Thrombosis of mesenteric vessels
Mesothrombosis, or mesenteric thrombosis, is the process of blockage of the vessels in the mesentery (mesentery). As a result of the formation of a thrombus, blood circulation in the vessels of the mesenteric film that covers the organs of the abdominal cavity worsens. Due to the violation of blood supply in the affected areas, irreversible changes and necrosis of these parts of the mesentery occur. Thrombosis of mesenteric vessels requires immediate removal of the blood clot.
Most often, mesenteric thrombosis is localized in the superior mesenteric artery, less often in the mesenteric veins and in the inferior mesenteric artery. The defeat of the mesenteric arteries occurs more often than the defeat of the veins. The mixed form of mesenteric thrombosis occurs in advanced cases.
According to ICD-10, this disease has the code K55.0, included in the interval "acute vascular intestinal diseases". Most often it occurs in elderly patients, in women a little more often than in men. In rare cases, mesenteric thrombosis is diagnosed in newborns with congenital bowel pathologies and in people under 40 years of age.
The mesentery fixes the intestinal loops in a "suspended" state. Veins, inferior and superior mesenteric artery pass between its leaves.
The distribution of blood supply between the vessels of the mesentery:
-
The superior mesenteric artery (90% provides blood supply to the gastrointestinal tract) - feeds the small intestine, blind, ascending, 70% of the transverse colon;
- Lower mesenteric artery - feeds 30% of the transverse colon, rectum, sigmoid, descending colon;
- Collateral vessels (anastomoses) - pump blood from the superior mesenteric to the inferior mesenteric artery; with thrombosis of the superior artery, intestinal collaterals are unable to provide blood supply to the mesentery.
Venous outflow of blood from the intestine occurs through the portal vein. As a result of blockage of the vessel with a thrombus, an acute disturbance of the blood supply to the intestine, ischemia of its walls develops. Further development of the process leads to irreversible destruction of tissues, hemorrhagic necrosis of the intestinal walls. The pathology is distinguished by a severe course, a high probability of death.
Content:
- Ways of blood clots entering the mesentery
- Classification of mesenteric thrombosis
- Symptoms of mesenteric thrombosis
- Diagnostics
- Treatment of mesenteric thrombosis
- Development forecast
Ways of blood clots entering the mesentery
The movement of a blood clot along the arterial system:
- From the heart - when the aortic aneurysm is torn off the wall resulting from a heart attack;
- From the thoracic or abdominal aorta - in case of vessel dissection;
- Detachment of atherosclerotic plaque;
- Directly from the mesenteric artery - as a consequence of its damage as a result of trauma (for example, when hitting the abdomen).
Blood clot formation in the venous system:
- Inflammatory bowel disease affecting the veins (thrombophlebitis);
- Decreased blood pressure against a background of deterioration in the activity of the heart muscle;
- Portal hypertension as a complication of hepatitis;
- Stagnation of blood with portal vein thrombosis;
- Diseases and conditions that increase blood viscosity - the consequences of splenectomy, long-term use of hormonal oral contraceptives, pathology of the hematopoietic organs.
In case of heart disease, characterized by the communication of its chambers, a thrombus can enter the mesenteric arteries from the vessels of the leg through the vena cava, right atrium, left ventricle, and abdominal aorta.
Classification of mesenteric thrombosis
Depending on the location and extent of the lesion, the following forms of mesenteric thrombosis are distinguished:
- Compensation - intestinal functionality is fully restored;
- Subcompensation - as a result of incompletely restored blood flow, intestinal pathologies such as colitis, enteritis, and abdominal toad develop;
- Decompensation - leads to the development of purulent peritonitis and abdominal sepsis.
Symptoms of mesenteric thrombosis
Before the onset of acute symptoms of thrombosis, precursors such as abdominal toad or chronic occlusion of the mesenteric vessels may appear. Its symptoms are diarrhea, abdominal pain after eating, and noticeable weight loss.
Symptoms of acute thrombosis in the first 6-12 hours:
- Sudden onset, acute cramping abdominal pain;
- The general anxiety of the patient, he is in a forced position with his legs pressed to his stomach;
- Nausea, vomiting of blood, bile, feces odor;
- Frequent bloody stools;
- Cyanosis of the skin;
- A pancake symptom is an increase in blood pressure by 60-80 mm Hg. Art;
- Slowing heart rate.
At the beginning of the pathology, there are no symptoms of peritoneal irritation, the abdomen remains soft and almost painless.
Symptoms of thrombosis in the heart attack stage (after 6-12 hours):
- Deterioration of the general condition;
- Reducing the intensity of the pain syndrome;
- Increased pain on palpation of the affected area;
- Symptom Mondora - the appearance of a dough-like swelling between the pubis and the navel;
- Increased heart rate;
- Preservation of the excretory function of the intestine.
Symptoms of mesenteric thrombosis at the stage of peritonitis (after 18-36 hours):
- Severe deterioration of the condition;
- Signs of intoxication;
- Peritonitis symptoms;
- Severe pain on movement;
- Intestinal paralysis, obstruction.
It is important to distinguish mesenteric thrombosis from acute pancreatitis, perforated duodenal ulcer, intestinal obstruction, acute appendicitis. The main difference between thrombosis is that there is no pain on palpation of the abdomen in the projection of the pancreas, there is liquid stool, and vomiting has a shade of coffee grounds.
Diagnostics
Diagnosing a pathology, the doctor examines the patient's history, the presence of heart and vascular diseases, analyzes the clinical symptoms, the presence of an acute pain symptom.
Laboratory and instrumental diagnostic methods:
- Blood test for coagulogram;
- Blood test for cholesterol;
- Determination of the number of platelets;
- Abdominal x-ray;
- Selective mesentricography, which determines the presence or absence of blood flow in the mesenteric arteries;
- Magnetic resonance imaging of the mesenteric vessels;
- Diagnostic laparoscopy to detect signs of intestinal infarction, changes in the abdominal cavity.
Treatment of mesenteric thrombosis
The only possible method for eliminating mesenteric thrombosis is emergency surgery.
The purpose of the surgery:
- Assessment of intestinal viability;
- Restoration of blood flow;
- Removal of areas of intestinal necrosis;
- Revision of mesenteric vessels;
- Prevention of sepsis and peritonitis.
There are several methods of operative elimination of mesenteric thrombosis. The surgeon reconstructs the great vessels, restoring their blood supply. In the area of intestinal stenosis, conditions are created for shunting. In case of necrosis, the gangrenous area is resected, then the blood supply is restored, measures are taken to prevent intestinal paresis. After 1-2 days, a repeated laparotomy is performed to re-revise the abdominal cavity.
Postoperative measures:
- The introduction of antithrombotic drugs to prevent the re-formation of a blood clot;
- Restoration of general blood circulation;
- Treatment of the consequences of intoxication;
- Stabilization of the functioning of the heart muscle;
- Stimulation of tissue metabolism;
- Sanitation of the abdominal cavity;
- Antibiotic therapy for the prevention of sepsis and peritonitis.
Development forecast
If the patient is assisted in the first 4-6 hours after the disturbance of blood flow in the mesenteric vessels, it is possible to completely restore the functioning of the intestine and prevent his infarction. With the provision of assistance at later stages, the number of irreversible changes increases, the mortality rate increases to 90%. The history of the underlying disease, the elderly age of the patient worsens the prognosis.
To prevent the development of mesenteric vascular thrombosis, it is necessary to timely treat the underlying disease, which becomes a source of blood clots - aneurysms, rheumatic heart disease, atherosclerosis.
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.
