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Non-occlusive mesenteric ischemia
Last reviewed: 04.07.2025
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The true incidence of non-occlusive mesenteric ischemia is not determined, since the process is reversible. However, it is known to be responsible for 50% of intestinal infarction cases. One of the main causes of non-occlusive mesenteric ischemia is heart failure of various etiologies. According to S. Rentom, 77% of patients with acute intestinal ischemia suffered from severe heart disease. Almost half of them had various types of arrhythmia. The role of arrhythmia in reducing cardiac output and developing intestinal damage is also supported by other researchers, who have experimentally proven that atrial fibrillation leads to a sharp decrease in mesenteric blood flow. Attention is also paid to digitalis preparations, which have a selective vasoconstrictor effect on mesenteric circulation. Another factor that plays a causal role in the development of non-occlusive ischemia in some patients is hemoconcentration, which develops after the administration of fast-acting diuretics.
Clinic. The clinical manifestations of non-occlusive mesenteric circulatory failure are similar to those observed in embolism or thrombosis of the superior mesenteric artery. However, it should be noted that clinical symptoms are less pronounced in non-occlusive ischemia. Abdominal pain may be non-acute even in critically ill patients. Therefore, symptoms of increasing hypovolemia and unexplained metabolic acidosis should be considered as additional key signs of non-occlusive ischemia.
Angiography in non-occlusive ischemia most often does not reveal pathology: mesenteric vessels of normal structure and patency are detected.
Treatment is drug-based if there are no peritoneal symptoms. Infusions of dilators are given, which can give good results. The appearance of signs of peritoneal irritation suggests the development of intestinal infarction and requires surgical treatment. The prognosis for non-occlusive ischemia remains unfavorable due to the frequent combination of this lesion with severe cardiovascular disease.
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