Case Discussions X2

[Krin135 at aol.com]

In a message dated 2/6/2007 12:15:05 PM Central Standard Time,  
wildmedic at gmail.com writes:

Absolute  postulation, but what about a mesenteric artery intimal tear that
later  causes dissection and subsequent thrombotic  obstruction?


or one along the arch of Riolan? 
 
from _http://www.gastroresource.com/GITextbook/en/chapter8/8-3-pr.htm_ 
(http://www.gastroresource.com/GITextbook/en/chapter8/8-3-pr.htm)   figure 2:
 
      Figure 2. Schematic representation  of splanchnic circulation.
 
There is an area of limited circulation just caudal to the splenic flexure  
(right in the area of interest), where the blood feed from the superior and  
inferior mesenteric arteries join. If your patient does not have a  functional 
Arch of Riolan (either for developemental reasons or due to  occult trauma), 
and there is damage to either of the mesentaric arteries (the  intimal tear 
noted above, for example), then I can see the delayed ischemic  results happening 
after the patient is mobile and eating well, as those would  increase the 
metabolic demands on the gut.
 
ck
Charles S. Krin, DO FAAFP