Document Detail


Diagnosis and management of splanchnic ischemia.
MedLine Citation:
PMID:  19109864     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Splanchnic or gastrointestinal ischemia is rare and randomized studies are absent. This review focuses on new developments in clinical presentation, diagnostic approaches, and treatments. Splanchnic ischemia can be caused by occlusions of arteries or veins and by physiological vasoconstriction during low-flow states. The prevalence of significant splanchnic arterial stenoses is high, but it remains mostly asymptomatic due to abundant collateral circulation. This is known as chronic splanchnic disease (CSD). Chronic splanchnic syndrome (CSS) occurs when ischemic symptoms develop. Ischemic symptoms are characterized by postprandial pain, fear of eating and weight loss. CSS is diagnosed by a test for actual ischemia. Recently, gastro-intestinal tonometry has been validated as a diagnostic test to detect splanchnic ischemia and to guide treatment. In single-vessel CSD, the complication rate is very low, but some patients have ischemic complaints, and can be treated successfully. In multi-vessel stenoses, the complication rate is considerable, while most have CSS and treatment should be strongly considered. CT and MR-based angiographic reconstruction techniques have emerged as alternatives for digital subtraction angiography for imaging of splanchnic vessels. Duplex ultrasound is still the first choice for screening purposes. The strengths and weaknesses of each modality will be discussed. CSS may be treated by minimally invasive endoscopic treatment of the celiac axis compression syndrome, endovascular antegrade stenting, or laparotomy-assisted retrograde endovascular recanalization and stenting. The treatment plan is highly individualized and is mainly based on precise vessel anatomy, body weight, co-morbidity and severity of ischemia.
Authors:
Jeroen-J Kolkman; Marloes Bargeman; Ad-B Huisman; Robert-H Geelkerken
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  World journal of gastroenterology : WJG     Volume:  14     ISSN:  1007-9327     ISO Abbreviation:  World J. Gastroenterol.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-25     Completed Date:  2009-05-19     Revised Date:  2010-09-23    
Medline Journal Info:
Nlm Unique ID:  100883448     Medline TA:  World J Gastroenterol     Country:  China    
Other Details:
Languages:  eng     Pagination:  7309-20     Citation Subset:  IM    
Affiliation:
Department of Gastroenterology, Medisch Spectrum Twente, 7500 KA Enschede, The Netherlands. j.kolkman@mst.nl
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MeSH Terms
Descriptor/Qualifier:
Angiography
Humans
Ischemia / diagnosis*,  therapy*
Severity of Illness Index
Splanchnic Circulation / physiology
Ultrasonography, Doppler, Duplex
Vascular Surgical Procedures
Viscera / blood supply*,  radiography,  ultrasonography
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