Mesenteric thrombosis or intestinal infarction: how to prevent a fatal outcome

Mesenteria or mesentery is a special fold of the peritoneum, with which the abdominal cavity organs attach to the back wall of the abdomen.

In other words, it is a kind of "bag" with ligaments that keeps and fixes the insides in a certain position. In addition, the mesentery performs an important function of blood supply to internal organs - it is all permeated with blood vessels.

Mesenteric thrombosis is the partial or complete cessation of blood flow in the mesenteric vessels of the intestine .The disease can also be called thrombosis of visceral vessels, mesenteric infarction, intestinal ischemia. In any case, this is an extremely difficult condition, which often leads to death.

Contents

  • 1 Description of the disease and statistical data
  • 2 Causes and risk factors
  • 3 Species, forms, stages, their description and differences
  • 4 Danger and consequences
  • 5 Symptoms
  • 6 Diagnosis
  • 7 Treatment methods
  • 8 Forecasts and prevention measures

Description of the disease and statistics


Intestinal blood supply is carried outwith the help of visceral veins and arteries( upper and lower), each of which is responsible for the delivery or outflow of blood from its specific site. If a blood clot enters one of these vessels - it occludes the bloodstream partially or completely , which leads to a disruption in the blood supply and nutrition of certain parts of the intestinal tract.

As a result of ischemia , intestinal tissues begin to suffer from oxygen starvation, and the processes of necrosis and necrosis of gradually increase in them. Without providing timely assistance in the next few hours, some parts of the gut simply die, peritonitis and sepsis develop - this is the cause of death in most patients.

The sad statistics of this disease is as follows:

  • mortality among unoperated patients in case of acute mesenteric infarction reaches 100%;
  • among operated patients - 80-90% with a lethal outcome;
  • frequency of the disease - 1 person out of 50,000 per year;
  • is 2 times more common in older women;
  • is most often diagnosed with thrombosis of the superior mesenteric artery - in 90% of cases, the lower artery or mesenteric veins are thrombosed ten times less often.

Causes and Risk Factors

Mesenteric thrombosis is caused by clotting of the bloodstream by thrombus as a result of:

  • atherosclerosis, in which the lumen of blood vessels narrows and the risk of thrombosis increases;
  • myocardial infarction or endocarditis - a thrombus forms which, with blood flow, reaches the mesenteric arteries and clogs them;
  • of a severe intestinal infection of , an inflammatory or tumoral process in the abdominal cavity - tumors or abscesses can squeeze the mesenteric vessels, preventing normal blood flow in them;
  • hypercoagulation - increased clotting leads to thrombosis;
  • blood stasis in the mesentery vessels , which significantly increases the risk of vascular obstruction;
  • injury , which causes bleeding and can form clots.

The risk of mesenteric thrombosis increases if a person:

  • has reached the advanced age( more than 60 years in women, 70 - in men);
  • suffers from cardiac and vascular diseases;
  • underwent heart surgery;
  • suffers from cirrhosis of the liver, which leads to increased pressure in the portal vein;
  • suffered prolonged dehydration;
  • leads a sedentary lifestyle;
  • was susceptible to prolonged chemotherapy.

types, forms, steps, their description and differences

basis for classification Types mesenteric thrombosis features
process flow acute suddenly develops myocardial intestine with subsequent necrosis
chronic gradually develop functional bowel disorders without necrosis
Localization circulatory disorders arterial blood flow in mesenteric arteries is disturbed, which in most cases leads to bowel infarction in 6-8 hours
venous the blood flow in the mesenteric veins is disturbed, the infarct is formed quite a long time - from several days to several weeks
mixed the blood flow is disturbed first in the arteries and then in the veins of the mesentery
The degree of the blood supply violation with the blood flow compensation blood supply is provided due to unaffectedvessels
with blood flow subcompensation blood supply is not fully implemented
with blood flow decompensation blood supply to sites toshechnika missing, comes bowel infarction
prevailing symptoms ileusny pain rhythmic and cramping as in intestinal obstruction
pankreatopodobny severe pain above the navel, nausea and vomiting, purple spots on the body
appendicular symptoms of appendicitis
holitsistopodobny pain in the upper right abdomen, nausea
angiospastic symptoms of the "abdominal toad" that subside after taking nitroglycerin
ulcerative by symptoms is similar to perforated gastroduodenal ulcer

During the acute disease several stages can be identified, of which only the first is reversible:

  1. Ischemia with arterial thrombosis and hemorrhagic impregnation with venous thrombosis. At this stage, the blood flow in the affected area of ​​the intestine ceases, changes occur in the intestinal wall, the processes of intoxication of the organism with products of tissue decay increase.
  2. Intestinal infarction and progressive necrosis with severe intoxication of the body.
  3. Peritonitis .As a result of necrosis of the intestinal wall, it becomes perforated with the entry of intestinal contents into the abdominal cavity. Inflammation of the peritoneum develops.
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Danger and consequences

All types and forms of mesenteric intestinal thrombosis are dangerous, because without the timely medical assistance of their result can be bowel necrosis, peritonitis and deaths .And if in the chronic course of the disease or its venous form the patient theoretically has time to detect and eliminate the problem, then with acute arterial mesenteric thrombosis, the lethal outcome may occur within a day.

Symptoms

Symptoms are different depending on the stage of the disease, its type and form of flow:

Stage or type of thrombosis Possible symptoms
Prodromal stage of arterial thrombosis( in several weeks)
  • periodic abdominal pain, especially after eating
  • nausea and vomiting
  • unstable stool and bloating
Prodromal stage of venous thrombosis( in a few days)
  • tolerable painsthroughout the abdomen
  • slight increase in temperature
Stage of ischemia
  • severe abdominal pain: permanent or cramping, localized depending on the lesion site, sometimes "in the lower back
  • vomiting in the first day with bile
  • diarrhea
Stage of infarction
  • abdominal pain
  • abdomen swollen but soft
  • pallor of the skin and blue lips
  • temperature rise
  • vomiting with a faint odor
  • constipation
  • feces with an admixture of blood in the form of "crimson jelly »
  • can be palpated in the intestine
  • may increase blood pressure
Stage of peritonitis
  • unbearable abdominal pain
  • stomach becomes solid
  • stops intestinal peristalsis
Chrothrombosis in which the lumen of the vessels overlaps gradually
  • the stomach hurts after eating so much that a person tries not to eat as long as possible
  • frequent diarrhea and flatulence
  • the body temperature rises
If a thrombosis of the mesenteric vessels is suspected, it is necessary to consult a doctor immediately - it depends on itlife of the patient. The ambulance and the surgeon are the ones who can help in this case.

Diagnosis

Death from intestinal thrombosis is so common because it is very difficult to diagnose it. Symptomatic of the disease is similar to a number of other conditions:

  • with acute appendicitis;
  • by intestinal obstruction;
  • gastritis or bulbitis;
  • perforated ulcer;
  • pancreatitis;
  • cholecystitis.

In case of suspected thrombosis of mesentery vessels, doctors prescribe laboratory blood tests and a series of instrumental studies. But it should be noted that in the early reversible stages of the disease can only be detected by the angiography of vessels with contrast medium or laparoscopy. Intestinal ultrasound and X-ray diagnostics are informative only in the late stages of the disease, when the changes that have occurred are often irreversible.

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Methods of treatment

Conservative drug treatment for mesenteric thrombosis is possible only in the case of chronic course of the disease, if the blood flow in the mesenteric vessels is preserved. In this case, the patient is prescribed medications for blood thinning and resorption of blood clots ( Heparin and its analogs) and closely monitor his condition, including blood tests.

In acute mesenteric thrombosis with pronounced symptoms of ischemia and intestinal infarction, only surgical intervention is shown, whose purpose is to save the life of the patient .

Preparing for surgery and emergency rescue measures are already beginning to be provided by ambulance doctors on their way to the hospital - after all, any delay is deadly to the patient.

Variants of surgical treatment depending on the state of the intestine and the stage of the disease can be:

  • thrombectomy - removal of a thrombus from the vessel without intestinal resection is possible only in rare cases when the process of necrosis did not start, that is during the first 5-6 hours after vessel thrombosis;
  • reconstructive surgery on the affected artery - when the thrombus is removed together with the vessel site;
  • removal of the part of the intestine , affected by necrosis;
  • combined operation , in which the operation on the vessel and removal of part of the intestine at the same time.
The operation to remove thrombosis of the mesenteric vessels of the intestine, especially in the late stages of the disease, is classified as heavy. It is carried out under general anesthesia and requires a long rehabilitation period after. Often within 6-12 hours after the first operation, the second - in case of repeated thrombosis and irreversible changes in the intestinal wall - may be required.

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Forecasts and prevention measures


The outcome of the disease depends on the degree of neglect of the disease, the nature and area of ​​the lesion. In acute thrombosis, the patient has virtually no chance of surviving without surgery. In the case of , if the operation was carried out in the early stages - the forecast is favorable .If surgical intervention has occurred after the beginning of necrosis of the intestine or peritonitis - postoperative mortality reaches 80%.

In order to avoid this terrible diagnosis, it is necessary to implement the following preventive measures :

  • take care of the condition of your heart and blood vessels, fight with atherosclerosis;
  • with a tendency to thrombosis to take prescribed anticoagulant by the doctor;
  • lead a healthy and vibrant lifestyle.

Mesenteric intestinal thrombosis - is a formidable disease with a rapid onset and dramatic finale .Independently you can not overcome it - the patient should seek medical help immediately if he has the slightest suspicion of this ailment.