Case

A 53 year old patient undergoes a CT angiogram for a suspected aortic aneurysm. An incidental finding shows an embolic clot has broken free and completely blocked the right colic artery. However, the patient is exhibiting no symptoms.

Question 1/3 - Why are they symptom free?

Click on your selected option(s) below  (correct = 1, over-thinking = 2+)

Incorrect. Emboli are rarely transient. Also, any dislodged particle moves in the direction of blood flow, which is to smaller vessels in the target organ. To reach the lung the blockage would have to enter the organ capillaries then into the venous system before return to the lungs, as the capillaries are very small any fragments get trapped in vessels of smaller diameter than the fragment. 

Emboli go to the lung only when they form in veins. From a vein, an particle moves through larger veins to the lung and then becomes trapped inside one of the progressively smaller branches distributing into the lung tissue (i.e. a pulmonary embolism). 

Correct!  In the large intestines there is a tangentially running marginal artery from the cecum around to the sigmoid colon, this can often shunt blood to cover territory when an intermediate feeder artery becomes blocked. In the small intestines the equivalent system is present in the arcades allowing some blood to move tangentially from different parts of the intestines to other parts.

Incorrect. A the radiology report in the case stem indicates a complete blockage, not a stenosis (narrowing). In a stenosis some blood passes through, often enough to sustain the organ until the stenosis becomes rate limiting narrow. 

Incorrect. Even a small region of bowel becoming necrotic is a life threatening condition. The bowel wall fails in the region of necrosis leaking intestinal contents into the peritoneum or infecting blood stream. Life threatening sepsis is highly likely in this situation.

Incorrect.  An arterial blockage that generates ischemia will usually manifest symptoms on time scales proportional to the target tissues tolerance for ischemia - brain is tolerant of lack of blood/oxygen for minutes only, organs can handle flow loss for up to an hour, limbs are quite resistant but still on the order of several hours...no body tissue can tolerate ischemia for weeks.