis
•H/O post prandial abdominal pain, weight loss, food fear
•SMA thrombosis
•Takes time to progress critical obstruction
• Associated with collaterals – symptomatic when
accompanies with celiac occlusion

9. MESENTRIC VENOUSTHROMBOSIS
< 1% cases of MI
FollowsVirchow’sTriad 80%
20% ideopathic
portal HTN, Pancreatitis, IBD, sepsis & trauma

11.  Severe pain abdomen – 95%
 Nausea –44%
 Vomiting – 35%
 Diarrhoea – 35%
 Bleeding per rectum – 16%
 Triad of pain + fever + blood in stools – 1/3rd patients
 Signs of peritonitis – irreversible bowel ischemia with necrosis
 Delayed presentation – septic shock

12.  Risk factors may be found on evaluation

13.  High index of suspicion in cases with clinical features with
 Abnormally highTLC
 Metabolic acidosis
 Elevated lactates >2 mmol/L
 These cases should undergo early CT angiography
 D-Dimer: >0.9 mg/L, reflecting ongoing clot formation &
fibrinolysis

14.  Should be done in any suspected case as soon as possible

16.  Irreversible bowel ischemia:
 Dilated bowel
 Pneumatosis intestinalis
 Portal venous gas
 Free intraperitoneal gas

17.  At the time of diagnosis:
 Fluid and electrolyte resuscitation
 Naso-gastric suction
 Broad spectrum antibiotics
 Heparin therapy
 Vasopressors: used with caution, dobutamine, low dose dopamine
and milrinone cause less impact on mesenteric blood flow
 Continued monitoring of lactates
 Prompt laparotomy in unstable, perforation peritonitis cases

18.  Goal of surgery:
 Re-establishment blood supply to the ischemic bowel.
 Resection of all non-viable regions.
 Preservation of all viable bowel.
 Damage control surgery:
 choice in case of critical ill with AMI
 Planned 2nd look laparotomy after resuscitation in ICU
 Examination of stapled bowel

19.  AMAE – Embolectomy & primary/patch angioplasty
 AMAT– Bipass procedure
 NOMI – treatment of underlying condition
 MVT – continued heparin therapy

20.  Jatinder Kumar Gosain 67/male
 Admitted on 21st sept 2017
 Acute mesenteric venous thrombosis with ischemia

21.  Post operatively, patient developed septic shock and MODS
 Died on oct 2nd, 11:05 AM

22.  Darshan singh 65/male
 15 days history
 Admitted on 20th oct, 2017 and discharged on 2nd Nov 2017

24.  Severe abdominal pain out of proportion to physical findings
is assumed to be AMI
 Early CT angiography
 Prompt resuscitation, antibiotics & anticoagulation
 Inotropes must be used with caution
 MVT – anticoagulation is mainstay of treatment