Mesenteric artery thrombosis
Mesenteric artery thrombosis is a violation of blood circulation in the mesenteric vessels. This condition in 25% of cases is the cause of the development of acute intestinal ischemia. Pathology is expressed in severe pain in the lower abdomen, accompanied by diarrhea, vomiting with bloody impurities, and shock. To help the patient, he needs to urgently perform an operation.
The superior mesenteric artery is responsible for the supply of blood to the small intestine, the blind, ascending, and transverse colon. Part of the transverse intestine, the entire colon, sigmoid, and rectum are fed from the inferior mesenteric artery. Most often, the superior mesenteric artery is affected, which is responsible for the blood supply to the digestive tract as a whole. However, a mixed lesion of the mesenteric veins and arteries cannot be ruled out. First, a thrombus clogs the lumen of one vessel, and then chronic obstruction of another vessel develops. Men over the age of 50 most often suffer from pathology.
Until now, mesenteric artery thrombosis remains an urgent problem for surgeons. This is explained not only by the difficulties in diagnosing a pathological condition, but also by the fact that it can be provoked by many reasons and often leads to the death of the patient.
Content:
- Causes of mesenteric artery thrombosis
- Symptoms of mesenteric artery thrombosis
- Diagnostics of the mesenteric artery thrombosis
- Treatment of mesenteric artery thrombosis
- Prevention of mesenteric artery thrombosis
Causes of mesenteric artery thrombosis
Mesenteric artery thrombosis can be due to several reasons, including:
- Diseases of the heart and blood vessels: atherosclerosis, heart disease, rheumatism, vasculitis, hypertension, arrhythmia, abdominal aortic aneurysm.
- Postponed operations on the cardiac aorta.
- The presence in the body of a tumor of a malignant nature.
- Hypercoagulability of blood, polycythemia vera, thrombocytosis, sickle cell anemia.
- The period of bearing a child.
- Taking hormonal drugs for contraception.
- Paraneoplastic syndrome.
- Infection of organs located in the peritoneal cavity, including diverticulitis, appendicitis, etc.
- Liver cirrhosis with portal hypertension leading to venous congestion.
- Surgical intervention, accompanied by injury to the mesenteric artery.
- Imposition of an anastomosis.
- Acute inflammation of the pancreas.
- Decompensated illness.
With thrombosis, the mesenteric artery is blocked by thrombotic masses. As a result, blood flow slows down, which leads to pathological changes in the organ.
There are three possible options for the development of this pathological condition. In the first case, blood flow can be restored spontaneously or with the help of drugs (thrombosis with compensation of blood flow of the mesenteric artery). In this case, the functioning of the intestine will not be disturbed.
In the second case, impaired blood flow will lead to various intestinal diseases (thrombosis with subcompensated blood flow of the mesenteric artery).
In the third case, impaired blood flow causes purulent peritonitis, sepsis and death of the patient (decompensated thrombosis).
There are categories of patients who are at risk for developing mesenteric artery thrombosis:
- Elderly people.
- Patients with malignant tumors of the peritoneum.
- Patients who have had myocardial infarction.
- Patients who underwent atrial fibrillation.
- Patients with atherosclerosis.
Symptoms of mesenteric artery thrombosis
Acute mesenteric artery thrombosis has a sudden onset. Severe pains come to the fore. They are localized in the abdomen and proceed as contractions. A person is not able to stay in place, he is constantly rushing about in search of a comfortable position of the body that will relieve pain. The patient feels best when the knees are pressed tightly to the stomach.
Other signs of mesenteric artery thrombosis:
- The patient is nauseous, vomiting may occur. Bile and blood are found in the vomit. Then, the smell of feces will begin to come from the vomiting.
- The stool is liquid, blood is visible in it.
- The skin of the face and body becomes cyanotic.
- Shock may develop.
- Blood pressure rises, bradycardia is observed.
- After 6-12 hours from the onset of the development of the pathological process, the pain becomes less intense. At the same time, it acquires a clearer localization, that is, it does not spread throughout the peritoneum, but concentrates in the intestinal region.
- In the area between the navel and the pubis, it will be possible to feel a tumor-like seal.
- The patient's state of health is getting worse: the pulse quickens, but the blood pressure returns to normal.
- After 18-36 hours from the start of the first symptoms, the patient develops peritonitis. His condition deteriorates sharply, the pain becomes incredibly intense, especially during physical activity. Signs of body intoxication are increasing.
- The patient cannot empty the intestines, as his paralytic obstruction develops.
- The body temperature rises sharply.
So, in its development, mesenteric artery thrombosis goes through three phases: the hyperactive phase (the first 6-12 hours), the paralytic phase (12-18 hours) and shock (18-36 hours).
Diagnostics of the mesenteric artery thrombosis
During the examination of a patient who entered a medical institution in the first hours after the onset of thrombosis, the doctor will find a soft abdomen, the participation of the peritoneal wall in breathing. There are no symptoms of internal irritation of the peritoneum, that is, the severity of the pathology does not correspond to the initial symptoms of the disease. This is one of the factors that complicate the correct diagnosis. An increase in body temperature and signs of irritation of the peritoneum will appear only at the stage of peritonitis, when it will be difficult for the patient to help.
It is imperative to check with the patient whether he had previously had an attack of angina pectoris with abdominal pain that would occur after eating. As a rule, about 50% of patients with mesenteric artery thrombosis give a positive answer to this question. Since the process of digesting food contributes to an increase in intestinal perfusion, the patient may suffer from exhaustion, since such patients often develop a fear of eating, and satiety occurs much faster.
Such conditions in the medical history as coronary artery disease, atherosclerosis, obliterating endarteritis, as well as surgical interventions on the aorta, can suggest a mesenteric artery thrombosis.
What you should pay attention to:
- Against the background of the development of intestinal necrosis, the pain may subside somewhat. Patients take this for an improvement trend, which is a false belief.
- Narcotic pain medications do not reduce the intensity of painful sensations. At the beginning of the development of symptoms of thrombosis, antispasmodics are much more effective.
- As the disease progresses, the intoxication of the body increases.
- Symptoms of thrombosis most often do not correspond to the severity of ischemic bowel disease.
To perform high-quality diagnostics, it is necessary to perform the following studies:
- Bowel X-ray. Attention should be paid to such indicators as: excessive stretching of the intestine, its thickened wall, etc. The specificity of the method does not exceed 30%.
- CT scan of the intestine. Signs of mesenteric artery thrombosis: swelling of the intestinal wall, hemorrhage in certain parts of the intestine. This method allows visualization of a thrombus. However, CT with vascular angiography is more specific. This study reveals thrombosis in 94% of cases.
- Intestinal angiography. Allows you to make the correct diagnosis in 88% of cases.
- UZGD has specificity in 92-100% of cases. However, if the thrombus is located outside the great vessels, then the study will not allow it to be detected. Therefore, this method is not taken as a basis, regarding it as an auxiliary one.
- Other methods that make it possible to clarify the diagnosis: MRI (disadvantages: expensive research, lack of necessary equipment in many clinics, but high specificity of the method), echocardiography (makes it possible to clarify the source of the thrombus), ECG, etc.
The patient must take blood for biochemical and general analysis, as well as for a coagulogram.
Treatment of mesenteric artery thrombosis
After admission to the hospital, the patient is placed in the intensive care unit.
He is shown the following treatment:
- Restoring the body's water-salt balance.
- Correction of electrolyte levels.
- Oxygen therapy.
- If there is evidence, then the patient is given a blood transfusion.
- Pressure and urine output control.
- Placement of a nasogastric tube.
- Normalization of the work of the heart muscle.
- Pain relief.
- Prescribing broad-spectrum antibacterial drugs.
Use of medicines:
- Introduction of Papaverine through a catheter into the affected part of the intestine. The drug is administered throughout the day (this is the minimum period for drug submission). It is impossible to combine the use of Papaverine and Heparin.
- Introduction of trobolytics by catheter, provided that the patient has not yet developed peritonitis or intestinal necrosis. It is important to perform this procedure no later than 8 hours after the onset of symptoms. If after 4 hours the patient's well-being does not improve, then surgery is recommended.
- Introduction of Heparin followed by switching to Warfarin.
Surgical intervention:
- Intestinal resection is prescribed provided that the patient develops peritonitis.
- Revascularization with further anastomosis can also be considered as a method of surgical treatment for mesenteric artery thrombosis.
According to different authors, the death of patients with mesenteric thrombosis can reach 50-100%. A more accurate prognosis depends on the speed of seeking medical attention. It is aggravated by the fact that many patients go to the doctor with already developed intestinal necrosis, or with peritonitis. If the patient refuses the operation, then death occurs in 100% of cases.
Prevention of mesenteric artery thrombosis
Prevention of mesenteric artery thrombosis is reduced to maintaining a healthy lifestyle, quitting smoking. It is also important to monitor body weight, preventing obesity.
It is imperative to treat all diseases that pose a threat to the formation of a blood clot. We are talking about atherosclerosis, rheumatism, arrhythmias, etc.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003, he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
