Vascular Disease of
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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
• 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
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
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
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
colon, where there is a large redundant sigmoid loop which twists upon itself to
of the mesentery; volvulus of the caecum is usually secondary to a highly mobile
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