According to statistics, in general surgical practice, pathology is not as common as purulent inflammatory diseases, however, the severity clinical manifestations makes the diagnosis, treatment and prevention of mesenteric thrombosis very relevant in modern surgery.
Reasons
Thrombosis is a typical pathological process and, regardless of the location, the pathogenetic mechanism of its formation will always be the same. The following triad of factors plays a key role in the development of intestinal vascular thrombosis:
- Tendency to thrombophilia or hypercoagulopathy on the part of the patient's blood plasma.
- Damage to the endothelial layer of blood vessels.
- Change of blood flow from laminar to turbulent or vortex.
The combination of all three mechanisms sharply increases the risk of blood clots or thrombi forming in the lumen of the vessel. Overlapping of the lumen by more than 75% becomes the cause of the first clinical manifestations of intestinal thrombosis.
Symptoms
Depending on the level of localization of the blood clot, mesenteric intestinal thrombosis will manifest itself in various clinical variants. There is a close connection between the affected area and the characteristics of the intestinal blood supply:
- Occlusion at the level of the upper mesenteric artery- defeat of everything small intestine and the right half of the thick one.
- Occlusion of segmental mesenteric arteries is necrosis of certain areas of the small intestine, for example, the ileal segment or cecum.
- Occlusion of the inferior mesenteric artery - compensation of blood flow due to collateral (additional) blood flow or necrosis of the left side of the colon.
- Thrombophlebitis or thrombosis of mesenteric veins is isolated necrosis of the small intestine.
It is important to note that the symptoms of damage to the above-described parts of the digestive tract develop within 1-2 days, and the dynamics of the severity of symptoms is directly proportional to the volume of the affected intestine.
Stages
Depending on the stage pathological process certain symptoms will occur and predominate:
- Ischemia. In the first hours after thrombus formation, the victim begins to experience severe pain. The pain can be so severe that it leads to reflex vomiting. At the beginning, the pain syndrome is paroxysmal in nature, and after a few hours the sensations become constant. Most patients have a one-time loose stool.
- Intestinal infarction. At this stage, ischemic processes become irreversible, which leads to the occurrence of local abdominal symptoms. Abdominal pain is more pronounced, general intoxication of the body begins to appear as a result stagnation in the intestines. Body temperature rises.
- Peritonitis. The stage is terminal. The first signs of peritonitis may appear 16–20 hours after the onset of thrombosis. Necrosis of the intestinal wall leads to its insolvency, the tightness is lost and the intestinal contents begin to actively penetrate into the free abdominal cavity, thereby causing acute intoxication of the body.
Diagnostics
Differential diagnostic search plays exclusively important role when examining a victim with suspected mesenteric thrombosis.
In the first hours, the disease has much in common with conditions such as:
- abdominal form of myocardial infarction;
- pancreatitis and pancreatic necrosis;
- stomach ulcer;
- intestinal obstruction.
For staging preliminary diagnosis A thorough collection of disease history data and an analysis of the clinical picture are carried out. To confirm the diagnosis, they resort to special instrumental diagnostic studies: angiography of intestinal vessels and diagnostic laparoscopy or laparotomy. Angiography allows you to accurately detect intestinal thrombus and its location.
The importance of first aid
It is important to transport the victim to the hospital as quickly as possible medical institution for carrying out diagnostic examination. It is impossible to help a victim with suspected intestinal thrombosis at home.
Antispasmodics and painkillers can alleviate the patient’s condition, but you need to understand that they can also distort the clinical picture of the disease. The sooner the patient is taken to the surgical hospital, the better the prognosis.
Which doctor treats intestinal thrombosis?
The pathology is treated by a general surgeon. The direction of general surgery deals with emergency and planned treatment of any pathology gastrointestinal tract. Mesenteric thrombosis is an emergency pathology.
Treatment
After production clinical diagnosis and determining the stage of thrombosis, specialists are determined with treatment tactics, which can be either conservative or operative (surgical).
Conservative
Possible only with early diagnosis at the stage of ischemia, when disturbances in the digestive tract are functional and reversible. To compensate for mesenteric circulation, anticoagulants and antispasmodics are used.
Surgical
Surgical treatment is indicated when the effect of conservative therapy is not adequately successful, no positive dynamics are observed in the clinical picture, or obvious irreversible processes are identified during diagnosis - intestinal necrosis.
Already during the examination of the patient, he is prepared for surgery. To do this, the blood type and Rh factor are determined and premedication is carried out for the purpose of pain relief and sedation.
Surgical treatment can be:
- vascular correction – thrombectomy;
- resection of the affected intestine;
- combination treatment;
- treatment of peritonitis.
Volume surgical intervention determined intraoperatively depending on the volume of intestinal damage.
Rehabilitation
Rehabilitation measures play an important role in the subsequent recovery of the patient. With extensive intestinal lesions and severe peritonitis, the patient can have an intestinal stoma, which undoubtedly reduces the standard of living, but allows the intestines to recover.
In the first 5–7 months after treatment, the patient needs strict adherence therapeutic diet. Limited and intense physical activity for 12–16 months.
Complications
In case of acute mesenteric thrombosis, the speed of treatment therapeutic measures directly affects the development of complications. So in case of untimely provision qualified assistance The patient may develop the following life-threatening conditions:
- diffuse peritonitis;
- toxic shock;
- multiple organ failure;
- sepsis.
Prevention
The patient must register with a gastroenterologist and cardiologist. This is necessary to exclude repeated episodes of mesenteric thrombosis. Also in persons suffering from atherosclerosis, intestinal diseases and cardiovascular system For preventive purposes, a course of treatment with the use of anticoagulants, antiplatelet agents and antispasmodics is prescribed.
To summarize, it is important to reiterate that thrombosis of the mesenteric or mesenteric arteries is an acute surgical disease requiring immediate correction and treatment. Symptoms of pathology can be disguised as others no less serious illnesses, which requires careful diagnosis before starting treatment and always in a hospital setting.
Useful video about mesenteric thrombosis
13.10.2017
The vessels that are located in the intestine and ensure the delivery of blood cells to all areas of the esophagus are called mesenteric. Thrombosis of mesenteric vessels in the acute course of the disease leads to thrombosis, which ends in the death of the patient. At the same time, mesenteric intestinal thrombosis is much more difficult to diagnose compared to. The initial stages of development of the pathology occur with virtually no clinical manifestations.
The pathology occurs mainly in people over 35 years of age; gender does not play a role in the risk of developing the disease. Intestinal infarction, which leads to thrombosis of the mesenteric arteries, develops during occlusion upper vessels mesentery. Another reason for the development of esophageal infarction is occlusion of the trunk. The trunk, in turn, is divided by medical specialists into 3 sectors, the damage to which differs in the localization of damage to the esophagus.
- Thrombosis of the mesenteric vessels of the 1st sector is characterized in most patients by blockage of the small intestine, in some cases the right part of the colon is affected.
- With mesenteric thrombosis, 2 sectors are completely affected ileum, in some cases the blind and skinny suffer.
- With thrombosis of the mesenteric vessels of the intestine in section 3, the blood flow is compensated, and with an infarction of the esophagus, only the ileum is affected.
Depending on the location of intestinal thrombosis, treatment methods will differ.
Why does it happen?
Mesenteric thrombosis is a consequence of the development of the patient's intestines. Plaques form in the arterial canals, narrowing the lumen of the vessels. This worsens the circulatory system in this area.
Thrombosis of the superior mesenteric artery can lead to complete blockage of the vessel. As a result, the intestine suffers destructive changes. Initially, ulcers and necrosis begin to appear in the mucosal area, after which the intestinal tissue begins to disintegrate and holes appear. The entire contents of the esophagus penetrates into the patient's abdominal cavity. The result of the entire process described above is peritonitis, which in some cases ends in the death of the patient.
Medical specialists highlight following reasons the occurrence of blood clots in the area of the mesenteric vein and other areas of the intestine.
- A common cause of intestinal thrombosis is atherosclerosis.
- Another factor that increases the risk of developing this pathology is hypertension.
- A number of heart pathologies significantly increase the risk of developing thrombosis in the intestinal area, among them it is worth highlighting heart defects, heart attack, and cardiosclerosis.
- Neoplasms of a malignant nature.
- intestines can develop as a complication after surgical methods treatment of the gastrointestinal tract.
- Various injuries of the gastrointestinal tract.
- Diseases of the liver and spleen.
If you know the causes of blood clots, you will be able to diagnose the disease in time and begin treatment early stages pathology.
Clinical manifestations
It is very important to have an idea of what intestinal thrombosis is and its symptoms. More often the pathology is characterized acute course. The initial stages are characterized by the absence of clinical manifestations, but they are characteristic only of thrombosis of arterial canals. Within 30–60 days, a person develops various symptoms, more often patients complain of pain in the gastrointestinal tract, a feeling of bloating. Sometimes patients experience pain in the abdomen after eating, and the person may feel sick or vomit.
Medical experts explain the symptoms by narrowing of the arterial channels, which is explained either by atherosclerosis or intestinal thrombosis.
Mesothrombosis is characterized by rapid development, which occurs in a period of 2 to 5 days. On initial stage patients noted pathologies elevated temperature and minor pain that occurs in different areas of the abdomen.
The main sign of esophageal thrombosis, according to medical experts, is severe pain. The ischemic stage of development of the pathology is characterized by severe intestinal pain, which means the need to consult a medical specialist for advice. One of the unpleasant properties of thrombosis is the inability to relieve pain with painkillers; even medicines. Antispasmodic drugs can only slightly reduce abdominal pain.
Medical experts have identified a number of clinical signs thrombophlebitis.
- A large number of patients had pallor and cyanosis of the skin.
- Slow heart rate.
- People suffering from intestinal thrombosis complained of high blood pressure.
When the clinical manifestations of the disease worsen, the abdominal cavity remains soft and there is no dry mouth. Analysis of blood cells during exacerbation of pathology shows an increased concentration of leukocytes. Painful sensations are concentrated in the mesentery, sometimes throughout the entire gastrointestinal tract.
Over time, a person suffering from intestinal thrombosis begins to feel sick and vomit. A large number of patients complain of loose stools mixed with blood cells. Another part of the patients had constipation.
5–13 hours after an exacerbation, the disease enters the infarction stage, which lasts about a day. During this period of time, painful sensations decrease, this is explained by the death of receptors. Patients become calmer, but due to intoxication of the body, their behavior can hardly be called adequate. Heart rate increases, pressure normalizes, leukocyte concentration returns to normal. Painful sensations are localized in the area of damaged organs.
After 17 - 36 hours from the moment of exacerbation of the pathology, intestinal thrombosis passes into the next stage - peritonitis. Inflammation in the gastrointestinal tract is accompanied by increased painful sensations during palpation, a cough occurs. The patient’s general health is deteriorating; medical experts attribute this to dehydration and intoxication of the body. A person's electrolyte balance is disturbed, pain spreads throughout the abdomen. This stage is characterized by clinical manifestations such as dry mouth, gray tint skin, the pulse takes on a threadlike character. The level of leukocytes is very high, and low blood pressure is also noted.
If you ignore the clinical manifestations of thrombosis and do not start fighting the pathology in time, the patient’s death will occur within 48 hours. Reason fatal outcome serves as peritonitis and intoxication of the body. With the venous nature of the disease, the period for providing first aid is much longer, about 5 – 7 days.
Therapy
A person suffering from intestinal thrombosis can only be helped by immediate surgery. Reception medicines antispasmodic action complicates the process of diagnosing the disease.
Medical specialists carry out fibrinolytic therapy if the patient comes to them in the first 6 hours after an exacerbation of the pathology. The treatment method is individual and depends on the nature and stage of the disease. If there are no necrotic changes in the esophagus, the doctor is faced with the task of restoring blood circulation, thereby eliminating the risk of ischemic damage to the gastrointestinal tract.
To restore circulation, the medical professional either squeezes out the clot with his hands or creates a shunt between the levels of stenosis, ignoring the area with the clot. Subsequently, the doctor prescribes Heparin to the patient in large dosages, which is necessary to liquefy the blood cells.
Forecast
The pathology is observed much more often in comparison with its officially registered cases. This is explained by the fact that the disease occurs against the background of exacerbations of other pathologies of the gastrointestinal tract, among which appendicitis and cholecystitis stand out. The time to diagnose the disease is short; for this reason, mesenteric thrombosis is not always detected by medical specialists.
If the patient was in the hospital during an exacerbation of intestinal thrombosis, the chance of survival is quite high - more than 97%. However, if surgical treatment was carried out later than 12 hours after an exacerbation of the disease - the chances of favorable outcome small. Nine out of ten such patients died after surgery.
Favorable prognosis for full recovery, when using conservative methods treatment for chronic course The disease persists only in the initial stages.
If you contact us in a timely manner medical specialists it is possible to prevent perforation of the intestinal wall and save the patient’s life.
Mesenteric intestinal thrombosis is considered to be a pathology of older people. Middle age patients - 70 years old. Often the victims are women. Considering the age of the patient, it is not only the diagnosis that is difficult, but also the treatment tactics. What do you need to know about the disease?
Blood supply to the intestines
The intestines are part digestive system, whose function is:
- digestion of food;
- absorption of useful and nutrient substances;
- formation of the immune system;
- hormone production.
According to medical statistics The leading place among gastrointestinal diseases is given to intestinal diseases. Deep vein thrombosis is also quite common. Small intestine provides blood celiac trunk and the superior mesenteric artery, and the thick one - the inferior and superior mesenteric arteries. When blood flow is disrupted, ischemia develops.
Arteries and veins passing through the mesentery are responsible for the circulation of organs abdominal cavity, primarily the intestines
Why is primary arterial blood flow disrupted?
Vascular diseases are caused by impaired arterial or venous circulation. If the influx arterial blood is disrupted, the tissues no longer receive enough oxygen and beneficial elements. This leads to their death. Arterial obstruction can develop gradually or acutely.
The acute course is the most dangerous. Acute mesenteric thrombosis - dangerous pathology that a surgeon encounters in his practice. It leads to extensive tissue necrosis.
In addition, unpleasant symptoms occur:
- pain;
- marble skin tone;
- paresthesia;
- loss of sensitivity.
In a chronic course, the diameter of the artery decreases gradually. Various vessels are affected: mesenteric, carotid, renal, coronary. The intensity of symptoms depends on the degree of blood flow disturbance.
Thrombosis of mesenteric vessels can develop against the background of the following disorders and diseases:
- Raynaud's syndrome;
- arterial insufficiency;
- blockage of blood vessels with foreign particles;
- blockage of blood vessels with blood clots;
- obliterating atherosclerosis or endarteritis.
Thrombosis of mesenteric vessels is a blockage of the vessels of the mesentery (mesentery) by a thrombus
Secondary occlusion of mesenteric arteries
Arterial obstruction can be caused by pathologies such as:
- Atherosclerotic stenosis. When the lumen of the artery narrows, the mesenteric vessels become clogged. A critical indicator is a narrowing of the lumen by 2/3. When the lumen is completely closed, tissue necrosis develops.
- Tumors. Increasing in size, the tumor compresses the artery and thereby disrupts the blood circulation process.
- Heart dysfunction. With frequent and sharp decline blood pressure heart failure develops.
- Surgeries on the aorta. During the operation, the surgeon removes the blood clot. Blood quickly passes through the highways, bypassing the mesenteric arteries. This serves as an impetus for the development of multiple thromboses with necrosis and infarction of the intestine.
Despite what caused the blockage, the result of the pathological condition is always the same - ischemia.
Forms of ischemia
In medicine, intestinal ischemia is divided into acute and chronic. For acute form three stages of development are characteristic:
- Compensated. This stage is considered the easiest. With timely treatment, blood flow is completely restored.
- Subcompensated. Blood supply occurs through collateral circulation.
- Absolute. This is a severe form. If blood flow is not restored in time, intestinal gangrene occurs.
The chronic form is characterized by gradual compression of the intestinal mesentery. Ischemia occurs latently. Blood flow is carried out through a system of collaterals.
Mesenteric thrombosis, like any other, is directly related to cardiovascular and blood diseases
Clinical manifestations of intestinal vascular thrombosis
A blood clot can form not only in the mesentery, but also in the rectum. Symptoms of thrombosis are as follows:
- sharp pain in the abdomen, which worsens after eating;
- loose stools or constipation;
- nausea;
- vomit;
- blood in stool;
- flatulence;
- dry mouth;
- pale skin;
- blood pressure surges;
- dizziness.
If these signs appear, you cannot hesitate. You can count on a favorable outcome only if you consult a doctor in a timely manner. Self-medication is prohibited; this will only worsen the situation.
The pathology develops in stages:
- First stage. At this stage, the damaged organ is still subject to restoration. The symptoms are dominated by paroxysmal pain in the navel, vomiting of bile, and diarrhea.
- Second stage. Pathological changes lead to poisoning of the body. Loose stools give way to constipation. The intestinal walls are gradually destroyed. The pain intensifies. Pain syndrome cannot be relieved with analgesics and narcotic drugs.
- The third stage is considered the most difficult. Due to the accumulation of feces, the body is poisoned with toxins. Abdominal bloating, nausea and vomiting appear. Paralysis develops in the affected segment of the intestine. Symptoms include low blood pressure and high temperature bodies. Without treatment, the disease is fatal.
Paroxysmal or persistent abdominal pain, diarrhea, vomiting containing bile
Diagnosis of mesothrombosis
Diagnosis of thrombosis of mesenteric vessels consists of:
- taking anamnesis;
- general and detailed blood test;
- x-ray;
- laparoscopy;
- laparotomy;
- vascular angiography;
- colonoscopy;
- endoscopy.
Based on the data obtained, the doctor makes a diagnosis and prescribes appropriate treatment.
Only a radical method that cannot be postponed
Conservative treatment carried out at a stage when the disease does not progress. Doctors prescribe special injections and inhalations to thin the blood (Heparin). The use of anticoagulants, thrombolytics and antiplatelet agents is mandatory.
If the patient comes too late, then the only chance for a favorable outcome is surgical intervention. This radical method is also carried out in case of ineffectiveness of drug treatment.
Mesenteric intestinal thrombosis is treated with emergency surgical intervention
In order to restore blood flow, surgery on the mesenteric vessel is possible - endarterectomy, resection with prosthetics of the damaged area, creation of a new anastomosis with the abdominal aorta. If it is not possible to restore the viability of the intestine, then during the operation the doctor removes the damaged area of intestinal tissue and stitches the healthy areas together.
After surgery, the patient is prescribed drug treatment as an adjuvant therapy.
- Avoid heavy lifting and bathing;
- follow a diet;
- carry out physical therapy;
- maintain hygiene;
- undergo a timely examination by a doctor.
Thrombosis of mesenteric veins and mixed form of blood flow disorders
Acute disruption of blood flow often develops due to blockage of the venous vessels, which covers an entire area of the mesentery. This appears pathological condition due to increased blood clotting and disturbances of central and peripheral hemodynamics.
When venous vessels are blocked, the following is noted:
- Diarrhea. Mucus and scarlet blood appear in the stool.
- Painful sensations. The pain is dull, but after eating it becomes sharp and is localized below the navel.
- Inflammation of the peritoneum. The abdomen is distended, vomiting and nausea are present. There is no peristalsis. In addition, the patient's body temperature rises, breathing becomes intermittent, and the heartbeat slows down. In severe cases, delirium and confusion may occur.
When the veins are blocked, the prognosis for a person is favorable, since there is no total damage and the intestines continue to be supplied with arterial blood.
IN medical practice There are rare cases where a blockage is diagnosed in one area of the intestine venous vessel, and in the other - arterial.
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Mesenteric thrombosis is a vascular pathology in which partial or complete blockage of the arteries supplying the intestines occurs. These vessels are called mesenteric. In most cases, the superior mesenteric artery is affected, less often the inferior mesenteric artery. Acute occlusion requires emergency care and if left untreated, leads to serious complications (intoxication, peritonitis, tissue necrosis and intestinal obstruction). Mostly men over 50 years of age are affected.
Reasons for development
Experienced specialists know the causes of intestinal thrombosis, what it is and what possible consequences. The development of this pathology is based on a decrease in the lumen of the vessel due to the formation of a thrombus (blood clot). For the development of thrombosis it is necessary following conditions:
- Damage vascular wall. The arteries of the intestine are lined internally with endothelium. If its integrity is violated, fibrin and other substances that contribute can accumulate.
- Reduced blood flow speed.
- Increased blood clotting.
The formation of a blood clot is a complex process. Initially, increased platelet aggregation (sticking) is observed. They glow in areas with damaged endothelium. Fibrin is then formed, which thickens. Platelets are joined by other blood cells (erythrocytes, leukocytes) and blood plasma proteins. A blood clot forms, which is initially unstable.
Not everyone knows the risk factors for the development of intestinal thrombosis and the causes of this pathology. The development of the disease is promoted by:
- Damage to mesenteric arteries by atherosclerotic plaques. This pathology is caused by an increase in low-density lipoproteins in the blood. Forming plaques damage the inner lining of blood vessels, which facilitates the formation of blood clots.
- Vasculitis (inflammatory vascular diseases).
- Hypertension. High pressure (more than 139/89 mmHg) contributes to faster wear and tear of blood vessels and their damage.
- Congenital and acquired heart defects.
- Previous myocardial infarction.
- Imbalance between the coagulation and anticoagulation systems of the blood.
- Arrhythmias.
- Aortic aneurysm.
- Rheumatism.
- Surgical interventions on blood vessels.
- Tumors.
- Obesity.
- Smoking.
- Injuries.
- Sedentary lifestyle. Mesothrombosis is possible during long flights and transfers, because in this case the blood flow slows down.
- Autoimmune diseases.
- Hereditary predisposition.
How often do you get your blood tested?
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21.10.2019
Symptoms
Clinical picture depends on the degree of vascular occlusion by a thrombus and the type of occlusion (acute or chronic). Manifestations of thrombosis of intestinal vessels according to the type of chronic occlusion are:
- Constant pain in the abdomen. It occurs 20-30 minutes after eating. Pain syndrome does not disappear after vomiting, when used warm heating pad and antispasmodics. Pain may be felt near the navel, in the epigastric region or in the iliac region.
- Vomit.
- Nausea.
- Alternating diarrhea with normal stool or constipation. In the case of obstruction of the inferior mesenteric artery, constipation is most often observed. Such people may have stool retention for 3-4 days or more.
- Progressive loss of body weight. It is observed in the decompensated form of the disease. Causes of weight loss - frequent diarrhea, abstinence from eating due to pain and loss of appetite.
- Depression (low mood).
Acute intestinal thrombosis and thromboembolism are more severe. In most cases, the disease develops suddenly. The following symptoms are typical:
- Severe pain in the stomach. It can be cramping and unbearable. The pain is most severe in the first hours after the artery is blocked. After some time, the pain subsides, which is due to necrosis of the nerve fibers.
- Anxiety.
- Forced position of the patient (bringing the legs to the stomach).
- Vomit. It often has a fecal character. Semi-digested food moves in the opposite direction (from the intestines towards the stomach and into the esophagus).
- Increased pressure.
- Bradycardia (rare heartbeat). Heart rate during thrombosis and acute thrombophlebitis in the intestine is less than 60 per minute.
- Participation in the act of breathing of the abdominal muscles.
- Pain on palpation.
- Presence of swelling. Observed 6-12 hours after the onset of thrombosis.
- Disappearance intestinal peristalsis. The cause is paralytic ileus.
- Frequent loose stools or lack thereof (with intestinal obstruction).
- Weakness.
- General malaise.
- Signs of peritonitis.
Important information: What to do in case of cardiac thrombosis and what can cause a thrombus to come off (intracardiac)
The disease rarely occurs without clinical manifestations.
Stages
Intestinal thrombosis occurs in several stages. The following stages of disease development are distinguished:
- ischemia (first 6 hours);
- infarction (tissue necrosis);
- peritonitis (develops 18-36 hours after acute occlusion of the mesenteric arteries).
Each stage has its own characteristics. The appearance of severe intoxication of the body in combination with stool and gas retention, pain and symptoms purulent inflammation front abdominal wall points to last stage pathology.
Varieties
The following forms of thrombosis of mesenteric vessels are distinguished:
- Compensated. The obstruction of blood flow through the mesenteric vessels is compensated by collateral (bypass) pathways. In this case, acute intestinal ischemia does not occur. The disease occurs in a chronic form.
- Subcompensated. A person develops chronic vascular insufficiency.
- Decompensated. Thrombosis of mesenteric vessels can cause irreversible changes. In this case, the collaterals are unable to maintain normal blood flow. Ignoring the symptoms leads to intestinal gangrene and other consequences.
Diagnostics
If you suspect intestinal thrombosis you will need:
- Physical examination (palpation and percussion of the abdomen, listening to the heart and lungs).
- External inspection.
- Laparoscopy.
- Selective angiography (X-ray examination mesenteric vessels).
- Survey radiography. Detects fluid in the abdominal cavity and increased airiness of the intestines.
- Blood test.
- Urinalysis.
- Coagulogram.
Thrombosis of the mesenteric arteries must be distinguished from atherosclerosis, mechanical intestinal obstruction, venous lesions, acute surgical pathology (perforated ulcer, appendicitis, acute cholecystitis and pancreatitis).
First aid
For thrombosis of the mesenteric vessels of the intestine, the following is required:
- calling an ambulance;
- emergency hospitalization;
- use of painkillers.
Treatment
Acute intestinal thrombosis requires radical treatment. Conservative therapy has an auxiliary value. The earlier treatment is started, the better the prognosis.
Conservative therapy
Conservative treatment of mesenteric intestinal thrombosis includes:
- Restoration of circulating blood volume.
- Intensive care.
- Detoxification of the body.
- Normalization of heart function and stabilization of blood pressure.
- Drainage and sanitation of foci of infection.
- Use of medications. To prevent recurrent thrombosis, antiplatelet agents and anticoagulants (Aspirin, Curantil, Heparin, Clopidogrel) can be used. For fresh thrombosis of the mesenteric vein or artery, fibrinolytics (Streptokinase or Urokinase) can be prescribed. Painkillers and antispasmodics are also indicated. At infectious complications(peritonitis) antibiotics are indicated wide range.
- Bypass surgery. In case of thrombosis of the mesenteric artery, a shunt can be installed between the artery and the aorta below the thrombosis zone.
- Replacement of the superior mesenteric artery.
- Partial or extensive bowel resection. Required for tissue necrosis. The operation is complemented by drainage.
- Relaparotomy.
- Formation of anastomosis.
Postoperative period
Intestinal thrombosis requires rehabilitation and care for the patient after surgery. Required:
- taking blood thinning medications;
- control of blood pressure, heart rate and respiration;
- diet (patients are recommended to include citrus fruits, tomatoes, beets, dark chocolate, ginger, garlic, onions, olive oil, raspberries, cherries, cranberries, red grapes, strawberries and blueberries, as these products help thin the blood);
- treatment of somatic pathology (heart disease, arterial hypertension, atherosclerosis);
- quitting smoking;
- therapeutic exercises;
- drinking enough fluid.
Complications
The consequences of mesenteric artery thrombosis can be:
- Painful shock. It is manifested by pallor of the skin, depression of consciousness, cyanosis of the skin, decreased temperature, decreased pressure, loss of sensitivity and decreased muscle tone.
- Gangrene of the intestines.
- Peritonitis (inflammation of the peritoneum).
- Acute intestinal obstruction.
- Cachexia (wasting). Observed in chronic thrombosis.
- Severe intoxication.
- Relapse (repeated cases of thrombosis).
Rehabilitation
If a person has intestinal thrombosis, the prognosis is relatively unfavorable. With timely treatment (within the first 6 hours), rapid rehabilitation and full recovery are possible. When performing surgery at stages 2 and 3 of thrombosis of the superior mesenteric artery, the prognosis worsens. With advanced acute arterial occlusion, mortality after surgery reaches 80%. After surgery, the patient needs rehabilitation (proper care from relatives, medical supervision and sanatorium-resort treatment).
An “acute” stomach is one of the most dangerous conditions requiring immediate medical examination and treatment. Its causes can be different - an attack of appendicitis, poisoning, renal or hepatic colic, gynecological diseases. However, there is another reason that can cause sharp pains in the stomach and worsening general condition up to the death of patients - mesenteric thrombosis of intestinal vessels.
Why does blockage of intestinal vessels develop?
The mesentery is the mesenteric cords with which organs are attached to the posterior abdominal wall. It is with the help of the mesentery that the intestines are attached to the wall. Vessels to the small intestine, nerve endings, and mesenteric lymph nodes pass through it.
Long lasting vascular diseases in many cases, they lead to severe circulatory disorders and the formation of blood clots in the cavities of blood vessels - blood clots of various sizes, clogging the lumen and depriving entire sections of the walls of nutrition.
Thrombosis can be arterial or venous. It develops in the superior and inferior mesenteric arteries, with the upper section suffering from blockage by blood clots more often than the lower.
Vascular diseases progress over the years and come to their end when patients reach old age or old age, therefore, among patients diagnosed with mesenteric thrombosis there are no young people: this condition belongs to the category of age-related pathologies.
Heart and intestines: what is the connection?
Thrombosis of mesenteric vessels is directly related to heart disease: most often this condition is observed in patients with atrial fibrillation against the background of:
- cardiosclerosis;
- cardiac aneurysms;
- endocarditis of various etiologies.
A recent myocardial infarction, in which the heart muscle ruptures, accompanied by bleeding and the formation of a blood clot at the site of injury, can also cause the development of mesenteric vascular thrombosis.
The fact is that blood clots are able to “travel” through the arteries and veins of the body, breaking away from the bleeding area. If such a clot settles somewhere in the vessels of the mesentery and does not move further with the blood flow, they become clogged.
As a result, the walls of the vessel around the thrombus are not only deprived of the necessary nutrition provided by circulating blood, but can also die, which often leads to extremely serious consequences.
Other causes of thrombosis
Almost any disease in which internal bleeding is possible is fraught with the formation and separation of blood clots, and therefore there are other reasons for the development of thrombosis of the mesenteric vessels.
These include:
- Heavy intestinal infections;
- with blood stagnation in portal vein;
- Injuries;
- Tumors compressing intestinal vessels.
How does the disease manifest itself?
The intensity of clinical manifestations and symptoms depends on several factors:
- Places of vessel blockage;
- The degree of ischemia (bleeding) of the intestinal area;
- Development of blood circulation around the affected area.
So, if the upper part of the mesenteric artery is blocked, the small intestine is completely thrombosed and right side thick.
Occlusion (blockage) of the middle part of the artery leads to thrombosis of the ileum and cecum. Development of the pathological process in lower segment The mesenteric artery affects the colon and sigmoid colon.
Necrosis of the small intestine becomes a consequence of thrombosis of the portal and superior vein mesentery.
Clinically, the disease is divided into three stages:
- Ischemia (with partial bleeding of the walls of blood vessels and subsequent restoration of blood circulation);
- Heart attack (with symptoms of intoxication and changes in the tissues of the abdominal cavity);
- Peritonitis (stage of increasing intoxication, hemodynamic disorders and development of inflammation of the peritoneum).
Staged symptoms of thrombosis
Ischemia
Thrombosis of mesenteric vessels begins acutely:
- Paroxysmal or constant pain in the stomach;
- Vomiting mixed with bile already on the first day from the onset of the disease;
- Diarrhea.
These symptoms are very similar to the course of ordinary food poisoning, and therefore a visit to the doctor is often delayed.
Heart attack
When the vessels of the mesentery rupture under the pressure of blood trying to push out the thrombus, the stage of infarction occurs.
Diarrhea gives way to constipation, as deep pathological changes, blood appears in the stool. Usually there is not a lot of it: heavy bleeding is not typical for mesenteric thrombosis.
If blood accumulates in the intestinal loops, patients may feel a small lump below the navel, which in medicine is called Mondor's sign.
The pain in the abdomen can be so unbearable that shock develops: patients are very restless, cannot find a place for themselves, and scream. Severe pallor and cyanosis of the lips are noted. Sometimes blood pressure may increase by 40-60 units (with thrombosis of the upper artery).
The rupture of the vessel brings temporary relief to the patient: the person calms down, since the intensity of the pain is noticeably reduced, but vomiting and stool disorders persist.
The abdomen remains moderately swollen and soft, the characteristic phenomena of peritonitis (muscle protection and Shchetkin’s symptom) are not observed. The diagnosis of mesenteric thrombosis of intestinal vessels is made on the basis of ultrasound data and changes in the blood picture, which are expressed in sharp increase number of leukocytes: this figure can reach 40.109 / l. In data general analysis blood shift is recorded leukocyte formula to the left and high ESR numbers.
Peritonitis
Symptoms of peritonitis with thrombosis of intestinal vessels manifest themselves in a very unique way: tension in the muscles of the anterior abdominal wall and Shchetkin’s symptom are delayed, and inflammatory process starts from the bottom.
Developed intestinal paresis leads to the cessation of diarrhea and gas discharge.
Treatment and prognosis
Treatment of mesenteric thrombosis can only be surgical, even if the disease can be diagnosed at the stage of ischemic damage to a section of the intestinal wall.
Depending on the results of the examination, the patient may be offered:
- Embolectomy (removal of a blood clot);
- Reconstructive surgery on the superior mesenteric artery with implantation of its stump into the aorta;
- Removal of part of the intestine affected by gangrene.
A combined operation, including resection of a necrotic area of the intestine and plastic surgery, significantly increases the patients’ chances of life.
Unfortunately, the intestinal vascular pathology described in the article still has a very low patient survival rate even after surgical intervention: in postoperative period Three quarters of patients die.
This high mortality rate is explained by the difficulty of diagnosing the disease and too late application to specialists for hospitalization and treatment.
Afterword
Sick, long time Those suffering from vascular and heart diseases should be especially attentive to their health: the tendency to form blood clots and the danger of their breaking off greatly increases the likelihood of developing severe complications and the threat of death from them.
Appearance acute pain in the abdomen - a reason for immediate contact with specialists, and, if necessary, emergency hospitalization with subsequent treatment.
General practitioner, candidate of medical sciences, practicing physician.
My mother (71 years old) was diagnosed with thrombosis of the wall of the cecum and underwent intestinal resection. The doctor talked about diarrhea, but my mother began to have constipation 2 weeks after discharge, but there was no diarrhea. Now he is on prunes, vinaigrette and kefir. Is this normal after such an operation?
Answers the question: Vatolina Tatyana Vladimirovna
Candidate of Medical Sciences, phlebologist.
Bowel resection has nothing to do with constipation. Shortening of the intestine suggests that the process of resorption of water from the chyme will be less active ( smaller area). Logically, this can manifest itself as persistent diarrhea. If not, great. This means that the absorption function of the large intestine was compensated. Try drinking choleretic drugs: allochol, for example, or Duspatolin.
