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Intestinal ischemia is an uncommon vascular disease associated with a high mortality that generally presents in patients more than 60 years of age.
The SMA comes off of the ventral aorta and supplies the midgut by giving off the inferior pancreaticoduodenal artery and the middle colic, right colic, and jejunal and ileal branches. The splanchnic blood flow normally ranges from 10- 40% of the cardiac output depending on the state of the patient.
Intestinal ischemia occurs when there insufficient perfusion to intestinal tissues produces ischemic tissue injury.
Blood supply to the intestines includes the celiac artery, superior mesenteric artery (SMA), inferior mesenteric artery (IMA), and branches of the internal iliac artery (IIA). Processed foods, beverages and stress sometimes affect the microbial balance in our intestines. Kolorex® Advanced Candida Care contains a patented liquid extract of New Zealand Active Horopito™ (Pseudowintera colorata). The plants are grown on a certified organic farm, and are independently tested for activity.
Our program provides a multidisciplinary team approach, combined with focused and customized care. Because she was born with a rare intestinal disorder, little Crista has struggled for almost all of her short life. Nebraska Medicine's Intestinal Failure Team provides extensive support and education to patients and their families throughout their journey at our center, and even after they return home. For over 10 years Nebraska Medicine has provided adults and children with intestinal rehabilitation care. Intestinal failure is the inability of the small bowel to ingest, digest and absorb nutrients, water and electrolytes required to maintain the nutritional status in adults and the nutritional status and growth in children. Functional intestinal failure is caused by the intestine's inability to absorb or digest food or fluids. Patients can undergo a comprehensive medical and nutritional assessment in an inpatient or outpatient setting.
The plan of care for many patients evaluated for intestinal failure begins with Intestinal Rehabilitation.
Oftentimes, patients and caregivers will stay in the Omaha area for a period of time to allow our team to get to know the patient, their needs and to develop a plan of care to continue as we assist with medical management with local healthcare teams when at home. The Pediatric Feeding Disorders Program provides a comprehensive approach to assisting our patients to enjoy a meal around the table like so many other families do through assessment and treatment services. Assessment by an experienced surgeon specializing in the bowel and liver surgeries can lead to surgical options based on the needs of the individual. The Intestinal Rehabilitation program will continue to work with you, your family and your local physicians well after you leave Omaha. Nebraska Medicine is the premier transplant program in the country focused on outstanding patient outcomes.
If complications associated with intestinal failure due to the inability to wean from intravenous nutrition occur, you may be asked to consider intestinal transplantation. You and your family members may find it very confusing and frightening when you learn you may be in need of a transplant. Following a discussion with the transplant team, the patient's medical case is discussed in a multi-disciplinary patient selection committee meeting.
Depending on the organ(s) transplanted, the operation will take between four to seven hours to complete. At Nebraska Medicine you will receive education regarding the entire transplant process from one of the world's most experience intestinal transplant teams.

Many highly trained nurse coordinators who specialize in pediatric and adult intestinal failure. The inferior mesenteric artery provides blood to the distal transverse, descending, and sigmoid colon and the rectum. This wide variation in flow through the mesenteric system is caused by local and regional control mechanisms.
Extensive collateralization occurs between major mesenteric trunks and branches of the mesenteric arcades. Griffiths' and Sudeck's points (shaded areas) are watershed areas within the colonic blood supply and common locations for ischemia. Emboli originate from the heart in >75% of cases and lodge preferentially just distal to the origin of the middle colic artery from the superior mesenteric artery. In the last six years, Braxton has had 11 central line placements, 15 scopes, 13 major abdominal surgeries, plus additional procedures requiring anesthesia.
After many long hospital stays, Crista's foster mother brough her to the Intestinal Rehabilitation Program (IRP) at Nebraska Medicine.
The team approach to care offers patients a customized treatment plan, support and education to intestinal rehabilitation patients and their families. The causes of intestinal failure are often divided into two major categories: structural and functional failure.
Consultation is provided by a multi-disciplinary team with vast experience in intestinal failure and intestinal rehabilitation.
Medical management or surgical intervention is determined based on each individual patients underlying medical condition by our experienced and skilled team of gastroenterologists, surgeons, dieticians, social workers and nurse coordinators.
While we are known for taking on the most severe cases and helping those children to become age-typical developmentally appropriate eaters, we are at the forefront in this research arena. Procedures may include: repair of fistulas, ostomy takedown to restore small bowel to remaining colon for enhanced enteral absorption, small bowel lengthening and tapering procedures or reverse intestinal segments. Our team will always be available for questions or consultations 24 hours per day, 7 days per week.
For over 20 years Nebraska Medicine has provided adults and children with intestinal transplant care. This team meeting will determine if intestinal transplantation is an appropriate treatment for you.
This time of waiting can be a difficult time for you and your family because there is no way to know when a suitable donor organ will become available. Patients return to the Intensive Care Unit for one to two weeks or longer following surgery.
This team includes transplant surgeons, gastroenterologist, dieticians, pharmacists, social workers, pain therapists, feeding therapists and clinical transplant coordinators. However, the transplant team will continue to monitor lab work and adjust the anti-rejection medications.
It is categorized according to etiology: (1) arterioocclusive mesenteric ischemia (AOMI), (2) nonocclusive mesenteric ischemia (NOMI), and (3) mesenteric venous thrombosis (MVT).
Adenosine, a metabolic byproduct of ischemia, causes dilation of the splanchnic vessels, as does nitric oxide. Collateral vessels within the small bowel are numerous and meet within the duodenum and the bed of the pancreas (Griffiths' point).
Embolism most frequently is due to a dislodged thrombus originating from the left atrium, left ventricle, or cardiac valves. Kolorex® Advanced Candida Care helps maintain balanced intestinal micro-flora, including Candida*.

Here, doctors, nurses and coordinators pay close, personal attention to every patient, and believe once you are part of the intestinal rehab program, you are family. Russell was treated at Nebraska Medicine's Intestinal Rehabilitation Program; something he believes saved his life. Following evaluation an individualized plan of care is developed and shared with patient, family and referring physicians.
Treatment options are discussed to determine the best opportunities for patients and their caregivers. Our team of experts has shown that surgical intervention enhances many patients' ability to be weaned off enteral or parenteral nutrition. We ask our patients to stay in contact with our nurse coordinators and dietitians frequently in order to optimize care. The team approach offers patients a customized treatment plan, support and education to transplant patients and their families.
That is why we have a designated transplant team member who is available to talk with you about your disease, various treatment options and which options are best suited to treat your disease. A transplant coordinator will contact patients after the meeting to discuss the suggested plan of care. Some patients may only wait days or weeks, while others may wait for months or years for transplant. The time spent in Omaha allows you and your family to become familiar with the necessary care you will need to maintain following transplantation. In addition, we will follow any health problems or concerns and may ask you to return to Omaha if we do not feel we can safely handle a medical issue over the phone.
Therefore, progressive diminution of flow in one or even two of the main mesenteric trunks is usually tolerated.
The sympathetic system antagonizes these vasodilatory effects and causes redirection of the blood from the gut to the more vital brain and heart during times of stress. Every effort is made to reduce or eliminate the need for parenteral or enteral nutrition through medical, surgical and nutritional intervention. Our patients are to come back to Intestinal Rehabilitation Clinic every 3 to 6 months if possible. In addition, our team of doctors, nurses, technicians, dietitians, social workers and many others are available to provide you with care and support throughout the transplant process, during your hospital stay and even after you return home. Many patients remain in the Omaha area for three to six months following transplantation for optimal nutritional support, physical rehabilitation, feeding therapy and stabilization of lab work, including anti-rejection medication. In contrast, acute occlusion of a main mesenteric trunk may result in profound ischemia due to lack of sufficient collateral flow. Activation of the renin-angiotensin pathway also cause vasoconstriction of the splanchnic bed. The transplant program has clinical coordinators on call 24 hours a day though the year, including holidays and weekends. During times of hypovolemia, a patient may experience nonobstructive mesenteric ischemia because of the low-flow state. These areas are inherently at risk for decreased blood flow and are the most common locations for colonic ischemia. The mechanism by which a patient experiences pain because of the ischemia is poorly understood.

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