Ischemic Bowel Disease Path 18

Intestinal Obstruction Hernias (worldwide) mostly inguinal hernias (narrow orifices and large sacs) Adhesions (USA) fibrous bridges that can create closed loops where other viscera may slide and get trapped Intussusception (under 2 years old) when a segment of the intestine, constricted by a wave of peristalsis, telescopes into the immediately distal segment and is then pulled along via peristalsis generally caused by a mass (that serves as the initiating point of traction) Volvulus (sigmoid colon) Twisting of a loop of bowel results in both luminal and vascular compromise presents with features of both obstruction and infarction

Ischemic Bowel Disease Mucosal infarction muscularis mucosae Mural infarction mucosa and submucosa Transmural infarction all three wall layers caused by acute vascular obstruction necrosis of the muscularis propria in 1 to 4 days (perforation may occur) Watershed zones are particularly susceptible to ischemia splenic flexure sigmoid colon and rectum Infarcted bowel is initially congested and dusky to purple-red Lesions are segmental and patchy Mucosa is hemorrhagic / ulcerated Bowel wall is thickened by edema Serositis (inflammation) is also seen

Ischemic Bowel Disease Acute colonic ischemia left lower abdominal pain sudden cramping a desire to defecate bloody diarrhea Women over 70 Severe cases = shock within hours Surgury if peristaltic sounds diminish or disappear (or signs of necrosis) Prognosis Mortality is doubled in patients with right sided colonic disease Right side of the colon is supplied by the SMA, which also supplies most of small intestine (COPD) or symptoms for over 2 weeks is also bad Most fully recover without future episodes