Prepared by: Dr. Mohamed Al-Shekhani. Kurdistan Board GEH Journal club.

MOST OFTEN MISUNDERSTOOD BY GASTROENTEROLOGISTS. MAY OCCUR WITH OR WITHOUT DIGESTIVE VASCULAR OCCLUSION. WHATEVER THE MECHANISMS THE INCIDENCE IS INCREASING THE PROGNOSIS COULD BE IMPROVED BY AN INNOVATIVE MULTIMODAL & MULTIDISCIPLINARY MANAGEMENT INITIATED AT EARLY PRESENTATION.

DIAGNOSIS MUST BE SUSPECTED WITH ANY SUDDEN, CONTINUOUS & UNUSUAL ABDOMINAL PAIN, CONTRASTING WITH NORMAL PHYSICAL EXAM INITIALY. THROMBO-ATHERO-EMBOLIC RISK FACTORS ARE OFTEN UNKNOWN AT PRESENTATION & NO BIOCHEMICAL TEST IS SPECIFIC. ABSENCE OF INDIVIDUAL RISK FACTORS OR NORMAL BIOLOGY MIGHT NOT DENY OR DELAY THE DIAGNOSIS, WHICH SHOULD BE CONFIRMED BY ABDOMINAL CT ANGIOGRAPHY IDENTIFYING GASTRO-INTESTINAL ISCHAEMIC INJURY, WITH OR WITHOUT VASCULAR OCCLUSION.

GASTROENTEROLOGISTS HAVE A MAJOR ROLE IN THE MANAGEMENT, TO AVOID DEATH & LARGE INTESTINAL RESECTIONS, BY INITIATING & COORDINATING A MULTIDISCIPLINARY A/MULTIMODAL MANAGEMENT INCORPORATING A MEDICAL PROTOCOL, REVASCULARIZATION OF VIABLE DIGESTIVE SEGMENTS&RESECTION OF NON- VIABLE INTESTINE. THERAPEUTIC STRATEGY DEPENDS ON THE PRESENCE OF AT LEAST ONE OF THREE CRITERIA (NECROSIS, ORGAN FAILURE, OR ELEVATED SERUM LACTATE).

IN THE EARLY STAGES, PATIENTS WITHOUT SURGICAL COMPLICATION, ORGAN FAILURE OR HIGH LACTATE LEVELS SHOULD BE TREATED MEDICALLY WITH ENDOVASCULAR REVASCULARIZATION WHENEVER POSSIBLE.

AT LATER STAGES, SURGICAL MANAGEMENT REQUIRES BOTH RESECTION & REVASCULARIZATION. ANY FACTOR THAT MAY HAVE CONTRIBUTED TO THIS ISCHAEMIC STROKE (I.E ATHEROSCLEROSIS, CARDIAC EMBOLISM OR THROMBOPHILIA) SHOULD BE INVESTIGATED &TREATED, WITH PARTICULAR REFERENCE TO ISCHAEMIC COLITIS & NON-OCCLUSIVE MESENTERIC ISCHEMIA.

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