THE IMPORTANCE of redistribution of blood flow from the mesenteric to the peripheral vascular bed as a causal factor for mesenteric ischemia has not been appreciated. Although necrosis of the gut following aortoiliac reconstructive surgery with or without concomitant sympathectomy is uncommon, symptoms that could be due to intestinal ischemia frequently occur following these reconstructive procedures, but in most cases they are mild and reversible. Because the patient has just undergone an intra-abdominal procedure, symptoms of distention, nausea, and diarrhea are ascribed to the surgery rather than a physiological redistribution of blood flow in the mesenteric and peripheral vascular beds. The sequence and cause of the hemodynamic alterations responsible for the symptomatology and the pathological lesions have remained obscure and frequently impossible to document.
In 1963 Young et al31 reviewed the literature and collected 42 cases of severe intestinal ischemia following surgery on the abdominal aorta and its branches