Mesenteric infarction

A 79-year old woman with a serum digoxin concentration of 4.9 ng/ml had a mesenteric infarction (116). At postmortem no other causes were discovered. 

Gughehninotti J, Tremey B, Maury E, Alzieu M, Offenstadt G. Fatal non-occlusive mesenteric infarction following digoxin intoxication. Intensive Care Med 2000 26(6) 829. 

Although dizziness is a fairly frequent complaint at the beginning of diuretic treatment (1), postural hjrpotension is rarely reported. Ischemic complaints (mesenteric infarction and transient cerebral ischemic attacks) have been observed in elderly patients, but it is not clear whether these resulted from diminished organ perfusion or from an effect of the drug itself. The former is more likely, since similar problems have arisen with any form of antihypertensive treatment in old people who have to some degree become dependent on their hypertension to ensure a blood supply through sclerotic vessels. 

Pancreatitis, any cause (P-AMY T) Pancreatic trauma (P-AMYT) Biliary tract disease (P-AMYT) - Intestinal obstruction (PtAMYT) Mesenteric infarction (P-Alv4Y(t Perforated peptic ulcer (P-AMYiT) Gastritis, duodenitis (P-AMY ) Ruptured aortic aneurysm Acute appendicitis Peritonitis Trauma... 

Minerals require a suitable mucosal surface across which to enter the body. Resection or diversion of a large portion of small bowel obviously affects mineral absorption. Extensive mucosal damage due to mesenteric infarction or inflamatory bowel disease or major diversion by jejunoileal bypass procedures reduces the available surface area. Minerals whose absorption occurs primarily in the proximal intestine, e.g., copper or iron, are affected differently than those absorbed more distally, e.g., zinc. In addition, the integrity of the epithelium, the uptake of fluids and electrolytes, the intracellular protein synthesis, the energy-dependent pumps, and the hormone receptors must be intact. 

Graeber, G. M., P. J. Cafferty, M. J. Reardon, C. P. Curley, N. B. Ackerman, and J. W. Harmon. 1981. Changes in serum total creatine phosphokinase in experimental mesenteric infarction. Annals of Surgery 193 499-505. 

Kanda, T., Fujii, H., Tani, T., Murakami, H., Suda, T., Sakai, Y, Ono, T., and Hatakeyama, K. 1996. Intestinal fatty acid-binding protein is a useful diagnostic marker for mesenteric infarction in humans. Gastroenterology, 110 339-343. 

Unlabeled Uses Acute peripheral occlusive disease, basilar artery occlusion, cerebral infarction, deep vein thrombosis, femoropopliteal artery occlusion, mesenteric or subclavian vein occlusion, pleural effusion (parapneumonic)... 

A review of trials has suggested that vasopressin is more likely to cause adverse effects at doses of 0.04 U/minute or more when it is used to treat septic shock mesenteric ischemia and cardiac dysfunction and ischemia were particularly associated with high doses (30). The authors suggested that limiting the dosage to 0.03 U/minute may minimize these effects. This suggestion has been supported by a retrospective audit of the effects of continuous vasopressin infusion in septic shock in 102 men and women, mean age 53 years (31). There were adverse events that may have been linked to vasopressin in 18 patients cardiac arrest (n = 9) ischemic/mottled digits (n = 8) myocardial infarction (n = 1) and hyponatremia (n = 1). Adverse events occurred with doses of vasopressin of 0.04 units/minute and over, except in one patient (dose not stated). 

Infarction of the bowel was formerly a very occasional complication of abdominal aortography and was due to injection of contrast medium into the mesenteric arteries. Most of these cases were due to the older media, such as acetrizoate however, small bowel injury has occurred after injection of a concentrated bolus of sodium iotala-mate (144). Ileus has been reported after mesenteric angiography in a patient with renal insufficiency (SED-12,1177) (145). 

Nevertheless, cases of myocardial infarction, mesenteric ischemia, and ischemic colitis have been described, as has splenic infarction (14). 

Abdominal distension and ileus may also be a manifestation of acute bowel infarction, a rare but catastrophic complication that results from prolonged hypotension or mesenteric artery vasospasm (caused, for ex-... 

Fig. I.76a-c. Omental infarction, a Hyperechoic mass just behind the abdominal wall (arrows), b Axial CT image shows an area of fat stranding indicating inflamed mesenteric fat (arrows), c Another patient. Longitudinal US at the sub-hepatic region shows a hyperechoic mass just underneath the anterior abdominal wall that progressively attenuates the sound suggesting a fat origin (arrows). fi,dilated bowel loops L, liver...

Differences in segmental arterial supply probably also impact on the risk of infarction. The rectum is likely to tolerate embolization better than other regions since it has a dual blood supply with the superior hemorrhoidal artery off of the inferior mesenteric artery and middle hemorrhoidal arteries arising from the internal iliac circulation. This translates into increased potential for collateral blood flow and thus decreased risk of ischemia. The cecum may be more prone to ischemia since there is not a well developed arcade along the mesenteric border of the cecum and instead there are separate anterior and posterior cecal branches. The tissue supplied by these individual branches may be more susceptible to ischemia and in fact infarction of the cecum (even after microcatheter embolization) has been reported [13]. 

The major complicating factor of embolization in the mesenteric distribution is bowel ischemia and infarction. Ischemia can cause strictures and obstruction whereas infarction can lead to perforation and sepsis from dead gut. Dissection and... 

To conclude, the epidemiological studies on oral contraceptives and thromboembolism all point to the same direction, i.e. to an increased risk of thromboembolic disease (deep vein thrombosis, pulmonary embolism, cerebral thrombosis, myocardial infarction) in women using oral contraceptives of the combined type. Support can also be obtained from the studies on changes in the fibrinolytic system (see below). For thrombosis with rare localization, e.g. in the mesenteric vessels, epidemiological data are still lacking. It remains to be seen whether the risk of thrombosis is reduced with the new low-dose combinations. 

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