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Abstract The results of treatment of acute intestinal ischaemia are not encouraging, success is virtually confined to those cases where there are definite vascular occlusion, and there is only one recorded case in the world literature of a fully documented non-occlusive infarction having survived with treatment (Carey, J.S. et al., 1967). This is due to the complicated physiological disturbances with acute massive ischaemia of the midgut, also there are other factors which are encountered in such condition:(!) The condition usually bccurs in elderly patients, who already have established degenerative disease of the myocardium, lungs, brain and kidneys.so, under these cir mstances, intestinal failure is more a mode of dying than a cause of death. (2) Milder forms of the illness occur, which pass unrecognized and either resolve spontaneously or else respond to incidental supportive measures (Bhagwat, A.G. and Hawk W.A. 1966). (3) There are no definite laboratory tests which correlate with functionally significant intestinal ischaemia. In chronic intestinal ischaemia, it is agreed that the patient presents with a combination of upper abdominal pain,- 138 - epigastric bruit, and narrowed origin of their visceral arteries, those patients benefit from arterial reconstruction or division of the median arcuate ligament of the diaphragm, however it is very difficult to go beyond this point and to prove that the pain is caused by diminished blood flow, that this interferes with function and that the symptoms and the dysfunction. are cured by surgery. So, it is not enough to abolish the symprtoms, but it is necessary to show a measurable disturbance of function which has thus been correct by surgery. Ischaemic colitis is now a well recognized and establishPd clinical condition, which may occur spontaneously or following interference with the vasculature of the colon. Two distinct forms of the illness occur and it is rare though not unknown, for one to progress to the other. In the first place there is a severe form of colitis due to full-thickness necrosis of the colonic wall , which presents as and acute abdomen, requires urgent excisional surgery and carries a high mortality.The milder form of the illness presents as an acute left-sided peritonitis, usually associated with diarrhea and rectal bleeding, and can safely be treated expectantly, about half the patients, managed in this way will form a fibrous stricture in the colon, but only a minority of these develop symptoms which are had enough to warrant resection (Marston, A. 1977). |