Overview
Nonocclusive intestinal infarction (NSII) refers to ischemic injury to the bowel without mechanical obstruction, often challenging to diagnose due to overlapping clinical signs with other gastrointestinal disorders like idiopathic peritonitis and acute colitis 1.Diagnosis
Clinical Signs: Gastric reflux >5L, abnormal rectal palpation findings (intestinal dilatations/impactions, colon displacements, intestinal mass) 1.
Laboratory Findings: Elevated white blood cell count, decreased packed cell volume 1.
Imaging: Careful microscopic examination of distal mesenteric arteries for intimal fibromuscular proliferation and luminal narrowing 2.
Diagnostic Imaging: Early detection using 99mTc-pyrophosphate scintigraphy, effective within 15 minutes post-injection 3.Management
Surgical Intervention: Early surgical exploration and resection of infarcted segments are crucial for improved survival 1.
Supportive Care: Fluid resuscitation, monitoring of vital signs, and supportive measures to manage complications 1.
Monitoring: Continuous assessment of laboratory parameters and clinical status for timely intervention 1.Special Populations
Horses: Specific diagnostic criteria apply; careful rectal examination and imaging are particularly important 1.Key Recommendations
Early Surgical Exploration for horses presenting with suggestive clinical signs (gastric reflux >5L, rectal abnormalities) to diagnose and manage nonocclusive intestinal infarction promptly (Evidence: Moderate 1).
Utilize 99mTc-pyrophosphate scintigraphy for early detection of experimental small-bowel infarction, aiding in timely intervention (Evidence: Moderate 3).
Thorough Microscopic Examination of distal mesenteric arteries is essential in diagnosing nonocclusive infarction due to subtle arterial changes (Evidence: Weak 2).References
1 Poulsen L, Henriksson FV, Dahl M, Honoré ML, Olsen SN, Leifsson PS et al.. Differentiating Strongylus vulgaris-associated, non-strangulating intestinal infarctions from idiopathic peritonitis and acute colitis in horses. The Veterinary record 2023. link
2 McGregor DH, Pierce GE, Thomas JH, Tilzer LL. Obstructive lesions of distal mesenteric arteries. A light and electron microscopic study. Archives of pathology & laboratory medicine 1980. link
3 Barth KH, Alderson PO, Strandberg JD, Fara JW. Early imaging of experimental intestinal infarction with 99mTc-pyrophosphate. Radiology 1979. link