Bowel infarction

Bowel infarction or gangrenous bowel represents an irreversible injury to the intestine resulting from insufficient blood flow. It is considered a medical emergency because it can quickly result in life-threatening infection and death.[1] Any cause of bowel ischemia, the earlier reversible form of injury, may ultimately lead to infarction if uncorrected. The causes of bowel ischemia or infarction include primary vascular causes (for example, mesenteric ischemia) and other causes of bowel obstruction.[2]

Bowel infarction
Other namesGangrenous bowel
Intestinal obstruction. Note the tense wall indicative of gas under pressure and volvulus.

Causes

Primary vascular causes of bowel infarction, also known as mesenteric ischemia, are due to blockages in the arteries or veins that supply the bowel. Types of mesenteric ischemia are generally separated into acute and chronic processes, because this helps determine treatment and prognosis.[3]

Bowel obstruction is most often caused by intestinal adhesions, which frequently form after abdominal surgeries, or by chronic infections such as diverticulitis, hepatitis, and inflammatory bowel disease. The condition may be difficult to diagnose, as the symptoms may resemble those of other bowel disorders.[4] Bowel volvulus describes a specific form of bowel obstruction, where the intestine and/or mesentery are twisted, resulting in ischemia.[5]

Management

An infarcted or dead intestinal segment is a serious medical problem because of the fact that intestines contain non-sterile contents within the lumen. Although the fecal content and high bacterial loads of the intestine are normally safely contained, progressive ischemia causes tissue breakdown and inevitably leads to bacteria spreading to the bloodstream. Untreated bowel infarction quickly leads to life-threatening infection and sepsis, and may be fatal.

The only treatment for bowel infarction is immediate surgical repair and eventually removal of the dead bowel segment.[1]

Patients who have undergone extensive resection of the small bowel may develop malabsorption, indicating the need for dietary supplements.

Additional images
Bowel infarction. Note the grey discoloration.

See also

References
  1. Vallicelli C, Coccolini F, Catena F, Ansaloni L, Montori G, Di Saverio S, Pinna AD (January 2011). "Small bowel emergency surgery: literature's review". World Journal of Emergency Surgery. 6 (1): 1. doi:10.1186/1749-7922-6-1. PMC 3025845. PMID 21214933.
  2. Belyaev O, Müller C, Uhl W (2009). "Chapter 57: Small Bowel Obstructions". In Bland K (ed.). General Surgery: Principles and International Practice (2nd ed.). London: Springer. pp. 597–604. ISBN 978-1-84628-832-6. OCLC 314794037.
  3. Dhatt HS, Behr SC, Miracle A, Wang ZJ, Yeh BM (November 2015). "Radiological Evaluation of Bowel Ischemia". Radiologic Clinics of North America. 53 (6): 1241–54. doi:10.1016/j.rcl.2015.06.009. PMC 4633709. PMID 26526436.
  4. Smerud MJ, Johnson CD, Stephens DH (January 1990). "Diagnosis of bowel infarction: a comparison of plain films and CT scans in 23 cases". AJR. American Journal of Roentgenology. 154 (1): 99–103. doi:10.2214/ajr.154.1.2104734. PMID 2104734.
  5. Sturgess PA (June 1981). "The hospice tradition". Journal of the Royal Society of Medicine. 74 (6): 467. PMC 1438761. PMID 20894357.
Classification
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