Intestinal Infarction Without Mesenteric Vascular Occlusion

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Abstract
The records of 31 patients who died with infarction of the gastrointestinal tract without mesentric vascular occlusion were examined and their salient clinical, laboratory and pathologic findings summarized. The signs and symptoms were not typical of any distinct clinical syndrome and could mimic any intraabdominal catastrophe. Three patients had no abdominal findings. Albuminuria was the only consistent laboratory finding. The most constant pathological correlation was with chronic heart disease which was present in 30 patients. There were cardiac valvular lesions in 14 patients, cardiac arrhythmias in 17 and congestive heart failure in 22. Ten of the 14 patients with valvular lesions had aortic insufficiency. Of the 16 patients who had clinical shock, only 9 developed shock before abdominal symptoms appeared. Seven of those 9 were treated with vasopressor agents. It would appear that in man, as opposed to certain other mammalian species, shock does not play an important role in the etiology of bowel infarction unless there is preexisting cardiovascular disease. Chronic heart disease seems to be the most important factor in predisposing to bowel infarction. In the presence of chronic heart disease, acute illness such as myocardial infarction, acute cardiac decompensation, shock, infection, or surgery may precipitate irreversible infarction of the bowel.