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]

  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]

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

  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]

  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]

• Abdominal Pain

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

  A 69-year-old female patient presented with a 1-day history of acute abdominal pain. However, she had recently been placed on a statin and had started to complain of abdominal pain 2 weeks after starting the medication. [vasculardiseasemanagement.com]

  pain that is disproportionate to their abdominal findings"., or simply, pain out of proportion to exam. [en.wikipedia.org]

• 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]

  Seite 72 - Anorexia Vomiting generally occurs in the early stages of the attack, but usually a few hours after the initial pain. Many patients do not vomit, but instead have a sensation of nausea. [books.google.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]

• Severe Abdominal Pain

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

  Symptoms caused by gradual hardening of the mesenteric arteries: Abdominal pain after eating Diarrhea Symptoms of sudden (acute) mesenteric artery ischemia due to a traveling blood clot include: Sudden severe abdominal pain Diarrhea Vomiting When symptoms [nlm.nih.gov]

  Report of a Case A 54-year-old male was admitted to the hospital complaining of severe abdominal pain and vomiting. [jamanetwork.com]

• 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]

  Therefore, decreased blood supply to these organs cause symptoms related to eating or after-meal digestion, including: Abdominal pain after meals Weight loss Fear of eating or change in eating habits due to post-meal pain Nausea and/or vomiting Constipation [my.clevelandclinic.org]

• Acute Abdomen

  […] of acute peritonitis -- The early diagnosis of abdominal injuries -- The postoperative abdomen -- The acute abdomen in the tropics -- Diseases that may simulate the acute abdomen -- Acute abdominal pain in the immunocompromised patient -- Abdominal catastrophes [worldcat.org]

  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]

  […] notes by dr Claudio Italiano Abdominal pain pertaining to surgery, namely that of the acute abdomen. [gastroepato.it]

  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]

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]

  Pneumoperitoneum and pneumoretroperitoneum can be seen with both idiopathic and ischemic pneumatosis 3 If bowel wall thickening, abnormal enhancement, dilatation or ascites is seen with air in portal or biliary tract, it signifies a life threatening cause [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]

  Parotis pleomorph adenoma Celiac disease Colitis ulcerosa biopszia Colitis ulcerosa resecatum Crohn colitis Colitis ulcerosa Diverticulosis et polyposis sigmatis Diverticulum perforatum sigmatis VI. [semmelweis.hu]

  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]

  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]

PTA: percutaneous transluminal angioplasty Options for surgical treatment Immediate surgical intervention remains the treatment of choice for central occlusion of the SMA, failure of endovascular treatment, or peritonitis. [doi.org]

The treatment should be directed towards the conditions causing intestinal ischaemia. [ncbi.nlm.nih.gov]

Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances. [books.google.com]

Two models were constructed with/without the cause of intestinal obstruction as a variable, since it might affect the prognosis. [ncbi.nlm.nih.gov]

Complications such as peritonitis and sepsis result in a poor prognosis. [amboss.com]

Acute Vasoocclusive Etiologies Acute vasoocclusive etiologies of ischemic bowel injury arise from sudden occlusion of mesenteric vasculature which can affect arteries or veins. [pathwaymedicine.org]

Representative intestinal sections were studied from 10 patients with NOMI of the small and/or large bowel and 12 patients, with OMI of varied etiology. [ncbi.nlm.nih.gov]

References:[3][10] Intestinal ischemia Summary Definition Ischemic colitis Epidemiology Etiology Pathophysiology Clinical features Diagnostics Differential diagnoses Therapy Complications Prognosis Acute mesenteric ischemia Epidemiology Etiology Pathophysiology [amboss.com]

Recent changes in the etiology of this disease have not been examined. A retrospective review of 121 consecutive patients over a 6-year period was undertaken. [jhu.pure.elsevier.com]

The second is a 40-year-old woman who consults for dry gangrene of hands and feet, without demonstrable etiology. [scielo.iics.una.py]

References:[3][10] Intestinal ischemia Summary Definition Ischemic colitis Epidemiology Etiology Pathophysiology Clinical features Diagnostics Differential diagnoses Therapy Complications Prognosis Acute mesenteric ischemia Epidemiology Etiology Pathophysiology [amboss.com]

Epidemiology The incidence of ischaemic colitis has risen from 6.1 cases/100 000 person-years in 1976-80 to 22.9/100 000 in 2005-09 [ 5 ]. Many mild cases may go unreported. [patient.info]

Pregnancy Considerations Common finding on the abdomen, breast, and thighs of pregnant women, especially during the 3rd trimester—called striae gravidarum Epidemiology Incidence Incidence range of 43–88% for women during pregnancy ( 1 ) Prevalence Adult [unboundmedicine.com]

Rivana: Fournier‘s Gangrene: Population Based Epidemiology and Outcomes. J Urol. Vol. 181, Issue 5, Pag. 2120-2126, May 2009. Miller, LG, Perdreau-Remington, F, Rieg, G, et al. [medigraphic.com]

New insights into the epidemiology and etiology of Fournier's gangrene: a review of 33 patients. Infection. 2009 Aug. 37(4):306-12. [Medline]. Yilmazlar T, Gulcu B, Isik O, Ozturk E. Microbiological aspects of Fournier's gangrene. [medscape.com]

The clinical history and microscopic findings are consistent with the hypothesis of a direct action of absorbed iron on vascular walls as the pathophysiologic mechanism for the toxic effects of iron on the gastrointestinal tract. [ncbi.nlm.nih.gov]

References:[3][10] Intestinal ischemia Summary Definition Ischemic colitis Epidemiology Etiology Pathophysiology Clinical features Diagnostics Differential diagnoses Therapy Complications Prognosis Acute mesenteric ischemia Epidemiology Etiology Pathophysiology [amboss.com]

Accepted 15 May 2003 Although intestinal ischaemia is an infrequent event, early recognition and appropriate treatment can reduce the potential for a devastating outcome Introduction Acute or chronic abdominal pain can be the result of many different pathophysiological [doi.org]

Pathophysiology• Arterial sources v.s. venous sources:proximately 9:1. [slideshare.net]

Although amyloidosis was suspected prior to death, a fixation artifact probably prevented the correct antemortem biopsy diagnosis. [ncbi.nlm.nih.gov]

Prevention Eating a nutritious diet and avoiding smoking can help prevent this disease. Prompt treatment of hernias and control of risk factors such as heart arrhythmias, high blood pressure, and cholesterol may also help. [webmd.com]

Prevention Preventive measures include: Controlling risk factors, such as irregular heartbeat, high blood pressure, and high cholesterol Not smoking Eating a nutritious diet Quickly treating hernias References Brandt LJ, Feuerstadt P. [pennstatehershey.adam.com]

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