Occlusive and non-occlusive gastrointestinal ischaemia: a clinical review with special emphasis on the diagnostic value of tonometry.

BACKGROUND

To review clinical features of the occlusive splanchnic ischaemia syndromes with special emphasis on the diagnostic value of tonometry.

METHODS

The English literature was reviewed with an emphasis on papers concerning anatomy and physiology of splanchnic perfusion, the clinical presentation and diagnostic procedures in occlusive splanchnic ischaemia syndromes.

RESULTS

Splanchnic ischaemia can result from hypovolaemic states, resulting in splanchnic vasoconstriction and ischaemia with normal splanchnic vessels (non-occlusive ischaemia) or from vascular stenoses (occlusive ischaemia). The former is frequently encountered in critically ill patients, whereas the latter is considered rare, despite a relatively high incidence of splanchnic atherosclerosis. The main problem hindering assessment of the incidence of symptomatic chronic splanchnic ischaemia is the lack of a diagnostic procedure separating symptom-free from symptomatic splanchnic atherosclerosis. Although angiography provides precise anatomical information, the correlation with symptoms is poor. From various studies it emerges that tonometry of luminal PCO2 enables assessment of ischaemia.

CONCLUSIONS

Splanchnic ischaemia may be more common than currently assumed, but a gold standard diagnostic tool is lacking. Tonometry of the gastric PCO2 may be the most promising technique for detecting and grading splanchnic ischaemia.