Intestinal infarction usually affects elderly individuals, with an average age of occurrence in the 6th-7th decade of life. Although symptomatology directs the physician towards a severe pathology, the symptoms elicited are not specific for intestinal infarction.

The predominant and profound symptom reported by the vast majority of the patients (94%) is that of intense and constant abdominal pain disproportionate in severity in comparison to the objective findings on a physical exam [1]. Additional symptoms that complete the clinical picture also include nausea, episodes of diarrhea, tachycardia, and vomiting. In a more advanced stage, the ischemic occurrence leads to necrosis of the intestine, sepsis, and peritonitis; symptoms also include hypotension, a distended, painful abdomen, rigidity and guarding [2] [3] [4] [5]. Progression of the ischemia is transmural [6].

• Fever

  A patient with paroxysmal nocturnal hemoglobinuria of 14 years duration presented with severe abdominal pain and fever. [ncbi.nlm.nih.gov]

  Symptoms of intestinal infarction are abdominal pain, fever, nausea, and vomiting. [sweeneylawfirm.com]

  Severe systemic illness with fever and sepsis (spread of infection to the blood stream) can result. Calling your health care provider Call your health care provider if you have any severe abdominal pain. [webmd.com]

  Some people may become severely ill with fever and a bloodstream infection (sepsis). Call your health care provider if you have any severe abdominal pain. [medlineplus.gov]

  Other symptoms include: Diarrhea Fever Vomiting Laboratory tests may show a high white blood cell (WBC) count (a marker of infection) and increased acid in the bloodstream. [lutheranhealthcare.org]

• Exertional Dyspnea

  Case report This is a case of a 62-year-old woman, with a few weeks history of fatigue, body ache, and exertional dyspnea. She denied fever or bleeding tendencies. [jahjournal.org]

• Abdominal Pain

  A patient with paroxysmal nocturnal hemoglobinuria of 14 years duration presented with severe abdominal pain and fever. [ncbi.nlm.nih.gov]

• Vomiting

  Additional symptoms that complete the clinical picture also include nausea, episodes of diarrhea, tachycardia, and vomiting. [symptoma.com]

  A 40-year-old HIV-infected woman developed nausea, vomiting, and epigastric pain and died following her third dose (per study protocol) of interleukin (IL)-2. Her HIV infection was diagnosed in 1996. [ncbi.nlm.nih.gov]

  Symptoms of intestinal infarction are abdominal pain, fever, nausea, and vomiting. [sweeneylawfirm.com]

  The outstanding clinical data were as follows: diarrhea followed by intestinal obstruction, fecaloid vomiting, bloody stools, consumption coagulopathy manifested by gastrointestinal hemorrhages, ecchymoses, petechiae, and skin necrosis. [jamanetwork.com]

  Vomiting, diarrhea, and in some cases, fever, are also seen. Signs and tests Laboratory tests may show an elevated white blood cell (WBC) count (a marker of infection) and increased acid in the bloodstream. [webmd.com]

• Severe Abdominal Pain

  A patient with paroxysmal nocturnal hemoglobinuria of 14 years duration presented with severe abdominal pain and fever. [ncbi.nlm.nih.gov]

  Calling your health care provider Call your health care provider if you have any severe abdominal pain. Prevention Eating a nutritious diet and avoiding smoking can help prevent this disease. [webmd.com]

  Call your health care provider if you have any severe abdominal pain. [medlineplus.gov]

  Call your health care provider if you have any severe abdominal pain. Intestinal infarction may require a colostomy or ileostomy, either temporary or permanent. Peritonitis is common in such cases. [lutheranhealthcare.org]

• Nausea

  Additional symptoms that complete the clinical picture also include nausea, episodes of diarrhea, tachycardia, and vomiting. [symptoma.com]

  A 40-year-old HIV-infected woman developed nausea, vomiting, and epigastric pain and died following her third dose (per study protocol) of interleukin (IL)-2. Her HIV infection was diagnosed in 1996. [ncbi.nlm.nih.gov]

  Symptoms of intestinal infarction are abdominal pain, fever, nausea, and vomiting. [sweeneylawfirm.com]

  The degree of nausea and the frequency of... ‎ Seite 22 - ... the common mesentery. [books.google.com]

  However, signs of an acute abdomen with distension, guarding (rigidity), and hypotension may also occur, particularly when diagnosis has been delayed. 1 Fever, diarrhoea, nausea, and anorexia are all commonly reported. [doi.org]

• Acute Abdomen

  This paper documents the first reported case of fatal intestinal infarction in a 49 year old woman with systemic oxalosis and advocates its consideration in the differential diagnosis of an acute abdomen in such patients. [ncbi.nlm.nih.gov]

  abdomen in the tropics -- Diseases that may simulate the acute abdomen -- Acute abdominal pain in the immunocompromised patient -- Abdominal catastrophes when sensation in impaired. [worldcat.org]

  Four weeks after recommencing haemodialysis she developed an acute abdomen and an urgent laparotomy was performed, which showed extensive infarction of the small intestine with three separate perforations. [jcp.bmj.com]

  However, signs of an acute abdomen with distension, guarding (rigidity), and hypotension may also occur, particularly when diagnosis has been delayed. 1 Fever, diarrhoea, nausea, and anorexia are all commonly reported. [doi.org]

• Chronic Hypotension

  The infarction was most likely caused by decreased splanchnic perfusion secondary to the chronic hypotension of the nephrotic syndrome and to amyloid deposition within the walls of the small blood vessels supplying the gut. [ncbi.nlm.nih.gov]

• Ectopia Lentis

  الصفحة 896 - Genetic linkage of the Marfan syndrome, ectopia lentis, and congenital contractural arachnodactyly to the fibrillin genes on chromosomes 15 and 5. N Engl J Med 1992;326:905-909. ‏ [books.google.com]

A detailed medical history is certainly the first step towards reaching a diagnosis of intestinal infarction. Intense, persistent pain disproportionate in severity compared to the physical exam is the hallmark of the condition. Nausea, tachycardia, vomiting and diarrhea may complete the clinical picture; signs of peritoneal irritation may also be present if intestinal infarction has already been complicated by gangrenous peritonitis. Peritoneal signs also include abdominal rigidity, a positive rebound sign, hypotension, guarding and a considerable distention in the abdomen.

With regard to laboratory findings, most patients display the following, although recent studies have shown that none of them can be relied upon for a definitive diagnosis [7]:

• Leucocytosis [6]: white cell blood count typically amounts to over 20 x 109/L in the serum. This finding is solely used as an inflammation indicator since it is exhibited in the vast majority of inflammatory processes [8] [9].
• Acid-base imbalance [10]: although patients are expected to exhibit metabolic acidosis, metabolic alkalosis is sometimes diagnosed, due to vomiting during the initial stages of the disease.
• Increased D-dimer serum levels, which also cannot be considered pathognomonic for intestinal infarction [11].
• Increased L-lactate levels

An extremely valuable tool for the definitive diagnosis of intestinal infarction is mesenteric angiography, due to its indisputable accuracy, efficacy and potential to increase the survival rate it is considered as a gold standard [12] [13]. Currently, another imaging modality, computed tomography angiography (CTA) has effectively replaced mesenteric angiography in the diagnosis of intestinal infarction, as it is less invasive and has a specificity and sensitivity of 94% and 96% respectively [14] [15].

• Pneumoperitoneum

  The pressure of the retro-pneumoperitoneum was 15 mmHg and the total duration of the surgery was 120 minutes. [journalofmas.com]

  Prolonged pneumoperitoneum at 15 mmHg causes lactic acidosis. Surg Endosc 1998;12:198–201. CrossRef PubMed Google Scholar 43. Windsor MA, Bonham MJ, Rumball M. Splanchnic mucosal ischemia. an unrecognized consequence of routine pneumoperitoneum. [doi.org]

  […] portalis: gas in the portal vein or in mesenteric vein can be differentiated by pneumobilia because gas usually reaches the periphery of the liver while pneumobilia is usually about 2 cm short of external liver border, and is more clustered at the hilum pneumoperitoneum [radiopaedia.org]

  Pneumatosis intestinalis and pneumoperitoneum complicating mixed connective tissue disease. Br J Rheumatol 1991; 30:146–149 [Google Scholar] 44. Solomon A, Bar-Ziv J, Stern D, Papo J. [ajronline.org]

• Colitis

  Ischemic colitis, enteritis, or enterocolitis NOS ICD-9-CM Volume 2 Index entries containing back-references to 557.9 : [icd9data.com]

  This review aims to help clinicians to understand the features and management of acute and chronic mesenteric ischaemia, mesenteric venous thrombosis, and ischaemic colitis. [doi.org]

  Ischaemic colitis (colonic ischaemia). [patient.info]

  Definition Intestinal ischemia is classified into three main types: Ischemic colitis (colonic ischemia): hypoperfusion of the large bowel, which is mostly transient and self-limiting (non-gangrenous form), but can also lead to severe acute ischemia with [amboss.com]

  Differential diagnosis of AMI includes infectious colitis, ulserative colitis, chron disease and diverticulitis. In conclusion; cocaine-induced gastrointestinal complications are fatal as well as unexpected. [arcjournals.org]

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