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home - Colon - Colonic Vascular Disorders - Colonic Mesenteric Ischaemia Written by Dr Sebastian Zeki

Colonic Mesenteric Ischaemia

-Chronic mesenteric arterial ischaemic - Chronic mesenteric venous thrombosis - Coeliac compression(= celiac axis syndrome, median arcuate ligament syndrome and Dunbar syndrome) Intestinal AnginaLoss of weight and sitophobia. On examination increased bowel sounds and peristalsis AetiologyIt is probably related to a splanchnic nerve plexus/ delayed gastric emptying rather than reduced blood flow.Up to a 1/3rd of the population have some com-pression of the coeliac artery. Chronic Mesenteric Ischaemia Types BRUIT Triad of postprandial abdominal pain, weight loss, and sometimes an abdominal bruit. Diagnostic methods:Duplex USS of the mesenteric vessels.MRA or CT angiogram can show compressionAortography. Surgery:Division of the fibers of the median arcuate ligament and other filamentous structures around the origin of the celiac axis.Occasionally combine decompression with either celiac artery dilatation/ reconstruction/ interposition grafting.Favourable predictor for surgery:Postprandial pain pattern Age 40-60 Weight loss of 20 pounds or more Definition:— Abdominal pain related to compression of the celiac artery by fibres of the median arcuate ligament. Clinical ManifestationsThe mean age of onset is 47.It is equally common in males and females. Features on aortography:Collateral vessels.Retrograde filling of the coeliac artery via a dilated gastroduodenal artery from the SMA.Post-stenotic dilatation.Blood pressure gradient across the coeliac Treatment: poor response to anticoagulation Treatment Written by Dr Sebastian Zeki

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