Vascular Disease of the Bowel

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Vascular diseases of the intestine may affect small or large bowel.
Interruption of the blood supply to the small bowel is most commonly seen in elderly patients:
Emboli from intracardiac thrombosis. Mural thrombus following a myocardial infarct, thrombotic
vegetations on mitral or aortic valves, or left atrial thrombosis. The emboli lodge in the superior mesenteric artery, which supplies the entire small intestine apart from the first part of the duodenum. The extent of the bowel infarction depends upon whether the occlusion is in a proximal or distal branch.
Thrombosis in severely atherosclerotic mesenteric artery.}This is less common than embolic occlusion but, when it occurs, it is usually located in the proximal part of the superior mesenteric artery, shortly
after its origin from the aorta; the small bowel infarction is extensive and usually fatal.
Venous infarction of the bowel Venous infarction due to strangulation.Venous infarction results from occlusion of the thin-walled veins draining blood from the small bowel, and is usually due to extrinsic pressure.
The bowel becomes deeply congested with venous blood, which is unable to drain out. This, in turn,
prevents entry of oxygenated arterial blood, so that ischaemic necrosis of the bowel wall ensues.
In the small intestine this pattern of venous infarction due to strangulation results from
strangulation of a loop of bowel in a narrow hernial sac. In volvulus
a loop of bowel twists on itself, usually in association with fibrous peritoneal adhesions
which, in turn, are usually the result of previous abdominal surgery.

Chronic bowel ischaemia

Angiodysplasia is a cause of large intestinal bleeding
Volvulus causes bowel ischaemia
In the colon, acute ischaemia is usually the result of volvulus, particularly in the sigmoid
colon, where there is a large redundant sigmoid loop which twists upon itself to produce torsion
of the mesentery; volvulus of the caecum is usually secondary to a highly mobile caecum.
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