Management of gut ischemia

Ischemia of the intestine may manifest with different clinical features, each one requiring a specific diag­ nosis and treatment approach. Early identification and treatment of acute mesenteric ischemia is cru­ cial to improve prognosis. For that purpose, early angiography followed by surgery or a direct laparo­ tomy in critically ill patients is warranted. Embolec­ tomy and bowel resection for arterial embolus, throm­ bectomy and revascularization for arterial thrombus, vasodilators for nonocclusive mesenteric ischemia, and heparin and eventual bowel resection for acute venous thrombosis, are the treatment modalities of choice. Chronic mesenteric ischemia has to be con­ sidered in elderly patients or those with risk factors presenting with postprandial abdominal pain and weight loss. Treatment may be performed either by surgical revascularization or angioplasty with or without stent placement according to patient conditions and surgi­ cal risk. Ischemic colitis is the most common form of intestinal ischemia, usually affects the left colon, and may resolve spontaneously. Bowel rest, IV flu­ ids, and antibiotics is the standard treatment. Ini­ tially, surgery is indicated for patients with peritoni­ tis, massive bleeding, or fulminant colitis. Subse­ quently, surgery is also indicated for patients who do not improve after 2-3 weeks of treatment, those evolv­ ing to sepsis, or those presenting late with colonic stricture or persistent chronic colitis. [Indian J Gastroenterol 2006;25(Suppl 1):S39-S42]