ISCHEMIA OF THE BOWEL

¹ From the Department of Radiology, St. Luke's Hospital Center, New York, New York

It has been repeatedly demonstrated, both clincally and experimentally, that depending upon the site and extent of vascular occlusion, roentgenographic changes can vary from a mild transient structural abnormality in the bowel wall to a destructive irreversible necrosis with perforation or stricture formation. Massive ischemia can result in death.

The delicate balance between vascular supply and the metabolic need of the intestine defies quantitation, even by relatively sophisticated methods. The incidental finding of major vessel occlusion, e.g., superior mesenteric artery or celiac axis during retrograde catheterization of a patient with an unrelated condition with no bowel symptomatology, is a common experience. This is not to imply that a major arterial block is not important in evaluating a patient with insufficiency, but merely to emphasize the commonly experienced frustrating inconsistency of this disease state.

The degree of collateralization, extent of bowel involved, acuteness of occlusion, and the varying metabolic needs of different areas of the bowel all play a significant part in the balancing process.

It would seem that the most secure diagnosis depends on visualization of arterial insufficiency plus the abnormalities in contour of the bowel wall by barium enema studies. Two cases have been reported to illustrate characteristic changes of ischemia in the small bowel and large bowel.

Barium enema studies should precede arterial catheterization. If actual ischemic disease is demonstrated, then correlation with arterial catheterization will allow a more realistic evaluation of the patient's vascular status.

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