OCCLUSIVE AND NONOCCLUSIVE GASTROINTESTINAL ISCHEMIA - A CLINICAL REVIEW WITH SPECIAL EMPHASIS ON THE DIAGNOSTIC-VALUE OF TONOMETRY

Background: To review clinical features of the occlusive splanchnic is chaemia syndromes with special emphasis on the diagnostic value of ton ometry. Methods: The English literature was reviewed with an emphasis on papers concerning anatomy and physiology of splanchnic perfusion, t he clinical presentation and diagnostic procedures in occlusive splanc hnic ischaemia syndromes. Results: Splanchnic ischaemia can result fro m hypovolaemic states, resulting in splanchnic vasoconstriction and is chaemia with normal splanchnic vessels (non-occlusive ischaemia) or fr om vascular stenoses (occlusive ischaemia). The former is frequently e ncountered in critically ill patients, whereas the latter is considere d rare, despite a relatively high incidence of splanchnic atherosclero sis. The main problem hindering assessment of the incidence of symptom atic chronic splanchnic ischaemia is the lack of a diagnostic procedur e separating symptom-free from symptomatic splanchnic atherosclerosis. Although angiography provides precise anatomical information, the cor relation with symptoms is poor. From various studies it emerges that t onometry of luminal PCO2 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 PC O2 may be the most promising technique for detecting and grading splan chnic ischaemia.