Exploratory laparotomy without arteriography to restore mesenteric flow may be justified in critically sick patients in whom clinical suspicion is high. Thrombolytic therapy with intra-arterial streptokinase or urokinase has been used in the treatment of splanchnic embolism with modest success, but it is not a good alternative to surgical reperfusion unless the surgical risk is very poor. Infarction of a portion of the liver from hepatic artery embolism and splenic infarction from splenic artery embolism may occur, but they rarely require surgical intervention. Prognosis is poor. It is characterized by the sudden onset of pain, pallor, paralysis, and coldness in the legs.
Urgent embolectomy is indicated and can usually be performed transfemorally.
Because collateral circulation between the major splanchnic trunks is extensive, chronic mesenteric vascular insufficiency almost invariably involves high-grade narrowing or occlusion of both the celiac axis and the superior mesenteric artery. The usual cause is arteriosclerosis. Pain may be relieved quickly by sublingual nitroglycerin, aiding diagnosis. Patients become fearful of eating, and weight loss, often severe, is the rule. Intestinal malabsorption may contribute to weight loss.