Ischaemicinfarcted bowel

Can occur following prolonged hypoperfusion or, occasionally, secondary to a mesenteric embolus. It usually presents with severe abdominal pain, bloody diarrhoea and signs of systemic toxicity including a rapidly increasing metabolic acidosis. Plasma phosphate levels may also be elevated. X-ray appearances of thickened, oedematous bowel loops ('thumb printing') with an increased distance between bowel loops are suggestive. Treatment is by restoration of tissue perfusion, blood transfusion to maintain haemoglobin >7g/dl and, if clinical features fail to settle promptly, laparotomy with a view to bowel excision.

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