Intestinal infarction - what is it? Symptoms, consequences, prognosis. Causes of stomach infarction Intestinal infarction may develop due to

Intestinal infarction is a disease in which there is a blockage of the bloodstream of the mesentery, and then, due to an acute violation of the blood supply, necrosis of the intestinal wall. The disease is also called thrombosis of visceral vessels, mesenteric infarction, intestinal ischemia.

For what reasons does an intestinal infarction develop, what is it and how to treat it?

With a heart attack of the small intestine, pain occurs in the central region or the right half of the abdomen, the large intestine - in the left half, the rectum - from the bottom left.

The mechanism of the development of the disease

The mesentery, or mesentery, is a fold consisting of two sheets of peritoneum, with the help of which the hollow organs of the abdominal cavity are attached to the back wall of the abdomen. Mesenteric arteries lie in the thickness of the mesentery, providing blood supply to the intestines (see photo). The branches of the mesenteric vessels are interconnected by means of anastomoses, providing the possibility of collateral circulation.

When blood circulation is disturbed in the vessels of the mesentery, arterial occlusion occurs, a sharp decrease or complete cessation of blood flow in them and ischemia of certain sections of the intestinal tract. As a result, the tissues of a certain part of the intestine receive insufficient oxygen and nutrients and die, i.e., necrosis occurs. The necrotic tissue softens, perforation of the intestine occurs, and through the resulting hole, the contents of the intestine enter the abdominal cavity. As a result, peritonitis develops, an acute inflammation of the peritoneum - a serious condition that threatens a fatal outcome.

Causes and risk factors

Usually, ischemia of the intestinal vessels occurs against the background of the progression of cardiovascular pathology in people over 70 years of age. In older women, mesenteric infarction occurs twice as often. Taking into account the advanced age of patients and the presence of concomitant diseases, the decision on the surgical tactics of treatment can be quite difficult. The process of preparing for surgery is also delayed due to objective difficulties in making a diagnosis. Despite the optimization of diagnostic and therapy methods, mortality in the case of acute mesenteric infarction among patients reaches 50–90%.

Sometimes the onset of the disease is preceded by a period of precursors - the first signs of a developing heart attack, which patients often do not pay attention to or attribute them to indigestion.

The etiological factors leading to blockage of the bloodstream of the mesentery are divided into two groups:

• thrombotic or embolic- blockage of the mouths of the mesenteric vessels by a thrombus or embolus that migrated from the proximal parts of the vascular bed. Atherosclerosis, erythremia, myocardial infarction or endocarditis, hypercoagulability (increased blood clotting), atrial fibrillation, nonspecific aortoarteritis, prolonged blood stasis, severe intestinal infection, purulent abscess, trauma can lead to mesenteric thrombosis;
• non-occlusive- deterioration of blood flow, a decrease in blood flow through the visceral vessels. The causes of this condition can be: arterial hypotension, vasospasm of the mesentery, a decrease in cardiac output fraction, massive blood loss, congestive heart failure, dehydration.

Often, mesenteric infarction develops as a result of the simultaneous action of several causative factors.

The risk of developing the disease increases:

• advanced age (more than 60 years for women, 70 for men);
• sedentary lifestyle;
• prolonged dehydration;
• arrhythmias and other pathologies of the heart and blood vessels;
• heart surgery;
• myocardial infarction;
• cirrhosis of the liver (leads to increased pressure in the portal vein);
• chemotherapy.

Classification

To determine the most effective treatment plan, it is important to know the full diagnosis, including the form and stage of the infarct. The disease is classified according to the course, localization and degree of circulatory disorders, the predominant symptoms.

Along the course, acute and chronic forms of the disease are distinguished.

Usually, ischemia of the intestinal vessels occurs against the background of the progression of cardiovascular pathology in people over 70 years of age.

Depending on the vessels in which the circulatory disorder occurred, there are three types of heart attack:

• arterial- blood flow is disturbed in the mesenteric arteries; in most cases, this leads to a heart attack in 6-8 hours;
• venous- damage occurs in the mesenteric veins, such a violation does not lead to a heart attack immediately, but after 1-4 weeks;
• mixed- characterized by impaired blood flow, first in the arteries, and then in the veins.

According to the degree of violation of blood flow:

• compensated;
• subcompensated;
• decompensated heart attack.

Compensation is a process in which the blood supply is maintained even if the vessel is damaged due to additional vessels. With a compensated violation, unaffected vessels completely take over the blood supply, with a subcompensated blood supply, the blood supply is not fully restored, with a decompensated one, the blood flow stops completely.

Stages of the disease

In its development, mesenteric infarction goes through three successive stages.

1. Ischemic- circulatory disorders are reversible. The symptoms are non-specific, which complicates the diagnosis.
2. Necrotic- the cells of the intestinal wall die from oxygen starvation resulting from ischemia.
3. Stage of peritonitis- the intestinal wall is destroyed, the intestinal contents enter the abdominal cavity, an acute infectious inflammation of the peritoneum develops.

Symptoms of an intestinal infarction

The clinical manifestations of mesenteric infarction are non-specific and may differ depending on the stage, type and concomitant diseases.

Despite the optimization of diagnostic and therapy methods, mortality in the case of acute mesenteric infarction among patients reaches 50–90%.

Sometimes the onset of the disease is preceded by a period of precursors - the first signs of a developing heart attack, which patients often do not pay attention to or attribute them to indigestion. In other cases, the symptoms of mesenteric infarction occur suddenly.

The patient is concerned about intense pain in the abdomen - first periodic, cramping, then constant. The localization of pain depends on which part of the intestine is affected. With a heart attack of the small intestine, pain occurs in the central region or the right half of the abdomen, the large intestine - in the left half, the rectum - from the bottom left. On palpation, the abdomen is soft and slightly painful. In addition to abdominal pain, nausea, vomiting, and diarrhea occur. Abdominal auscultation reveals increased peristalsis, which subsides within a few hours.

As the disease progresses, the patient's condition worsens, but at some point a period of imaginary well-being sets in - the pain gradually weakens or disappears, but this is a poor prognostic sign, as it can indicate complete necrosis of the intestinal wall. With the progression of the disease, the phenomena of intoxication and dehydration increase. The skin becomes pale and dry, the tongue is dry, coated with a coating. On palpation, the abdomen is swollen, but soft, in the abdominal cavity there is a densely elastic low-displacement formation - a swollen area of ​​the intestine and mesentery. The patient becomes indifferent, lethargic, does not make contact.

Diagnostics

Diagnosis of intestinal infarction is based on instrumental methods. An ultrasound revealed a thickened intestinal wall and the presence of free fluid in the abdominal cavity. An ultrasound examination of the vessels with an assessment of blood flow reveals a thrombus in one of the vessels of the mesenterium.

With a heart attack of the intestine, surgery is required, and the less time passes from the start of drug therapy to surgery, the higher the chances of a favorable outcome.

Abdominal x-rays can show swollen bowel loops, but do not provide accurate information about the location of the blocked vessel. Angiography also refers to radiography methods, but is considered more informative for making a diagnosis. This method makes it possible to determine the exact location of the affected vessel, to identify the type and degree of blood flow disturbance.

Treatment

Treatment of mesenteric infarction should be started as soon as possible, the chances of survival of the patient and how serious the consequences will depend on its timeliness. The goal of treatment is to eliminate the blockage of the vessel and remove the affected area of ​​the intestine.

In the first hours from the onset of a heart attack, it is necessary to start thrombolytic therapy, which helps to dissolve blood clots that clog the vessel. Used drugs that activate fibrinolysis, i.e., resorption of blood clots - streptokinase, streptodecase, urokinase and other anticoagulants. At the same time, infusion therapy is started - an intravenous infusion of drugs that stabilize blood circulation, compensate for the volume of circulating blood, and promote detoxification. With a heart attack caused by non-occlusive causes, the administration of antispasmodics is indicated to improve visceral blood flow.

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The above methods relate to conservative therapy, and in this case they play an important, but auxiliary role. With a heart attack of the intestine, surgery is required, and the less time passes from the start of drug therapy to surgery, the higher the chances of a favorable outcome.

As the disease progresses, the patient's condition worsens, but at some point a period of imaginary well-being sets in - the pain gradually weakens or disappears, but this is a poor prognostic sign.

Surgical treatment consists in removing the affected area of ​​the intestine, as well as restoring the blood supply to the affected area of ​​​​the intestine. With peritonitis, the abdominal cavity is also washed with saline and antiseptics.

Video

We offer you to watch a video on the topic of the article.

Intestinal infarction is an acute surgical disease, which is based on the cessation of the flow (or outflow) of blood to the intestine.

Intestinal infarction is a formidable disease in which a fatal outcome is not uncommon. The main cause of intestinal infarction is blockage of the lumen of the blood vessel by a thrombus or atherosclerotic plaque.

Intestinal infarction, as a rule, occurs in elderly patients with severe heart disease (atrial fibrillation, infective endocarditis, atherosclerosis). Extremely rarely, intestinal infarction can occur in young women taking combined oral contraceptives.

Symptoms of an intestinal infarction

The clinical picture of intestinal infarction is extremely non-specific. Patients complain of pain in the abdomen of varying severity (depending on the extent of the lesion), bloating, difficulty passing feces and gases. Often there is an admixture of dark blood in the stool or intestinal bleeding with dark old blood, which is due to rejection of the necrotic mucosa.

Diagnostics

Old age, the presence of severe atherosclerosis, especially atherosclerosis of the abdominal aorta and lower extremities, and thromboembolic processes are important for establishing the correct diagnosis.

Instrumental diagnostic methods:

• X-ray examination - survey radiography of the abdominal organs.
• Laparoscopy.
• Aortography.
• Selective mesentericography, which allows diagnosing any type of circulatory disorders in the earliest possible time.

Treatment of intestinal infarction

The presence of an established fact of intestinal infarction or suspicion of it is an indication for emergency surgery.

Causes of intestinal infarction:

Symptoms of intestinal infarction:

Symptoms of peritoneal irritation are initially absent, they appear later, with the development of peritonitis. Soon, with thrombosis of the upper intestinal artery, repeated vomiting appears with an admixture of blood the color of coffee grounds, as well as bile. In the future, vomit becomes fecal in nature.
With thrombosis of the lower intestinal artery, vomiting is usually absent. More characteristic is the detection of blood in the feces, which, due to intestinal bleeding, can be excreted from the anus unchanged in large quantities (1 liter or more). The presence of pure blood in the stool often leads to a misdiagnosis of hemorrhoid bleeding.

In the future, a severe picture of intestinal obstruction develops, the discharge of stool and gases stops, as a result of necrosis of intestinal loops, symptoms of peritonitis appear. The patient quickly dies if emergency measures (detoxification, surgical intervention) are not applied in a timely manner, which happens infrequently.

Correct intravital recognition of thrombosis of the intestinal arteries due to atherosclerosis is rare.
In most cases, patients are admitted to the hospital with a diagnosis of other diseases of the abdominal organs (appendicitis, intestinal obstruction, cholelithiasis, gastric or intestinal bleeding, acute abdomen). Old age, the presence of severe atherosclerosis, especially atherosclerosis of the abdominal aorta and lower extremities, and thromboembolic processes are important for establishing the correct diagnosis.

Treatment of intestinal infarction:

Prevention of intestinal infarction:

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Bowel infarction symptoms of mortality

Signs and Treatments for Intestinal Infarction

Intestinal infarction is one of the serious cardiovascular diseases that confidently ranks first among the causes of death. Diagnosis of this pathology is difficult and takes a lot of time, so the risk of complications is high. Mortality in some forms of intestinal infarction ranges from 50 to 100%.

Classification of disorders of the blood supply to the intestines

• Compensation. At this stage, there is a partial restriction of blood supply in the vessel, which passes without a trace, and the function of the intestine is completely restored.
• Subcompensation. It leads to the development of chronic ischemia, against the background of which bleeding, inflammation, and perforation of the intestinal wall can subsequently occur.
• Decompensation. At this stage, necrosis of the intestine develops, that is, a heart attack, after which adverse consequences occur. It can be complicated by peritonitis (inflammation of the peritoneum) and even sepsis - blood poisoning.

The reasons

Atherosclerosis

With this disease, the patient's metabolism of fats in the body is disturbed, due to which plaques form in the vessel. In addition, the vessel loses elasticity, limiting the flow of blood to the organ to which it supplies blood. If the pathology of platelets joins this condition, which begin to settle on the plaque and further reduce the lumen of the vessel, the blood flow may completely stop. In this case, an intestinal infarction will develop.

Thrombosis of the mesenteric arteries of the intestine is promoted by the pathology of the blood coagulation system, the discrepancy between plasma and formed elements. The formation of a blood clot leads to inadequate intake of oral contraceptives by patients, trauma.

An embolism is an occlusion of the lumen of a vessel by some body that has "arrived" from another organ. The most common embolism is a thrombus formed in the left side of the heart. This can occur with rhythm disturbances (especially with atrial fibrillation, which provokes eddy currents of the blood), after myocardial infarction. The formations on the leaflets of the heart valves in infective endocarditis and rheumatism can also clog the vessel supplying the intestines.

Compression of blood vessels by tumor

This cause is often found in elderly patients. Compression from the outside occurs gradually, leading to a complete cessation of blood flow and necrosis of intestinal tissues.

The necrosis of the intestinal wall occurs if the blood does not flow for 4-6 hours. The area of ​​the lesion is determined by the level at which the blockage of the vessel occurred. If it happened in the first, uppermost segment, there will be an extensive bowel infarction, most of the small intestine, the blind and the right half of the large intestine will suffer. Occlusion of the second segment will lead to necrosis of the lean and iliac, however, an area of ​​1-2 meters will remain viable, which is enough for digestion and absorption of nutrients. Blockage in the third segment is compensated and does not cause pronounced clinical manifestations.

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Intestinal infarction can cause not only damage to the arteries, but also thrombosis of the portal vein. This condition is caused by ascending inflammation of the peripheral veins. It is provoked by such diseases that the patient has: abscesses in the abdominal cavity, inflammation of the caecum, gallbladder, uterine appendages, appendicitis. The causes of descending thrombosis are cirrhosis of the liver, increased pressure in the portal vein, disorders in the blood coagulation system.

With the so-called venous infarction of the intestine, edema of the intestine occurs, which impairs the access of blood to it, that is, causes hypoxia. In this case, necrosis of the wall will occur in 5-7 days, which is explained by the well-developed collateral circulation of the intestine.

Clinical picture

The development of a heart attack is preceded by ischemia - a decrease in the blood supply to the intestine. This condition lasts 6-12 hours and is characterized by very intense abdominal pain. Pain syndrome occurs in the upper abdomen, it is not completely removed even with narcotic painkillers. Antispasmodics (drotaverine, spazmolgon) can have a small effect. Localization of pain depends on the location of the lesion: for the small intestine - the umbilical region, the ascending colon - the right, the descending - the left. Patients during this period are very restless, they cannot find a place for themselves, they scream, there may be vomiting. Often diarrhea occurs reflexively. The skin is pale, the pressure rises. The tongue is still wet. A distinctive feature of this period is that during palpation the abdomen remains painless, not swollen. When listening to the abdomen, active peristalsis is heard.

The stage of a heart attack lasts up to a day. At this time, the symptoms are less pronounced, because the nerve endings die off. Patients behave more calmly. It is important that at this stage, blood impurities are found in the vomit and feces, indicating damage to the small intestine. When examining the abdomen, pain is detected, pressure normalizes, and the level of leukocytes increases significantly in the general blood test. Tongue dry, coated. There is no peristalsis on auscultation.

The last, most dangerous stage is peritonitis. It occurs 18-36 hours after blockage of the artery. The patient's state of health deteriorates very sharply, delirium may begin. Patients are afraid to move, as any movement increases pain in the abdomen. The water-salt balance is disturbed, dehydration appears. Further progression can lead to coma and death.

It is possible to save the intestine only at the stage of ischemia, when necrosis has not yet occurred. Therefore, it is important to suspect this condition as early as possible. For diagnosis, special instrumental methods and a blood test are carried out.

Diagnostics

Vessels can be seen on ultrasound. The advantage of ultrasound is that it is non-invasive and can be used several times before a definitive diagnosis is made. A change in wall thickness is detected, the presence of fluid in the abdominal cavity. If the equipment is available, an MRI, CT scan will be useful.

The most accurate method is to fill the vessels with contrast and then take an x-ray to evaluate the movement of the blood. The lack of filling of any vessel indicates its blockage. Such a study is called lithographic.

Laparoscopy is an invasive procedure in which instruments and a camera are placed in the abdomen. Such an operation can be performed in most surgical hospitals. The surgeon can assess the condition of the intestine with his own eyes and determines further tactics. In the first stage (ischemia), the loops of the intestines are still pink, but acquire a bluish tint, and the pulsation of the vessels disappears. With a heart attack, the wall is edematous, red. In the last stage, when the peritoneum is involved in inflammation, the intestine is dull, gray, lifeless.

Of the laboratory indicators, attention is drawn to an increase in the number of leukocytes in the blood, the presence of occult blood in the feces, although today this analysis is not considered specific.

Differential Diagnosis

Symptoms of intestinal infarction may be similar to the surgical pathology of many abdominal organs, as well as infectious diseases. First of all, differential diagnosis is carried out with the following conditions:

• acute intestinal obstruction;
• hepatic / renal colic;
• acute pancreatitis;
• food poisoning.

Acute intestinal obstruction from the infarction of the intestine is distinguished by the absence of gases and stools. With adhesive obstruction, scars are visible on the abdomen. Also uncharacteristic symptoms are weight loss, loss of appetite.

With hepatic and renal colic, stones will be detected on the ultrasound of the patient, in the anamnesis more often such pains have already happened. Pain in colic is undulating and easily relieved. Acute pancreatitis is distinguished by a connection with a violation of the diet (alcohol intake, fatty and fried foods) and the presence of pancreatic enzymes in the general urine test.

Vomiting may be characteristic of an infectious disease. The diagnosis of toxicoinfection is confirmed by high fever, nausea. It is important to collect an epidemiological history: where the patient ate, what he ate, whether someone from the team fell ill.

Treatment

Treatment of intestinal infarction is always surgical. It should begin within the first day from the moment of occlusion, otherwise the outcome in 95% of cases may be unfavorable. Treatment of the patient must necessarily include resection of the necrotic part of the intestine, and restoration of the vessel.

The scope of the operation is determined by the following factors:

• the mechanism of occurrence;
• stage of the disease;
• localization of the lesion;
• the patient's condition;
• operating room equipment.

Restoration of blood supply in the involved intestine is possible within 6 hours after the blockage occurs. To do this, a blood clot is removed from the lumen of the vessel with a special catheter. If more time has passed and the changes have become irreversible, it is necessary to remove the dead part and restore the vessels of the preserved sections of the intestine.

The outcome of the operation largely depends on the preoperative preparation. It includes the normalization of the work of organs and systems, the restoration of blood volume, the improvement of gas exchange in tissues. In the first hours after hospitalization, infusion therapy begins - droppers with electrolyte solutions. To improve blood flow, antispasmodic solutions are introduced.

In the postoperative period, the fight against bacterial complications is added to the therapy. For these purposes, broad-spectrum antibiotics are prescribed, the resistance of microorganisms is preliminarily determined. They also prevent an increase in blood clotting in the vessel: prescribe anticoagulants and antiaggregants, use elastic bandages or stockings on the lower limbs, strive for early activation of the patient.

After discharge, the patient is sent to the clinic at the place of residence to the gastroenterologist. The doctor must control the outcome of the disease, correct the pathology that led to the infarction of the intestine. The most important is the treatment of atherosclerosis, monitoring of the lipid spectrum, monitoring the state of the liver, liver transaminases.

Of great importance is the correction of cardiac pathology, the restoration of sinus rhythm in atrial fibrillation, and the correction of valvular defects.

Forecast

With a favorable course of the disease, the patient's condition improves by the third day, peristalsis is restored, gases begin to leave. Debilitated patients may experience complications: pneumonia, sepsis, thrombosis.

The result of treatment directly depends on rapid diagnosis, the correct tactics of managing the patient and adequate therapy. Prevention of a repeated heart attack consists in the treatment of atherosclerosis, the normalization of fat metabolism, and the maintenance of a healthy lifestyle.

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Causes of intestinal infarction: how to prevent the disease?

Many are familiar with myocardial infarction and its dangers. However, few people know about the severe form of this disease - intestinal infarction. This disease has a high mortality, which is why it is worth familiarizing yourself with it.

Intestinal infarction: causes

Intestinal infarction is a dangerous disease that occurs due to blockage of intestinal vessels by blood clots. Because of this, the affected area of ​​the intestine, to which the blood does not reach, begins to die, which is acute necrosis. Basically, with such a heart attack, the small intestine and the surrounding areas are affected.

Elderly people are more susceptible to bowel infarction

According to age categories, the disease is similar to a common heart attack, because it occurs in people over 50 years old. Cases of such a pathology in young people are quite rare, because for its development diseases of the cardiovascular system are necessary.

The cause of intestinal infarction or, as it is also called, mesenteric thrombosis are blood clots. Because of them, there is a risk of blockages that appear during a reflex spasm - a sharp narrowing of blood vessels.

The causes of intestinal infarction are based on various diseases, including:

• Atherosclerosis. A disease that provokes the appearance of small plaques on the walls of blood vessels. They periodically explode, which leads to blood clots.
• Heart defects. Blood clots can form in the chambers of the heart due to impaired blood circulation.
• Myocardial infarction. One of the consequences of this disease is the formation of blood clots in the chambers of the heart.
• Rheumatism. This disease also leads to thrombosis through the occurrence of heart defects.

But there may be other causes of intestinal infarction:

• Sepsis
• Thrombophlebitis
• Endocarditis
• Hypertonic disease
• thrombosis after childbirth

In addition, the postoperative condition can also provoke the occurrence of blockages, because during this period the body actively creates blood clots in the blood to eliminate bleeding.

Therefore, intestinal infarction can occur in all cases when blood clots occur. For the most part, this is due to circulatory and vascular diseases that manifest themselves at a later age.

For more information about the causes of intestinal infarction, you will learn from the proposed video.

Diagnostics

For the diagnosis of intestinal infarction, laboratory and instrumental methods are used. They allow you to identify the disease at an early stage and begin treatment, which will protect against the occurrence of blood clots in the abdominal region.

Diagnosis is made to confirm the diagnosis

To determine the body's predisposition to intestinal infarction, you can use several methods:

• Clinical blood test. With a complete blood count, the chance of an illness is reflected in a high ESR (erythrocyte sedimentation rate) value and in the number of leukocytes in the blood. These indicators characterize the inflammatory processes in the body.
• Diagnostic laparoscopy. Incisions are made in the abdominal region, after which an optical instrument is inserted into them to visually analyze the condition of the intestinal walls. It is used to prevent a heart attack with obvious symptoms of this disease.
• Angiography of intestinal vessels. A substance is injected into the blood, which is reflected on the X-ray. After its distribution throughout the body, an x-ray of the abdominal region is performed, which allows an analysis of the mesenteric vessels.
• Diagnostic laparotomy. A direct examination of the abdominal cavity is carried out through the median incision of its anterior wall. Bowel loops and major vessels are analyzed. The method allows you to immediately remove the affected area when signs of a heart attack are detected.

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Only a blood test can prevent the disease in advance, other methods are used only with obvious signs of blood clots.

These four methods can detect bowel infarction at an early stage, reducing the risk of death. But most often only diagnostic laparotomy is used, because the manifestation of the symptoms of the disease does not leave a chance for an inoperable solution to the problem.

Intestinal infarction: symptoms

Symptoms of intestinal infarction can prevent death by providing medical care to the patient. But you need to act quickly, because their appearance is a clear sign of an imminent heart attack.

The symptoms of the disease are quite varied.

There are many symptoms of this disease, but several main ones always appear:

• Abdominal pain
• Vomiting (possibly bloody)
• First high, then low blood pressure
• Paleness and unhealthy appearance
• Increased stool (with profuse bleeding)
• Temperature rise
• Seals in the abdomen, its swelling

But other manifestations of the disease are also possible, which depend on the location of the thrombus and the characteristics of the organism. The symptoms do not improve with the introduction of narcotic drugs.

In severe cases of intestinal infarction, there are abundant hemorrhages in the stool and vomiting, a lot of blood comes out, often in its original form.

But the course of the disease is clearly visible in the patient, because the effect of a blood clot greatly affects the body. The pain is so strong that it is impossible now, which is why a person often takes a painful posture and screams.

With an infarction of the intestine of the lower artery, vomiting is usually absent. But there is a profuse hemorrhage along with the patient's feces, as a result of which about a liter of blood can come out.

In the future, the passage is blocked, the person can no longer release feces or gases. The intestine dies, symptoms of peritonitis appear. Further development of the disease leads to death if surgical intervention is not applied.

These symptoms are the main signs of intestinal infarction. You can't ignore them, because they are too strong. You should not hesitate, because premature treatment will avoid a fatal outcome.

Treatment

Intestinal infarction is a rapidly developing disease that has a high mortality rate. Therefore, its treatment is carried out only surgically, long-term therapy helps only with the first symptoms. But even after a successful operation, the consequences of the disease harm the body, which not everyone can survive.

The operation takes place in several stages.

Surgical treatment of intestinal infarction takes place in four stages:

• A blood clot is being searched for, blocking the access of blood to the affected area.
• The affected area of ​​the intestine and mesentery is highlighted.
• Affected areas and dead tissue are removed.
• The thrombus is eliminated, the vessel is sutured.

All this is carried out in a short time, because tissue necrosis occurs quickly. At the first manifestations of the disease, an operation is inevitable, because this is the only way to save. With untimely treatment, a fatal outcome occurs, which occurs in 90% of cases of the disease.

There is another method of treatment used only in the absence of a complete blockage. It consists in standard therapy for the administration of anticoagulants (Heparin or Fraxiparin). With the help of them, the blood liquefies, which prevents the formation of blood clots and further blockage of the vessel.

But the disease is difficult to detect at this stage. Medications are given to the patient intravenously at intervals of 6 hours, the period of treatment with anticoagulants is about two days. Acetylsalicylic acid, together with these drugs, helps to restore blood circulation in a clogged vessel, which leads to the restoration of a damaged tissue area.

So a heart attack or thrombosis of the intestine is a disease, in the event of which only surgical intervention is possible. Mortality from this disease is huge, so it is necessary to provide urgent treatment. The chance of a favorable outcome depends on this.

Intestinal infarction: prognosis

There are not many cases of intestinal infarction, but for the most part they are fatal. Therefore, it is necessary to predict their possible occurrence, which is allowed by tests and checking of symptoms. The early stage of thrombosis can be cured without consequences, so it is necessary to undergo examinations.

Healthy people do not need to be afraid of intestinal infarction

Concerns about intestinal infarction in healthy people are unfounded. The real danger is for those who have suffered some kind of vascular or heart disease that can lead to the formation of blood clots. Therefore, such people need to be regularly examined for recurrence of the disease and the occurrence of blood clots.

The prognosis of the disease allows you to make a regular blood test, which will identify the occurrence of blood clots. In these cases, a simple course of anticoagulants allows you to protect yourself from the risk of blockage of blood vessels. In the future, relapses are possible, but with regular examinations, the danger is minimal.

Read: Can I play sports with hemorrhoids or after it?

If intestinal thrombosis is detected and timely surgery is predicted, the complete rehabilitation of the patient without significant damage to the intestines is predicted. The consequences and possible complications are minimal, depending on the location of the thrombus in the circulatory system. In severe cases, surgery is powerless, which ultimately leads to death.

The sudden onset of thrombosis without immediate medical intervention has a high chance of death.

Surgery in such cases is useless, because necrosis progresses extremely quickly. In rare cases, when the thrombus is not located in the key nodes, it is possible to save the patient's life even with a large amount of tissue necrosis.

Forecasts for intestinal infarction show a high chance of death with delayed treatment. In other cases, there is a high chance of recovery without significant consequences for the body.

Prevention

Prevention of intestinal infarction is almost the same as prevention of myocardial infarction. It consists in the general improvement of the body, which will prevent the appearance of blood clots. To do this, three basic conditions must be met:

• Do not smoke
• To live an active lifestyle
• Burn excess weight

Blood clots are caused by smoking

Smoking is the main cause of blood clots. It is especially dangerous when combined with high cholesterol levels. Smoking increases blood clotting and density, which can lead to blockages in the arteries. This blood helps platelets stick together, which creates dead clots. And nicotine contributes to spasms of the arteries, which is the original cause of thrombosis.

Smoking reduces the amount of oxygen in the blood, which causes oxygen starvation of cells. The danger here is that tissue necrosis develops much faster.

An active lifestyle significantly reduces the dysfunction of the body, which reduces the chance of blood clots.

The elasticity of blood vessels increases, the risk of hypertension and blood clots decreases. Sport tones the whole body as a whole, optimizing blood circulation.

Excess weight is also a cause of thrombosis. Due to the large body weight, the need for oxygen increases, which contributes to more active blood circulation.

To optimize this process, the arteries and vessels are narrowed, which increases the chance of clogging the channels. In addition, obesity accompanies high cholesterol levels, which also significantly affects blood clotting.

Disease prevention includes the prevention of circulatory diseases. These include atherosclerosis, hypertension and other ailments that can lead to blood clots.

Intestinal infarction is a dangerous disease that has a high percentage of deaths. Its treatment is difficult, but with early detection of the disease, it is possible to protect the arteries from the occurrence of blood clots. The best option would be to prevent a heart attack, which is based on a healthy lifestyle and the absence of bad habits.

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Intestinal infarction

The first report on intestinal infarction was made by Despre (1834), in which he presented a description of a case of intestinal gangrene with blockage of the superior mesenteric artery in a woman suffering from persistent constipation, and the description of the clinic of intestinal infarction belongs to Tidman (1943). Under experimental conditions, intestinal infarction was first reproduced by Litten (1875) by applying a ligature to the superior mesenteric artery and vein after Opolzer (1862) in vivo recognized intestinal infarction in humans. Moore and Gosse in 1921 reported the observation of intestinal infarction without damage to mesenteric vessels, later (1935) Binet and Gregoire caused intestinal infarction in a dog by introducing microbial toxins or horse serum into the mesentery of the intestine, and Tinel caused visceral infarcts by irritation of the posterior roots of the spinal nerves.

There are: a) arterial infarction; b) venous infarction; c) mixed heart attack; d) infarction without vascular lesions (allergic, white, anemic).

According to pathoanatomical autopsies, acute disorders of the mesenteric circulation are noted in 1-2% of autopsies and still remain a "big drama of the surgical abdomen", with gloomy statistics - 85-95% mortality.

Etiology of intestinal infarction

The main and most common cause of acute disorders of mesenteric circulation are embolisms and thromboses of blood vessels in this area. Less commonly, they are based on blood flow disorders at the microcirculatory level, caused by angiospasm, paresis of blood vessels, and a decrease in perfusion pressure.

In most cases, the immediate cause of acute disturbance of mesenteric blood flow is mesenteric artery embolism in diseases of the heart and aorta (parietal thrombosis of the left atrium or ventricle in rheumatic heart disease, myocardial infarction, cardiosclerosis, infective endocarditis, heart aneurysm, atherosclerosis and aortic aneurysm). Emboli can be both thrombotic masses and particles of atherosclerotic plaques. Cases of bacterial, mycotic, fat embolism are also described. A typical localization of an embolus is the mouth of the superior mesenteric artery.

The main cause of mesenteric artery thrombosis is pathological changes in the arterial wall that precede thrombosis (atherosclerosis, nonspecific arteritis, periarteritis nodosa, etc.). Phlebo-thrombosis of the mesenteric veins can develop as an ascending (primary) or descending (secondary) thrombosis. Ascending thrombosis begins with inflammation of the veins (phlebitis) in the peripheral parts of the mesenteric venous system and, spreading in the proximal direction, captures the larger branches and trunk of the superior mesenteric vein. The cause of primary phlebothrombosis is usually acute purulent-destructive processes in the abdominal cavity and pelvic organs (intra-abdominal abscesses of various origins, acute appendicitis, adnexitis, mesadenitis, acute cholecystitis, typhlitis, etc.). Secondary descending phlebothrombosis of the mesenteric veins occurs due to a slowdown in blood flow in the trunk of the portal vein and subsequently spreads to the superior mesenteric and often splenic veins and their branches. The most common causes of secondary thrombosis are abnormalities in the development of the portal vein, cirrhosis of the liver, portal hypertension, diseases of the spleen, prolonged arterial hypotension, and increased blood clotting.

Acute disorders of the mesenteric circulation without occlusion of the main blood vessels develop as a result of impaired microcirculation and a decrease in perfusion pressure. Anaphylaxis, exposure to infectious-allergic factors, intoxication, increased activity of blood coagulation factors (hypercoagulation), a state of deep hypotension (shock, blood loss, cardiac decompensation, etc.) are important in the occurrence of these disorders. In the formation of intestinal infarction, there is often a combination of mechanisms of occlusive and non-occlusive disorders of the mesenteric circulation.

The pathogenesis of intestinal infarction

The mechanisms of occurrence of arterial (anemic, hemorrhagic, mixed) and venous (hemorrhagic) intestinal infarction have distinctive features. In the formation of an arterial infarction, three stages can be distinguished. A sharp and sudden decrease in arterial blood flow and the accompanying angiospasm underlie the anemic stage, characterized by pallor and spasm of the intestine (anemic infarction).

Subsequently, after about an hour, destructive changes begin to develop in the intestinal wall, and products of impaired tissue metabolism accumulate. Angiospasm is replaced by vascular paresis. There is a partial restoration of blood flow, which is accompanied by activation of the disintegration of the microvasculature (ruptures and thrombosis of microvessels), an increase in its permeability for the liquid part and blood cells that impregnate the intestinal wall, which becomes red (hemorrhagic infarction). At this stage of the development of a heart attack, a hemorrhagic effusion appears in the abdominal cavity. The process of sweating of the liquid part and migration of blood cells ends after complete thrombosis of the vessels.

The destruction of the intestinal wall begins with the mucous membrane (foci of necrosis, ulcers), and then goes to its deep layers, causing perforation and the development of peritonitis. Total ischemia of the intestinal wall lasting more than 3 hours leads to its irreversible changes even after complete restoration of blood circulation in the affected segment of the intestine [Saveliev VS, Spiridonov IV, 1976].

In violation of the venous outflow, the formation of intestinal infarction has a slightly different character. In the ascending form of phlebothrombosis, as already mentioned above, thrombosis begins with the intestinal veins, while in the descending form, thrombosis initially occurs in the trunk of the portal vein or its roots, subsequently spreading to the intestinal veins. Unlike arterial thrombosis in phlebothrombosis, this process captures a large number of venous vessels and often ends in total thrombosis of the portal system. Increased permeability of the vascular wall and the release of the liquid part and blood cells into the extravascular space occur immediately after vein occlusion and the appearance of venous hypertension to the periphery from the site of occlusion. For these reasons, disorders associated with hypovolemia and dehydration are predominant in venous infarction. Localization and prevalence of infarction depend on the type of occluded vessel and the characteristics of the blood supply to various parts of the intestine, and morphological changes are based on destructive-necrotic processes in the area of ​​the developed infarction.

Symptoms of an intestinal infarction

According to pathological changes in the intestinal wall in the clinical picture of intestinal infarction, there are three stages: the stage of ischemia (hemorrhagic edema in venous infarction), in which reflex and hemodynamic disorders predominate, the stage of infarction, in which local symptoms and intoxication phenomena appear, and the stage of peritonitis [Savelyev V. S., Spiridonov I. V., 1976].

Intestinal infarction often begins suddenly with sharp, excruciating pain in the abdomen, reminiscent of a pain symptom in acute pancreatitis, but without the girdle character of pain. The patient constantly changes position, but this does not bring relief. Against the background of such pain, nausea, vomiting, loose stools often occur. Some patients for 1-2 months. before the onset of such pain, symptoms of ischemic disease of the digestive system were noted. Leukocytosis rises to 20-50 x 109/l. There is pain on palpation of the abdomen, localized according to the zone of infarction. An infarcted and swollen intestinal loop can be detected on palpation as a formation without clear boundaries (Mondor's symptom). At this stage, there is also an increase in the severity of symptoms of intoxication and hypovolemia.

The patient's condition with intestinal infarction deteriorates sharply with the development of peritonitis: tachycardia and hypotension increase, the skin takes on a gray color, the patient becomes adynamic. In the peripheral blood, a high leukocytosis is detected, a stab-nuclear shift to the left is increasing. A feature of peritonitis with intestinal infarction is later than with purulent peritonitis, the appearance of muscle tension and Shchetkin-Blumberg's symptom.

The stage of ischemia takes the first 6 hours and passes into the stage of infarction, which after 12-24 hours passes into the stage of peritonitis. Death in arterial infarction of the intestine occurs in 1-2 days.

Venous thrombosis develops slowly (over several days) and begins with vague abdominal pain, slight fever, and chilling due to phlebitis.

Diagnosis of intestinal infarction is based on an assessment of the clinical picture, X-ray data (small intestinal loop swollen with gas with an infarcted intestinal wall), laparoscopy, aortography, selective mesentericography, which allows diagnosing any type of circulatory disorders at the earliest possible time.

Treatment of intestinal infarction

Treatment is surgical, and its success depends on the nature and stage. The type and scope of the operation are determined by the stage, type of occlusion, its location and extent. In the stage of a heart attack, reconstructive operations on blood vessels are recommended in combination with resection of the affected part of the intestine; if parts of the intestine of doubtful viability are forced to remain, 12 hours after the operation, a relaparotomy is performed. This technique allows you to assess the state of blood circulation in the intestine in dynamics and preserve its viable part as much as possible. In the course of treatment in the postoperative period, anticoagulants are used, antibacterial, symptomatic and detoxification therapy is carried out, which makes it possible to reduce mortality in this disease.

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Intestinal infarction - what is it?

The most common heart disease is a heart attack. Almost everyone knows about this disease. But few people know that there is a danger of acquiring an intestinal infarction. Despite its low popularity, this disease is extremely dangerous and entails serious health problems, and even danger to life. What is it - an intestinal infarction, what consequences does it entail, and everyone should know how to deal with such a disease.

Intestinal infarction is a circulatory disorder (vascular thrombosis, embolism), leading to necrosis (death) of the intestinal wall or to the last stage of the disease - peritonitis. The danger of a heart attack of this kind threatens not only with irreversible health problems, but also with a fatal outcome. The death rate from bowel disease is extremely high.

In the stage of peritonitis, only 50 percent of sick people survive. This pathology is one of the most common in gastroenterological medicine. To avoid this, it is important to know and recognize the symptoms of the disease and contact a specialist in time.

Symptoms of an intestinal infarction

Necrosis can be identified by the following signs:

• the occurrence of sharp, acute pain in the abdomen. Localization of pain - upper (stomach area), left or right side of the abdomen, navel. As a rule, the pains come on in bursts and then become regular and continuous. Pain usually comes after eating;
• there is nausea, accompanied by vomiting. Vomit may be mixed with blood. Diarrhea begins, also mixed with blood;
• the tongue becomes dry, with a whitish or yellow coating;
• sweating increases, dehydration occurs;
• bloating, after primary symptoms (pain, nausea);
• increased heart rate, increased blood pressure.

Intestinal infarction is a surgical disease in which there is necrosis (necrosis) of the intestinal wall. The same pathology sounds differently as acute mesenteric obstruction or acute mesenteric thrombosis.

Depending on which vessel is affected, arterial, venous and mixed mesenteric intestinal obstruction is distinguished.

1 Risk of disease

Intestinal infarction is a disease with a very unfavorable prognosis. Why?

1. Mortality from this disease is ahead of acute appendicitis, perforated ulcer, etc.
2. Mortality from intestinal infarction is 85-100%.
3. The disease in its manifestations resembles other acute surgical diseases, so it is often not diagnosed in time. And this often leads to irreversible consequences.

2 Causes of the disease

The main causes leading to the development of this disease can be divided into 2 groups.

Quite often, intestinal infarction develops as a result of simultaneous exposure to causes from the first and second groups.

3 Clinic of the disease

The manifestations of the disease can be varied depending on the onset. It can start in 3 ways:

• Acute.
• Gradually.
• With a period of "harbingers".

If the disease has an acute onset, then the symptoms occur suddenly:

Gradual onset is characterized by the slow development of symptoms. At first they are not pronounced, but over time they become more and more intense.

The beginning with precursors implies the presence of a certain period of time before the development of characteristic signs characteristic of intestinal infarction. During this period, transient abdominal pain, stool disorders such as diarrhea or bloating may disturb.

According to clinical manifestations, intestinal infarction can mask or resemble other intestinal diseases:

1. Acute appendicitis. With this option, the pains in the right half in the lower abdomen, which are accompanied by nausea and vomiting, are most disturbing.
2. Intestinal poisoning. The main manifestation of the disease will be a violation of the stool and vomiting. The patient may experience prolonged diarrhea.
3. Gastrointestinal bleeding. This form is characterized by the appearance of vomiting and feces with blood. This is due to the fact that with acute obstruction of the intestinal (mesenteric) vessels in the stomach, so-called "stress" ulcers or erosions can occur or worsen. It is they who in their bulk will be the source of bleeding. Such conditions complicate the timely diagnosis of intestinal infarction.

Outcomes of the disease can be very different:

• Patient recovery.
• Formation of ulcers in the intestines.
• Inflammatory processes in the intestines.
• Bleeding.
• Wall perforation.
• Purulent inflammation of the wall.
• Peritonitis.

4 Diagnosis of the disease

After reviewing the clinic and the "masks" of the disease, it is easy to conclude that the diagnosis of intestinal infarction is quite difficult.
In the diagnosis of the disease, the following instrumental methods are used:

1. Ultrasound examination of blood vessels with an assessment of blood flow. An affordable and safe diagnostic method that allows you to detect the presence of a blood clot in the lumen of an arterial or venous vessel. However, this method does not allow assessing the state of the lumen of all vessels without exception that are of interest to the doctor.
2. X-ray examination of the abdominal organs. The method is carried out using a contrast mixture. Allows you to see swollen bowel loops.
3. Examination of the small intestine with a probe.
4. Angiographic study. X-ray diagnostic method, in which a contrast agent is injected into the lumen of the vessel. The method makes it possible to determine the exact location of the affected vessel, the type of blood flow disturbance and assess the extent of the lesion.
5. Laparoscopy. A diagnostic method in which a probe is inserted into the abdominal cavity through the anterior wall of the abdomen at the end with an optical system that allows you to see the intestinal loops.
6. Laparotomy is an extreme diagnostic method, which consists in opening the abdominal cavity with a scalpel in case of insufficient information content of previous diagnostic methods and the patient's serious condition.

5 Treatment of intestinal infarction

Intestinal infarction is a disease that requires complex treatment. It includes medical and surgical methods. The tactics of choosing one or another method is determined by the severity of the course of the disease, the age of the patient, the presence of concomitant diseases, and the results of diagnosis.
1) Drug treatment includes the appointment of the following groups of drugs:

• Drugs that dilate pathologically narrowed blood vessels.
• Drugs that prevent the formation of blood clots.
• Drugs that reduce blood clotting.

As a rule, drug treatment as an independent method is used for mild severity of the disease. In other cases, it often serves as an addition to surgical treatment and is prescribed both before and after surgery.

2) Surgical interventions performed on the intestines are aimed at restoring blood flow, removing non-viable sections of the intestinal wall, and combating peritonitis. The management of patients depends on the form and stage of the disease. If attempts at medical treatment have not been successful, and the condition is progressing, surgical treatment is applied without delay. In the treatment of intestinal infarction, the following types of surgical interventions are used:

1. Vascular operations. These operations are aimed at preserving the entire intestine. Their meaning is to restore blood flow in the vessels. There are 2 types of operations:
   • Embolectomy is the removal of a blood clot that has come from another place with a blood stream. The lumen of the vessel is opened and the thrombus (embolus) is removed.
   • Thrombectomy is the removal of a blood clot that has formed in a blood vessel. These types of surgical interventions are more difficult, as part of the vessel must be removed along with the blood clots. After removal of the vessel section, the defect is closed with a patch.
2. Resection (removal) of part of intestinal loops. Such operations are used in the event that necrosis of the intestinal wall has occurred. Non-viable loops are removed, and the remaining parts are interconnected using intestinal sutures.
3. The fight against peritonitis consists in cleansing the abdominal cavity from the contents and washing with cleansing solutions. The operation ends with the introduction of antibacterial agents into the abdominal cavity and the installation of a system of drainage tubes that ensure its further purification. After a certain period of time, the tubes are removed and the wound is completely sutured.