- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Part 6.1 Physiology
- Part 6.2 Gastrointestinal monitoring
- Part 6.3 Gastrointestinal haemorrhage
- Part 6.4 Disordered gastric motility
- Part 6.5 The acute abdomen in the ICU
- Chapter 184 Pathophysiology and management of raised intra-abdominal pressure in the critically ill
- Chapter 185 Perforated viscus in the critically ill
- Chapter 186 Ischaemic bowel in the critically ill
- Chapter 187 Intra-abdominal sepsis in the critically ill
- Chapter 188 Acute acalculous cholecystitis in the critically ill
- Chapter 189 Management of the open abdomen and abdominal fistulae in the critically ill
- Part 6.6 Pancreatitis
- Part 6.7 Jaundice
- Part 6.8 Acute hepatic failure
- Part 6.9 Acute on chronic hepatic failure
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
Ischaemic bowel in the critically ill
- Chapter:
- Ischaemic bowel in the critically ill
- Author(s):
A. G. Peppelenbosch
and Martijn Poeze
- DOI:
- 10.1093/med/9780199600830.003.0186
Intestinal ischaemia is caused by occlusion of the visceral arteries, thrombosis of the mesenteric veins, or by (low-flow) non-occlusive mesenteric ischaemia (NOMI). Each condition has a specific diagnostic and therapeutic work-up and prognostic significance. The incidence of acute mesenteric infarction is as low as 0.63 cases/100,000 person years, but overall mortality rates remains high at 74%. In general, a high index of suspicion is necessary and should be followed by administering therapeutic low molecular weight heparin or systemic heparin infusion. In these patients resuscitation and organ support are essential, but should not delay diagnostic work-up, including CT-angiography. With arterial occlusion, revascularization should be performed if indicated, preferentially using endovascular techniques prior to laparotomy. For venous occlusion, thrombolytic therapy directly into the superior mesenteric artery or venous thrombectomy can be performed, followed by laparotomy. The treatment of NOMI is to treat the underlying cause.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Part 6.1 Physiology
- Part 6.2 Gastrointestinal monitoring
- Part 6.3 Gastrointestinal haemorrhage
- Part 6.4 Disordered gastric motility
- Part 6.5 The acute abdomen in the ICU
- Chapter 184 Pathophysiology and management of raised intra-abdominal pressure in the critically ill
- Chapter 185 Perforated viscus in the critically ill
- Chapter 186 Ischaemic bowel in the critically ill
- Chapter 187 Intra-abdominal sepsis in the critically ill
- Chapter 188 Acute acalculous cholecystitis in the critically ill
- Chapter 189 Management of the open abdomen and abdominal fistulae in the critically ill
- Part 6.6 Pancreatitis
- Part 6.7 Jaundice
- Part 6.8 Acute hepatic failure
- Part 6.9 Acute on chronic hepatic failure
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care