1. Ischemic Bowel Disease
Path 18

2. 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

3. 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

4. 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