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Ischemic bowel disease
Last reviewed: 07.07.2025
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Ischemic bowel disease (abdominal ischemic disease) is an acute or chronic insufficiency of blood supply in the basins of the celiac, superior or inferior mesenteric arteries, leading to insufficient blood flow in individual areas or in all parts of the intestine.
Causes and pathogenesis
The main causes of ischemic bowel disease are:
- atherosclerosis localized in the mouths of the corresponding arteries (the most common cause);
- systemic vasculitis (nonspecific aortoarteriitis, Buerger's thromboangiitis obliterans, nodular panarteritis, etc.);
- systemic connective tissue diseases;
- fibromuscular dysplasia;
Causes and pathogenesis of ischemic bowel disease
Acute mesenteric ischemia
According to the available statistics, acute intestinal ischemia leads to an abdominal catastrophe with high mortality, and little progress has been made compared to 30 years ago, when the mortality rate was 70-100%. In specialized institutions specifically dealing with this problem, mortality from ischemia can be reduced by 20-30% compared to the national average due to early diagnosis using selective angiography and subsequent timely treatment using vasodilators, embolectomy, thrombectomy, arterial reconstruction and intestinal resection.
Superior mesenteric artery embolism
The superior mesenteric artery supplies the entire small intestine, the cecum, ascending colon, and part of the transverse colon.
The sources of embolization of the superior mesenteric artery are different. In 90-95% of cases, these are thrombi in the left atrium, as well as thrombi on prosthetic or pathologically affected mitral or aortic valves, and particles of migrating atheromatous plaques.
Superior mesenteric artery embolism
Superior mesenteric artery thrombosis
The most common cause is widespread atherosclerosis.
The clinical picture of thrombosis of the superior mesenteric artery is basically similar to the clinical picture of embolism described above, however, thrombosis differs in that the abdominal pain is less intense and does not have a cramping nature.
Superior mesenteric artery thrombosis
Non-occlusive mesenteric ischemia
Its true frequency is not determined, since the process is reversible. However, it is known that it is responsible for 50% of cases of intestinal infarction. One of the main causes of non-occlusive mesenteric ischemia is heart failure of various etiologies. According to observations by S. Rentom, 77% of patients with acute intestinal ischemia suffered from severe heart disease.
Non-occlusive mesenteric ischemia
Mesenteric vein thrombosis
Mesenteric vein thrombosis can lead to acute intestinal ischemia. The clinical picture is characterized by the following manifestations:
- vague and poorly localized abdominal pain;
- bloating;
- diarrhea;
Chronic mesenteric ischemia ("abdominal angina")
Slowly progressing visceral artery obstruction over a long period of time may lead to the development of collateral circulation, without being accompanied by pronounced disorders and without manifesting clear symptoms. This is confirmed by pathologists' data.
Ischemic colitis
Ischemic colitis is a chronic inflammation of the large intestine caused by its ischemia.
The blood supply of the large intestine is provided by the superior and inferior mesenteric arteries. The superior mesenteric artery supplies the entire small, cecum, ascending and part of the transverse colon; the inferior mesenteric artery supplies the left half of the large intestine.
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