mid-gut ischaemia
نویسنده
چکیده
Acute mesenteric vascular occlusion continues to carry an unacceptably high mortality (Mavor et al., 1962; Aakhus and Brabrand, 1967; Marston, 1971; Wittenberg, et al., 1973; Boley et al., 1973; Singh et al., 1975), this being largely because of the diagnostic problem it presents (Recek et al., 1968; Mavor et al., 1972). Clinical diagnostic pointers are well known (Marston, 1971; Mavor, 1972) but are non-specific. These include severe epigastric or periumbilical pain which may be constant or, less often, colicky in nature, and vomiting or diarrhoea, the latter unassociated with blood in the early stages. Perhaps most significant is the paucity of abdominal signs in contrast to the severity of symptoms in a patient who can be effectively treated. Circulatory failure, peritonism, leucocytosis, and acidosis (Marston, 1971; Williams, 1971; Jamieson et al., 1975) identify the patients with advanced irreversible ischaemia. Three pathological types of acute arterial insufficiency are recognised-namely, acute embolism, acute thrombosis, and non-occlusive ischaemia. Acute embolism occurs in association with cardiovascular disease elsewhere; the embolus is usually lodged at or beyond the origin of the middle colic branch. The proximal artery is regular, the contrast cut-off distinct, and collaterals are absent. Acute thrombosis is more frequently the end stage of origin stenosis (Mavor, 1959) and prodromal symptoms are frequent. The severity of the final insult will relate to the imbalance between rapidity of occlusion to the development of adequate collaterals. Usually, even in acute decompensation some evidence of a collateral round the head of the pancreas may be discerned, and there may be extensive visceral and limb atherosclerosis in
منابع مشابه
Selective angiography in acute mid-gut ischaemia.
Acute mesenteric ischaemia has a high mortality. Early diagnosis and treatment appropriate to the type and extent of vascular insufficiency are essential. Selective angiography can establish the diagnosis and distinguish patients with acute vascular occlusion who require urgent surgery from those with non-occlusive ischaemia for which early surgery is contraindicated.
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