The histological findings in the bowel include atrophy of the tips of the villi, which leads to loss of the absorptive surface in the small bowel. The loss of the absorptive surface in conjunction with the patient's fear of eating results in the malnourished state commonly seen in this condition. Because of the high rate of thrombosis, medical management as a sole treatment is warranted only in patients whose risk with surgery outweighs the benefits. Some patients may find short-term relief with nitrate therapy. However, this treatment is not curative.
Medical management includes anticoagulation therapy with warfarin.
Once a diagnostic arteriogram is performed and surgery is deemed appropriate, start intraarterial papaverine to reduce the risk of arterial spasm. Stenting of visceral vessels has been reported with some success and may be an alternative to surgery. Due to the long period of malnutrition, patients should receive parenteral nutrition prior to surgery. Cross and match 2 units of blood. Bowel prep the patient the night prior to surgery, and arrange for patient to ingest nothing by mouth past midnight.