Small bowel infarction

O Primary peritonitis develops in up to 25% of patients with alcoholic cirrhosis.3 Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) average one episode of peritonitis every 2 years.4 Secondary peritonitis may be caused by perforation of a peptic ulcer traumatic perforation of the stomach, small or large bowel, uterus, or urinary bladder appendicitis pancreatitis diverticulitis bowel infarction inflammatory bowel disease cholecystitis operative contamination of the peritoneum or diseases of the female genital tract such as septic abortion, postoperative uterine infection, endometritis, or salpingitis. Appendicitis is one of the most common causes of intraabdominal infection. In 1998, 278,000 appendectomies were performed in the United States for suspected appendicitis.5... 

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). 

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. 

Sonography may show dilated fluid-filled bowel loops. The obstructing cause can occasionally be visualized if it is a tumor or hernia. Absence of peristaltic movements, bowel wall thickening without perfusion on color Doppler imaging and dilated small bowel containing fluid can all indicate infarction in the appropriate clinical setting. 

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