Intestinal infarction in the absence of occlusive mesenteric vascular disease

Abstract Nine cases of intestinal infarction in the absence of occlusive mesenteric vascular disease are added to the 100 cases previously reported. One case is described in detail. The histologic examination of the bowel in all 9 cases revealed edema, vascular congestion and hemorrhage into the mucosa and submucosa. Some degree of necrosis of the bowel wall was observed in all of the cases reviewed. Evidence of heart disease was present in all cases with congestive heart failure, present clinically in 7 of the 9 cases, and pathologic and anatomic evidence of congestive failure demonstrated in all. Of the total of 109 cases now reported 75 had congestive heart failure. Most of these patients had such cardiac or circulatory conditions that a reduced cardiac output and mesenteric angiospasm might be anticipated. That angiospasm of the mesenteric vasculature can significantly contribute to the ischemia and necrosis of the bowel seen in these patients appears reasonably well established. In addition, it also seems reasonable to presume that the vascular sclerosis in many of these patients might also be an underlying factor. It would also appear that the congestion of the bowel seen in these and in many similar patients might be expected to contribute to the development or extension of the infarction.