Check-up

ACUTE MESENTERIC ISCHAEMIA:What is mesenteric ischaemia? My brother-in-law was rushed into hospital with it and was brought to surgery within an hour of arriving at the emergency department.

Acute mesenteric ischemia is sudden blockage of blood flow to part of the intestines. The blockage can lead to gangrene and perforation of the bowel. The condition can be caused by an arterial embolism (a blood clot or piece of plaque can travel from the heart or aorta to lodge in the smaller arteries of the intestines). Or a blood clot may form spontaneously in the arteries or veins of the intestines, blocking flow. It can sometimes occur where there is a substantial reduction in blood flow to the intestine due to low heart output (in heart failure or shock) or because certain drugs (such as cocaine) narrow the blood vessels.

Blockage of blood flow to the intestine for a prolonged period can cause the affected intestine to die. This can result in widespread bacterial infection. Without immediate treatment, shock and organ failure can occur. The condition can be fatal.

His symptoms came on so fast. One minute he was at home, the next he was having surgery.

Symptoms can include vomiting, diarrhoea and sudden onset of severe abdominal pain, with only slight abdominal tenderness. The difference between the level of pain and the degree of tenderness is an important clue in the diagnosis of the condition. When the blood flow has been

severely reduced or completely blocked for some time, the intestine starts to die. At this point the abdomen becomes tender to the touch.

Why the rush to get him to surgery?

Early diagnosis is essential as prompt treatment usually results in a full recovery.

Where diagnosis and/or treatment are delayed it can prove fatal. Where symptoms are suggestive of acute ischemia, an angiography may be performed to confirm the diagnosis.

A small catheter is threaded through the artery in the groin and into the arteries of the intestines.

A contrast agent is injected into the catheter to locate the blood vessels affected. If a blockage is located, drugs or a stent may be used to open it. Where this is not possible, surgery will be required.

During surgery, the blood vessel blockage can sometimes be removed or bypassed – if not, the section of affected intestine will be removed. Following surgical intervention, medications may be prescribed to prevent further blood clots forming.