Key messages

• Causes include arterial embolism, arterial thrombosis, venous thrombosis, and non-occlusive infarction.

• Acute intestinal ischemia most commonly presents with severe abdominal pain out of proportion to objective physical findings.

• When the ischemia becomes transmural a peritonitic reaction occurs and the clinical state becomes that of a desperate illness with tachycardia, hypotension, fever, ileus, and rebound tenderness.

• Acute intestinal ischemia involves loss of body fluids, the effects of bacterial invasion, and the absorption of toxic factors into the portal and systemic circulations.

• The decision to operate will often depend upon clinical suspicion as there is no specific test (except angiography) for detecting ischemia. Introduction

The gastrointestinal tract has an abundant collateral blood supply, and so vascular accidents occur less frequently in the intestine than in heart, brain, kidney, or limbs. However, in an ageing population, the incidence of acute intestinal ischemia is increasing. In a community of 250 000 an average of one case occurs each month; therefore it is a common surgical emergency for which the mortality has remained at 70 to 100 per cent since 1930 ( Clavien §t..a[: 1987). It was observed more than 50 years ago that the difficulty in arriving at an early diagnosis undoubtedly accounts for the high mortality. The delay in diagnosis is often unavoidable owing to the lack of definite symptoms, even though the damage to the intestinal tract is severe. Although it is easy to say that an aggressive therapeutic approach offers the only hope of reducing mortality, the reality is different as in the early stages of this disease the clinical features are vague and non-specific, and routine laboratory data and radiographs are not diagnostic.

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