Vascular Disease of the Small Intestine

Ischemic injury to the small intestine occurs due to obstruction to the superior mesenteric arterial supply by embolization of clot or local thrombosis of the vessels. It can also occur as a result of diminished blood supply to the small intestine due to conditions such as systemic hypotension or hyperviscosity states. Occlusion of the superior mesenteric artery results in ischemia or infarction of nearly all the small intestine and the right half of the colon. It may present acutely with sudden severe abdominal pain and shock consequent on the infarction with or without perforation of the affected intestine. In these circumstances, emergency surgery to remove the large segment of affected intestine is life-saving but may leave the patient dependent on long-term intravenous feeding (parenteral nutrition). Ischemia may present more chronically with poorly localized abdominal pain, typically occurring 30-60 minutes after food intake. This leads to food avoidance and weight loss. The intestinal mucosa can become ulcerated. The diagnosis depends on mesenteric angiography.

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