Nonocclusive infarction

Non-occlusive intestinal infarction was first described in 1958 by Ende. It is recognized with increasing frequency and, at present, accounts for approximately 25 per cent of all cases of acute ischemia. Mucosal blood flow reduction occurs in a wide variety of clinical situations, including major surgery, sepsis, and cardiogenic and hemorrhagic shock (M., §.L§L 1991). This may not prove crucial in a young healthy individual with a resilient splanchnic circulation, but in a patient whose vessels are less adaptable and in whom other organ systems may be impaired, a vicious circle may be initiated, leading to a catastrophic series of life-threatening events.

The patient usually shows evidence of low cardiac output and hypotension. Many are receiving digoxin. Unexpected development of abdominal problems in a patient admitted to the intensive care unit (ICU) with a myocardial infarction, arrhythmia, or valvular heart disease, or who has recently undergone cardiac surgery, should arouse suspicion of such an infarct. Other potential causes of non-occlusive intestinal ischemia are the Arthus or Schwartzmann phenomena or vasoconstrictive bacterial toxins such as clostridial exotoxin.

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