Acute Gastro-intestinal Lesions and Acute Mesenteric Ischaemia

  • J. R. Le Gall
  • P. L. Fagniez


Gastro-intestinal (GI) bleeding may be the cause of admission to an ICU or a complication occurring in a patient hospitalized for another problem. In the first group, endoscopy allows the diagnosis in 95% of cases [36]. The second group will be described here, with especial reference to acute gastroduodenal lesions and acute mesenteric ischaemia in critically ill patients.


Ischemia Aspirin Acidity Angiotensin Dehydration 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    . Belliveau P, Vas S, Himal HS (1978) Septic induced acute gastric erosion. The role of cimetidine. J Surg Resp 24: 264–271CrossRefGoogle Scholar
  2. 2.
    . Croker JR (1979) Acute gastro intestinal bleeding in the critically ill patient. Intensive Care Med 5: 1–4PubMedCrossRefGoogle Scholar
  3. 3.
    . Czaja AJ, McAlhany JC Pruitt BA (1974) Acute gastroduodenal disease after thermal injury and endoscopic evaluation of incidence and natural history. N Engl J Med 291: 245–253CrossRefGoogle Scholar
  4. 4.
    . Davenport HW (1964) Gastric mucosal injury by fatty and acetylsalicylic acids. Gastroenterology 46: 245–253PubMedGoogle Scholar
  5. 5.
    . Deysine M, Katzka D (1977) Prevention of experimental gastric stress bleeding by intravenous hyperalimentation. Intensive Care Med 3: 156Google Scholar
  6. 6.
    . Fogelman MJ, Gravey JM (1966) Acute gastroduodenal ulceration incident to surgery and disease. Am J Surg 112: 651PubMedCrossRefGoogle Scholar
  7. 7.
    . Glass GBJ (1976) Mucus and gastric injury. In: Belk IT (ed) North American Symposium on carbenoxolone. Excerpta Medica, Princeton, pp 32–47Google Scholar
  8. 8.
    . Hasting PR, Skillman JJ, Bushnell LS, Silen W (1978) Antacid titration in the prevention of acute gastrointestinal bleeding. A controlled, randomized trial in 100 critically ill patients. N Engl J Med 298: 1041–1045CrossRefGoogle Scholar
  9. 9.
    . Kamada T, Fusamoto H, Kawano S, Noguchi M, Hiramatsu K, Masuzawa H, Sato N (1977) Acute gastroduodenal lesions in head injury. Am J Gastroent 68: 249–253PubMedGoogle Scholar
  10. 10.
    . Kiefharer P, Nath H, Monitz K (1977) Endoscopic controle of massive gastro-intestinal hemorrhage by irradiation with a high-power neodynium yag laser. Prog Surg 15: 140–144Google Scholar
  11. 11.
    . Kivilaakso E, Fromm D, Silen W (1978a) Relationship between ulceration and intramural pH of gastric mucosa during hemorrhagic shock. Surgery 84: 70–78Google Scholar
  12. 12.
    . Kivilaakso E, Fromm D, Silen W (1978b) Effect of the acid secretory state on intramural pH of rabbit gastric mucosa. Gastroenterology 75: 641–648Google Scholar
  13. 13.
    . Le Gall JR, Mignon FC, Rapin M, Redjemi M, Harari A, Bader JP, Soussy CJ (1976). Acute gastroduodenal lesions related to severe sepsis. Surg Gynecol Obstet 142: 377–380PubMedGoogle Scholar
  14. 14.
    . Levy E, Malafosse M, Huguet C, Liégeois A, Loygue J (1977) Prophylaxie des hémorragies gastroduodenales graves post-operatoires par la réanimation entérale continue hypernutritionnelle précoce. Intensive Care Med 3: 155Google Scholar
  15. 15.
    . Lewis FA (1973) Gastroduodenal ulceration and haemorrhage of neurogenic origin Br J Surg 69: 279Google Scholar
  16. 16.
    . Lucas CE, Sugawa C, Riddle J, Rector F, Rosenberg B, Walt AJ (1971) Natural history and surgical dilemma of “stress” gastric bleeding. Arch Surg 102: 266–273PubMedCrossRefGoogle Scholar
  17. 17.
    . MacDougall BRD, Bailey RJ, Williams R (1977a) H2 receptor antagonists and antacids in the prevention of acute gastro-intestinal hemorrhage in fulminant hepatic failure. Two controlled trials. Lancet I: 617–619CrossRefGoogle Scholar
  18. . MacDougall BRD, Bailey RJ, Williams R (1977b) Histamine H2 receptor antagonists in the prophylaxis and control of acute gastro-intestinal hemorrhage in liver disease. Cimetidine. Excerpta Medica, pp 329–336Google Scholar
  19. 19.
    . Martin LF, Staloch DK, Simonowitz DA, Patchen Dellinger E, Max MH (1979) Failure of cimetidine prophylaxis in the critically ill. Arch Surg 114: 492–496PubMedCrossRefGoogle Scholar
  20. 20.
    . McDonald AS, Steele BJ, Bottomley MG (1976) Treatment of stress-induced upper gastro-intestinal hemorrhage with metiamide. Lancet I: 68–70CrossRefGoogle Scholar
  21. 21.
    . McDonald AS, Pyne DA, Freeman A (1978). Upper gastro-intestinal bleeding in the intensive care unit. Can J Surg 21: 81–85Google Scholar
  22. 22.
    . McElwee HP, Stirineck KR and Levin BA (1979) Cimetidine affords protection equal to antacid in prevention of stress ulceration following thermal injury. Surgery 86: 620–626PubMedGoogle Scholar
  23. 23.
    . Menguy R (1980) The prophylaxis of stress ulceration. N Engl J Med 302: 461–462PubMedCrossRefGoogle Scholar
  24. 24.
    . Priebe HJ, Skillman JJ, Bishnell LS, Long PC, Silen W (1980) Antacid versus cimetidine in preventing acute gastro intestinal bleeding. A randomized trial in 75 critically ill patients. N Engl J Med 302: 426–430PubMedCrossRefGoogle Scholar
  25. 25.
    . Pruitt BA, Foley ED, Moncried JQ (1970) Cushing’s ulcer: a physiopatho logical study of 323 cases. Ann Surg 172: 523–530PubMedCrossRefGoogle Scholar
  26. 26.
    . Richardson JD, Avst JB (1977) Gastric devascularization: a useful lavage procedure of massive hemorrhagic gastritis. Ann Surg 185: 649–655PubMedCrossRefGoogle Scholar
  27. 27.
    . Ritchie WP Jr, Shearburn LW (1977) Influence of isoproterenol and cholestyramine on acute gastric mucosal ulcerogenesis. Gastroenterology 73: 62–65PubMedGoogle Scholar
  28. 28.
    . Skillman JJ, Silen W (1970) Acute grastroduodenal “stress” ulcerations barrier disruption of varied pathogenesis? Gastroenterology 59: 478–482PubMedGoogle Scholar
  29. . Silen W, Skillmann JJ (1979) Stress ulcers in gastrointestinal surgery. Year Book Medical Publishers Chicago, pp 949–952Google Scholar
  30. 30.
    . Simonian SJ, Curtis LE (1976) Treatment of hemorrhagic gastritis by antacid. Ann Surg 184: 429–432PubMedCrossRefGoogle Scholar
  31. 31.
    . Smith P, O’Brien P, Fromm D, Silen W (1977) Secretary state of gastric mucosa and resistance to injury by exogenous acid. Am J Surg 138: 81–85CrossRefGoogle Scholar
  32. 32.
    . Solem LD, Strate RG, Fisher RP (1979) Antacid therapy and nutritional supplementation in the prevention of Curling’s ulcer. Surg Gynecol Obstet 148: 367–370PubMedGoogle Scholar
  33. 33.
    . Strauss RJ, Stein TA, Mandell C, Wise L (1978a) Cimetidine, carbenoxolone sodium and antacids for the prevention of experimental stress ulcers. Arch Surg 113: 858–862PubMedCrossRefGoogle Scholar
  34. 34.
    . Strauss JR, Stein TA, Wise L (1978b) Prevention of stress ulcerations using H2 receptor antagonists. Am J Surg 135: 120–125PubMedCrossRefGoogle Scholar
  35. . Stremple JR, Mori H, Lev R, Glass GBJ (1973) The stress ulcer syndrome. Curr Probl Surg (April): 36–42Google Scholar
  36. 36.
    . Vilar HV, Fenker RH, Watson LC, Thompson JC (1977) Emergency diagnosis of upper gastro-intestinal bleeding by endoscopy. Ann Surg 185: 367–374CrossRefGoogle Scholar
  37. 37.
    . Watts CL, Clark K (1969) Gastric acidity in the comatose patients. J Neurosurg 30: 107–110PubMedCrossRefGoogle Scholar
  38. 1.
    Aakus T, Braband G (1967) Angiographie in acute superior mesenteric arterial insufficiency. Acta Radiol [Diagn] Stockh 6: 1–12Google Scholar
  39. 2.
    Adar R, Franklin A, Spark RF, Rosoff CB, Salzman EW (1976) Effect of dehydration and cardiac tamponade on superior mesenteric artery flow: Role of vaso-active substances. Surgery 79: 534–548PubMedGoogle Scholar
  40. 3.
    Aldrete JS, Han SY, Laws HL, Kirklin JW (1977) Intestinal infarction complicating low cardiac output states. Surg Gynecol Obstet 144: 371–375PubMedGoogle Scholar
  41. 4.
    Boley SJ, Schwartz S, Lash J (1963) Reversible vascular occlusion of the colon. Surg Gynecol Obstet 116: 53–60PubMedGoogle Scholar
  42. 5.
    Boley SJ, Sprayregan S, Siegelman S, Veith FJ (1977) Initial results from an aggressive roentgenological and surgical approach to acute mesenteric ischemia. Surgery 82: 848–855PubMedGoogle Scholar
  43. 6.
    Bounous G, Sutherland NG, Mc Ardle AH (1969) The prophylactic use of an elemental diet in experimental haemorrhagic shock and intestinal ischemia. Ann Surg 166: 312–343Google Scholar
  44. 7.
    Brown RA, Chiv C, Scott HJ (1970) Ultrastructural changes in the canine mucosal cell after mesenteric arterial occlusion. Arch Surg 101: 290–297PubMedCrossRefGoogle Scholar
  45. 8.
    Dawson MA, Schaeffer JW (1971) The clinical cause of reversible ischemic colitis. Gastroenterology 60: 577–580PubMedGoogle Scholar
  46. 9.
    Ende N (1958) Infarction of the bowel in cardiac failure. N Engl J Med 258: 879PubMedCrossRefGoogle Scholar
  47. 10.
    Hoyle M, Kennedy A, Prior AL, Thomax GE (1977) Small bowel ischemia and infarction in young women taking oral contraceptive and progestational agent. Br J Surg 64: 533–537PubMedCrossRefGoogle Scholar
  48. 11.
    Jackson BB (1963) Occlusion of the superior mesenteric artery. Monograph in American lectures in surgery. Thomas, Springfield, pp 1–141Google Scholar
  49. 12.
    Kangwalklai K, Saadat S, Bella E, Enquist IF (1973) Space studies during occlusion of the superior mesenteric artery. Surg Gynecol Obstet 137: 263–266PubMedGoogle Scholar
  50. 13.
    Lescher TJ, Bombeck T (1977) Mesenteric vascular occlusion associated with oral contraceptive use. Arch Surg 112: 1231–1232PubMedCrossRefGoogle Scholar
  51. 14.
    Marston A (1964) Patterns of intestinal ischemia. Ann R Coll Surg Engl 35: 150–181PubMedGoogle Scholar
  52. 15.
    Ottinger LW (1974) Non-occlusive mesenteric infarction. Surg Clin North Am 54: 689–698PubMedGoogle Scholar
  53. 16.
    Ottinger LW, Austen WG (1967) A study of 136 patients with mesenteric infarction. Surg Gynecol Obstet 124: 251–261PubMedGoogle Scholar
  54. 17.
    Pierce GE, Brockenbrough EC (1970) The spectrum of mesenteric infarction. Am J Surg 119: 233–239CrossRefGoogle Scholar
  55. 18.
    Recek C, Kren V, Fixa B, et al (1968) Selective mesentericography as a guide to diagnosis and treatment of acute superior mesenteric artery occlusion. J Cardiovasc Surg (Torino) 9: 184–189Google Scholar
  56. 19.
    Reiner L, Jimenez FA, Rodrigues FL (1963) Atherosclerosis in the mesenteric circulation: Observations and correlations with aortic and coronary atherosclerosis. Am Heart J 66: 200–209PubMedCrossRefGoogle Scholar
  57. 20.
    Rob C (1966) Surgical diseases of the coeliac and mesenteric arteries. Arch Surg 93: 21–32PubMedCrossRefGoogle Scholar
  58. 21.
    Shanbour LL, Jacobson ED (1972) Digitalis and mesenteric circulation. Dig Dis Sci 17: 826–827CrossRefGoogle Scholar
  59. 22.
    Sharefkin JB, Silen W (1974) Diuretic agents: Inciting factor in non occlusive mesenteric infarction. JAMA 229: 1451–1453PubMedCrossRefGoogle Scholar
  60. 23.
    Silen W (1979). Nonocclusive intestinal infarction. Gastrointestinal surgery. Year Book Medical Publishers, Chicago, pp 587–592Google Scholar
  61. 24.
    Thomchik FS, Wittenberg J, Ottinger LW (1970) The roentgenographic spectrum of bowel infarction. Radiology 96: 249–260Google Scholar
  62. 25.
    Viken JK (1973) Recovery from acute intestinal ischemia without bowel resection. JAMA 226: 776–777CrossRefGoogle Scholar
  63. 26.
    Williams LF (1971) Vascular insufficiency of the intestines. Gasteoenterology 61: 757–777Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1983

Authors and Affiliations

  • J. R. Le Gall
  • P. L. Fagniez

There are no affiliations available

Personalised recommendations