Acute occlusion of mesenteric vessels

Acute occlusion of mesenteric vessels. Causes: embolism, thrombosis, exfoliating aneurysm of the abdominal aorta, trauma. Necrosis of the intestine can also occur with a decrease in cardiac output below the critical level without occlusion of mesenteric vessels. In 90% of cases occlusion of the superior mesenteric artery occurs, in 10% of the lower. With thrombosis, the occlusion of the main trunk of the superior mesenteric artery often occurs, which is complicated by necrosis of the entire small and large intestine to the splenic angle. With embolism, an occlusion of the more distal parts of the vessel occurs, while the necrosis zone is smaller.

Symptoms, course. The clinical picture of the disease depends on the time that has elapsed since its inception. There are 3 stages: I - the initial stage. In the clinical picture, a triad of symptoms prevails: abdominal pain, shock and diarrhea. Characteristic is the discrepancy between the severe general condition of the patient and the relatively small changes detected during examination of the abdomen: bloating and moderate soreness without symptoms of irritation of the peritoneum. When auscultation - weakening intestinal peristalsis. The picture of the blood is not changed. Radiologic examination determines the pneumatization and thickening of the wall of the small intestine. The duration of the stage is 1-6 hours. Stage II (7-12 hours): severe pain in the abdomen, palpation shows an increase in soreness, but there are no peritoneal symptoms, the patient's condition gradually worsens. With finger examination of the rectum there may be bloody discharge. In the blood-the growth of leukocytosis, the radiographic changes are the same; Lit stage - stage of bowel necrosis (after 12 hours). Symptomatics of diffuse peritonitis and paralytic intestinal obstruction, in the blood - high leukocytosis, with radiographic examination of the abdominal cavity - multiple levels of fluid.

Diagnosis is based on history, search for a source of embolism (ciliary arrhythmia, rheumatic heart disease), clinical manifestations of shock, intestinal paresis. An angiographic study is desirable. Later, surgical intervention causes the development of severe complications. In the third stage of the disease, arterial occlusion is associated with mesenteric venous thrombosis.

Treatment is only prompt. In the first stage, intestinal revascularization is performed by removing thrombus or thrombinectomy; In the II stage, in the presence of focal necrosis of the intestinal wall, revascularization is supplemented with intestinal resection; In the Ill stage-only massive bowel resection can save the patient's life. As a rule, operative BMD is performed in stages II-III of the disease; The postoperative lethality is 90%.