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March 1966

Intestinal Infarction Resulting From Nonobstructive Mesenteric Arterial Insufficiency: With a Note on Hepatic Hypoglycemia as a Possible Aid in Diagnosis

Author Affiliations

From the Clinic of Surgery, National Heart Institute, National Institutes of Health, Bethesda.

Arch Surg. 1966;92(3):374-378. doi:10.1001/archsurg.1966.01320210054010

GASTROINTESTINAL hemorrhage and necrosis may result from intestinal ischemia secondary to inadequate cardiac output and increased splanchnic vascular resistance.* A variety of conditions, including severe congestive heart failure, acute myocardial infarction, shock, cardiac arrhythmias, and extensive operative procedures, may precipitate intestinal ischemia. The clinical manifestations which accompany this process are determined by the degree of mesenteric vascular insufficiency and range from transient abdominal angina, nausea, and diarrhea to signs of a perforated viscus. The abdominal symptoms and signs resulting from intestinal ischemia are, however, often obscured by the presence of serious disturbances of the nervous and cardiovascular systems. Detailed descriptions of patients who have developed severe abdominal pain secondary to nonobstructive mesenteric arterial insufficiency are unusual. This report describes the clinical, operative, and pathologic findings in such a patient, who had rheumatic mitral stenosis and congestive heart failure.

Report of Case 

Clinical Summary.  —A 41-year-old woman, who had acute rheumatic

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