​What is Surgery – Ischemic Bowel Treatment

​What is Surgery – Ischemic Bowel Treatment 

DEFINITION
Ischemic bowel or is also known as intestinal ischaemia.Intestinal ischaemia is a condition in which a mesenteric vascular is blocked (for example, by an embolus or thrombosis), resulting in bowel ischaemia and necrosis.

 AETIOLOGY Embolus (60%) is the most common type of thrombosis, followed by arterial thrombosis (25%), and venous thrombosis (25%). (15 percent ). Volvulus, intussusception, bowel strangulation within a hernia, or surgical excision are all possible causes. 

RISK FACTORS/ASSOCIATIONS
Emboli are caused by atrial fibrillation, cardiac mural thrombus, and endocarditis. Hypercholesterolemia, hypertension, diabetes mellitus, and smoking are all risk factors for arterial thrombosis. Portal hypertension, splenectomy, septic thrombophlebitis, and heart failure are all linked to venous thrombosis. 

EPIDEMIOLOGY 
It is dependent on the aetiology. Older people are more likely to have this condition. 

HISTORY 
Acute colicky stomach pain that is severe. It's possible that it'll cause you to vomit or have rectal bleeding. Chronic mesenteric artery insufficiency (e.g., gross weight loss and abdominal pain after eating) is a risk factor. History of heart or liver illness is significant.

EXAMINATION 
Tenderness and distension across the abdomen. If a hernia is present, there will be a sensitive palpable mass. It's possible that bowel sounds aren't present. The degree of cardiovascular collapse is disproportionate. 

INVESTIGATIONS Diagnosis can be challenging, and it may be based on clinical suspicion or discovered via a laparotomy. ABG (lactic acidosis), FBC, U&Es, LFT, clotting, and crossmatch are all blood tests. AXR may reveal thickening of the intestinal wall or thumbprinting. Gas in the intestinal wall may be visible on a CT scan. Mesenteric arteriography allows for localization, a measurement of the extent, and a trial of intervention if it is stable. 

MANAGEMENT Nil by mouth, IV fluid resuscitation and electrolyte balance correction, IV antibiotics. Surgical: An emergency laparotomy was performed, and the infarcted bowel was resected. Embolectomy or a saphenous vein bypass from the iliac artery to the superior mesenteric artery below the obstruction can restore arterial supply to non-necrotic bowel. A temporary dead stoma is frequently employed. After surgery, you'll need to be monitored and cared for closely, usually on HDU or ITU. Extensive small-bowel resection has occasionally been aided by total parenteral feeding, followed by small-bowel transplantation at a later stage.

Medical: Heparin for post-operative thrombosis prevention. Warfarinization for a long period of time may be necessary. 

COMPLICATIONS
Lactic acidosis, intestinal perforation, peritonitis, and multi-organ failure are all possible complications. 

PROGNOSIS 
A dangerous condition with a high mortality rate (50–100%).