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DIAGNOSIS

■ AXR may show “thumb-printing”orpneumonitis intesinalis, which are

late findings. Early findings include paucity of intestinal gas.

■ CT of the abdomen may reveal indirect signs such as ascites or bowel wall

edema and intraluminal gas in an arterial distribution.

■ CT angiography or conventional angiography remains the diagnostic test

of choice.

■ Serum lactate may aid in diagnosis but is relatively nonspecific for any

anaerobic metabolism.

■ Diagnostic laparotomy if the patient is unstable

TREATMENT

■ Resuscitation via IV fluids

■ Immediate surgery for necrotic bowel

■ IV antibiotics to cover gut flora

■ Nonocclusive ischemia may be treated with intra-arterial papaverin.

■ Chronic ischemia may be treated with revascularization.

COMPLICATIONS

■ Bowel ischemia, necrosis, perforation, shock, sepsis

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES