Intestinal Ischemia and Gangrene

1.1 Historical background Antonio Beniviene was the first to describe mesenteric ischemia as early as the 15th century. It was not before the mid 19th century during which the entity was extensively reported and researched after case reports by Virchow and others. The first successful surgical treatment of acute mesenteric ischmia (AMI) was performed by Elliot, who, in 1895, performed a resection of gangrenous portion of the bowel, followed by primary anastomosis of the viable parts. Dunphy correctly hypothesized that mesenteric ischemia was a manifestation of visceral atherosclerosis in the mid-twentieth century. During that time advancements in both the diagnostics and therapeutics of the disease as an entity was in full swing. Heparin was introduced for use in mesenteric venous thrombosis. In the 1950s, a major step in the vascular surgical repair to restore blood flow to ischemic bowel before gangrene occurred was introduced. The first successful embolectomy without bowel resection was performed in 1957. Nonocclusive mesenteric ischemia was first recognized as a subtype of AMI in the 1950s. By 1960, hypercoagulation status was identified as the apparent cause of most cases of mesenetric venous thrombosis and the combination of heparin administration and bowel resection became the standard treatment. In the 1970s, the use of angiography to diagnose and evaluate AMI, as well as the introduction of intra-arterial papaverine infusion, significantly improved the prognosis of patients by allowing early diagnosis and by elimination of residual arterial spasm.