60-year-old female patient presented with acute abdomen and signs of shock. A partial resection of the small intestine was performed.
- A section through the intestinal wall and the attached mesentery is shown.
- The architecture of the intestinal wall is maintained. However, the wall is swollen due to marked edema.
- The blood vessels show prominent congestion. Extensive interstitial hemorrhage permeates the wall and part of the mesentery.
- The mucosa shows extensive, submucosa and muscularis propria show beginning necrosis.
Small intestinal infarction may be due to mesenteric arterial or venous occlusion. In both instances the net result will be hemorrhagic infarction due to blood reflow into the damaged area. Infarction is more frequently caused by arterial occlusion. The latter may be due to arterial thrombosis (e.g. severe atherosclerosis, systemic vasculitis) or arterial embolism (e.g. cardiac vegetations in endocarditis of the mitral or aortic valve). Venous thrombosis is observed in patients with hypercoagulable states, intraperitoneal sepsis, cirrhosis or invasive carcinoma, especially hepatocellular carcinoma.