Fifty Shadows of Mesenteric Ischemia

A 66-year-old female presented to the emergency department with sudden onset of central abdominal pain irradiated to the back. Blood tests were unremarkable. Computed tomography scan showed acute focal ischaemia of small bowel loops sustained by an encircling omental band around a mid ileal loop, which was released on urgent mini-laparotomy. The ischaemic loops were covered with hot moist gauzes for several minutes until the normal luster and peristaltic wave returned. Indocyanine green fluorescence angiography confirmed sufficient bowel perfusion and viability. The patient was discharged 5 days after surgery and did not experience any symptom recurrence up to 6 months later. Mesenteric or colonic ischaemia may respectively affect the small or large intestine. The small intestine is able to compensate for a 75% reduction in mesenteric perfusion for up to 12 hours. If promptly treated, resection may be successfully avoided.