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Zahir M

Causes
Fall in cardiac output: cardiac failure,
myocardial infarction
Vascular occlusion: emboli from AF or MI,
thrombosis, particularly atheroma,
polycythaemia, and pts on oral contraceptive
pill
Microvascular damage: hypersensitive
reaction, endotoxins
Reduced circulation & dehydration
Strangulation relating to hernia, acute
vascular occlusion(SMA occlusion due to
thrombosis or embolus)

Treatment
Correction of shock with fluid
IV broad spectrum antibiotics (Cefuroxime, gentamicin and metronidazole or Tazocin
and metronidazole)
Digitalise AF +/- angiography
Continuous heparinisation or high dose S/C tinzaparine/
Transfer to ITU
Laparotomy, vascular reconstruction or embolectomy (re-circulation in the bowel)
Resection of necrotic areas and either primary anastomosis or exteriorization.
A re-look laparotomy at 48 hours unless there is clear general recovery, since further
ischaemic changes requiring surgery may have developed.