Small intestine ischemia

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Author: Mikael Häggström [notes 1]

Grossing

Gross examination

Optionally, blood vessels are dissected and submitted in several sections to detect inflammation and thrombosis

Tissue selection

Gross report

Example, in a case of acute ischemic bowel:

The specimen consists of a loop of small bowel measuring 41 cm in length and averaging 3.0 cm in diameter. The specimen is unoriented. Central areas, including mesentery, have dark red color. The surgical margins grossly appear normal and the discoloration starts approximately 3 cm from each surgical margin. The bowel is opened longitudinally and contains blood. The mucosa is dark red and granular with almost total loss of mucosal folds. There is marked hemorrhage within the mesentery. The bowel wall varies from 0.1 to 0.3 cm in thickness.

Microscopic diagnosis

Histopathology of acute small bowel gangrene, showing transmural hemorrhage and dilated blood vessels.

Acute total vaso-occlusive ischemia typically displays gangrene with transmural necrosis and ulceration.

By time since onset:[1]

  • Early:
  • Lamina propria hemorrhage
  • Superficial epithelial necrosis with preservation of deep crypts
  • Later:
  • Ulceration with minimal inflammation
  • Villous distortion
  • Pyloric gland metaplasia
  • Late: strictures of muscularis propria

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. Hanni Gulwani. Small bowel (small intestine) - Benign tumors and tumor-like conditions - Ischemia. PathologyOutlines. Topic Completed: 1 August 2012. Minor changes: 13 March 2019