In patients with acute mesenteric ischemia due to mesenteric embolism, which of the following statements is/are correct?

C. Thrombolytic therapy may be attempted in patients without signs of bowel infarction or gastrointestinal bleeding

E. At the time of exploration, the proximal jejunum is often viable and ischemia is most severe in the more distal small bowel and colon.

DISCUSSION: Patients who suffer mesenteric embolism usually have otherwise normal mesenteric arterial anatomy, and ischemic symptoms are acute and profound. A history of chronic gastrointestinal symptoms is most often seen in patients with mesenteric thrombosis. Although cardiac arrhythmias like atrial fibrillation (which predispose to mesenteric emboli) may be treated with digitalis, this has no causative role in mesenteric embolism. Digitalis use has been associated with the development of “nonocclusive” mesenteric ischemia. Thrombolytic therapy with streptokinase or urokinase has been used successfully to treat mesenteric emboli; however, patients with any signs of local or generalized peritonitis should have immediate surgical exploration. Mesenteric emboli usually lodge distally in the main superior mesenteric artery beyond the first jejunal branches and the origin of the middle colic artery. The orifice of the superior mesenteric artery and the proximal branches are normal, which explains the “jejunal sparing” often observed at the time of surgical exploration, even when arteriography has not been performed.