All are true about acute mesenteric ischemia except:
Correct Answer: Non-obstructive mesenteric ischemia has very good prognosis
Description: Ans. (c) Nonobstructive mesenteric ischemia has very good prognosis* Branch point of middle colic artery is the most common site for embolism causing obstruction in acute mesenteric artery ischemia.* IOC for acute mesenteric ischemia: Laparotomy* IOC for chronic mesenteric ischemia: Arteriography* IOC for mesenteric vein thrombosis: CECT abdomenNonocclusive mesenteric ischemiaMesenteric vein thrombosis20% of acute mesenteric ischemia cases5-15% of mesenteric ischemia causesFeatures are similar to mesenteric artery thrombosis but the vessels are patentSuperior mesenteric vein (SMV) is most common involved which may even extend to portal vein, IMV is sparedPathophysiology:* Splanchnic vasoconstriction due to hypoperfusionHypoperfusion may occur due to drugs, decreased cardiac output, renal or hepatic disease.(BP falls below 40mmHg)* Past history of thromboembolism is seen* Predisposed by hypercoagulable states* Most common presentation -- Colicky abdominal pain* 50% will have occult blood in stoolsArteriogram -- diffuse spasm and narrowing of SMA branches. (String of lakes appearance)IOC -- CECT abdomenHas very bad prognosisHas very bad prognosis. Mortality 50%
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