Small bowel infarction
المؤلف:
James Carton
المصدر:
Oxford Handbook of Clinical Pathology 2024
الجزء والصفحة:
3rd edition , p124-125
2025-01-04
1047
Definition
- Ischaemic necrosis of a segment of the small intestine.
Epidemiology
- Usually seen in patients aged >50 y.
Aetiology
- Thrombosis overlying an unstable atherosclerotic plaque in the superior mesenteric artery.
- Thromboemboli from the left ventricle or left atrium.
- Hypovolaemia.
Pathogenesis
- Sudden reduction in blood flow through the superior mesenteric artery leads to ischaemic necrosis of a segment of the small bowel.
- Massive haemorrhage into the infarcted bowel causes hypovolaemia.
- Bacteria rapidly permeate the devitalized intestinal wall, leading to sepsis.
Presentation
- Acute onset of severe abdominal pain with bloody diarrhoea and hypovolaemia.
Macroscopy
- The infarcted small bowel appears dusky purple (Fig. 7.3).
- On opening the segment of bowel, large amounts of blood are present in the lumen and the mucosal surface is friable and necrotic.
Histopathology
• Full-thickness necrosis of the bowel wall. Milder changes include crypt atrophy (withering).
Prognosis
- Early laparotomy is essential to resect the infarcted segment of bowel.
-Survival is generally poor due to the rapid development of hypovolaemia and sepsis, causing multiorgan failure.
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