Ischemia for Medical Professionals
Ischemia can lead to massive bowel resection and occurs when perfusion is no longer adequate to overcome capillary pressure in the wall of the bowel.
Can occur from inadequate inflow, increased wall tension due to intestinal obstruction, or impediments to venous outflow.
The most devastating event is an embolic event to the superior mesenteric artery (SMA) as it supplies the majority of the small bowel and the proximal colon up to the splenic flexure.
If a patient is being considered for intestinal transplant due to major resection of intestine due to a major thrombotic event, a thorough work-up for inherited thrombotic disorders (i.e. Factor V Leiden mutation, deficiency in anticoagulant protein S, protein C, or antithrombin III) should be undertaken prior to transplant.
Closed loop hernias and incarcerated hernias can also cause ischemia and can progress to gangrene that result in massive resections.