VASCULAR ABNORMALITIES OF THE MESENTERY Acute mese

VASCULAR ABNORMALITIES OF THE MESENTERY Acute mesenteric ischaemia

• ). The arterial inflow to the mesenteric domain is limited to three major vessels: the coeliac trunk and the superior and 65.5 ). Additional arterial inferior mesenteric arteries ( - inflow in the pelvis comes via the middle rectal arteries. The - limited number of arterial inputs to the mesenteric domain mean that narrowing or occlusion at the origin of any one vessel can have significant clinical e ff ects. Acute mesenteric ischaemia mostly follows embolisation to the origin of either the coeliac or superior mesenteric arterial trunk. Unless quickly reversed, it can lead to ischaemia and necrosis of most of the intestine. At first, the severity of abdominal pain does not match clinical findings on examination. If ischaemia and necrosis occur, the patient develops peritonism as a result - of irritation of the parietal peritoneum by the necrotic intes tine. The inferior mesenteric artery (IMA) is usually divided at open repair of an abdominal aortic aneurysm; however, anas - tomoses between peripheral branches of the SMA and IMA, Drummond, usually pre - referred to as the marginal artery of vent critical ischaemia of the sigmoid and descending colon. If ischaemia is limited to the mucosa, the patient may experience mally settles. cramping suprapubic pain and diarrhoea that nor If ischaemia is transmural the colon may become necrotic and require resection.

Severe mesenteric Mild Normal disease mesenteric mesentery disease Fat wrapping Creeping fat Figure 65.12 The mesentery in Crohn’s disease. (a) Levels of mesenteric disease manifestations. creeping fat. (Reproduced with permission from Coffey JC, Lavery I, Sehgal R (eds). applied principles . Boca Raton: CRC Press, 2017: 85–108.)