Occlusive and Non-Occlusive Gastrointestinal Ischaemia: a Clinical Review with Special Emphasis on the Diagnostic Value of Tonometry

Abstract

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 PCO 2 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 PCO 2 may be the most promising technique for detecting and grading splanchnic ischaemia.