What is mesenteric ischemia?
VASCULAR SURGERY – EURODOCTOR.RU – 2007
The blood supply of the intestines of our body is due to mesaraic (mesenteric) arteries. These arteries move away from the aorta at different levels. There are only two – the upper, part of the so-called celiac trunk and the lower extending from the aorta itself.
When the arteries in these disturbed blood flow (due to various reasons), there is bowel ischemia. Usually mesenteric ischemia affects the small intestine, large intestine less.
The cause of ischemia is a narrowing or blockage of mesenteric arteries. Most often, mesenteric ischemia suffer elderly and senile patients. In its current acute mesenteric ischemia is when the symptoms appear abruptly, and chronic when symptoms of small bowel ischemia occur gradually and periodically.
What are the causes of mesenteric ischemia?
The most common cause of acute mesenteric ischemia is sudden blockage of arterial lumen of the intestine. This occurs when a state of the heart as atrial fibrillation. Atrial fibrillation – a type of cardiac arrhythmias, kotoryts occurs in stenosis (narrowing) of the mitral valve. With this type of arrhythmia of the heart wall is very rapid decline, which leads to the development of blood clots in the cavities of the heart. These clots continue to fall into the aorta, from where they entered into the mesenteric artery. At the same symptoms depend on the size of blood clots, and the caliber of the branches of the mesenteric artery, in which there was a blockage.
Sudden blockage of the arteries supplying the intestines, leading to rapid necrosis of its walls. This leads to the development of severe pain in the abdomen and the appearance of peritonitis – severe complications.
What are the symptoms of mesenteric ischemia?
In chronic mesenteric ischemia may experience abdominal pain 15-60 minutes after eating. Pain can occur in any part of the abdomen, but more often in the middle and upper part of it. Abdominal pain in patients with chronic mesenteric ischemia can last up to six hours and then gradually goes away. The pain reappears after every meal. Thus, patients with chronic mesenteric ischemia often lose weight because even when hungry, they suffer, trying to avoid a recurrence of abdominal pain.
The appearance of abdominal pain in patients with chronic mesenteric ischemia due to a mechanism similar to the mechanism of pain in angina and is associated with atherosclerosis of the arteries. After the meal there hypercatharsis. However, due to the fact that the blood flow to the intestine is violated because of the narrow artery atheromatous plaques, there is pain.
Sometimes symptoms of mesenteric ischemia may be unclear, blurred. In addition to abdominal pain and weight loss, it is characterized by the following symptoms:
Acute ischemia is manifested sudden severe pain in the abdomen. This pain is sometimes not even removed narcotic analgesics. Additionally, there may be nausea and vomiting.
Thus, the main reasons leading to the emergence of mesenteric ischemia are
As already mentioned, atherosclerosis in the arteries are formed plaques that narrow their lumen. This in turn vdet to a deterioration of blood flow. Atherosclerosis is the cause of chronic mesenteric ischemia.
The cause of acute mesenteric ischemia is most often thrombi emboli. These clots are recorded in mesenteric blood flow from the heart.
There are other causes of mesenteric ischemia:
- Low blood pressure
- Congestive heart failure
- Stratification of aortic aneurysm
- Blood clotting disorders
It should be remembered that mesenteric ischemia – a medical emergency. When untimely medical attention for possible severe complications that lead to the removal of the intestines.
Diagnosis of mesenteric ischemia
At the beginning of the doctor asks the patient about the complaints, their nature, timing and duration of occurrence. Conducted a full examination, including diagnostic methods and tools. These methods include:
- Angiography (in this case arteriograiya) – a method of choice, especially in situations of acute mesenteric ischemia, when rapid diagnosis is required. This method consists in the fact that in the femoral artery through the access of groin catheter. The tip of the catheter is brought above the discharge of mesenteric arteries from the aorta. The entire process is monitored in real time on the monitor. Further, through the catheter radiopaque substance. Then made a series of x-rays. Angiography can also immediately after the results of the study to begin treatment.
- Doppler ultrasound. This method allows to determine the velocity of blood flow, and also shows the structure of the arteries, narrowing them to a place or a blockage.
- Analysis of blood. Typically, acute mesenteric ischemia in the blood was elevated levels of white blood cells – blood cells that signal the presence of inflammation in the body.
- Computed tomography – a method that allows visualization of the abdominal organs layer by layer. This method reveals, in particular, the separation of an aortic aneurysm.
- Magnetic resonance angiography – a method allows to obtain three-dimensional images of blood vessels and damaged organs layer by layer. However, its use is limited by the presence of implanted artificial cardiac pacemakers or metallic implants.
Treatment of mesenteric ischemia
The main goal of treatment mesenteric ischemia – a speedy restoration of normal blood flow in the intestine. Depending on the type of ischemia – acute or chronic, treatment may be in an emergency, and in a planned manner.
One method of treatment of chronic mesenteric ischemia is transaortalnaya endarterectomy. In this case the surgeon opens the abdomen to access the aorta and mezeneterialnym vessels. After that the endarterectomy – removal of atheromatous plaque from the inner walls of arteries. Another modern method of treatment of chronic mesenteric ischemia is bypass surgery. It lies in the fact that the surgeon sets the space around a narrowed mesenteric artery shunt. As a shunt is usually used subcutaneous Vienna hip patient, or a synthetic tube. After the shunt blood flow in diseased arteries is restored.
To date, the most modern methods of recovery of disturbed blood flow through blood vessels are angioplasty and stenting. Angioplasty is the summing up to the point narrowing of the arteries with a special catheter is inflated balloon on the end. When the tip of the catheter is in place narrowing, balloon is inflated and the artery expands. This procedure may be supplemented by stenting. Under the stent in place meant the installation narrowing artery stent – a cylindrical wire structure, which serves as a scaffold for the artery wall and allow it to continue to narrow.
Treatment of acute mesenteric ischemia – an emergency, since the belated treatment developed necrosis of the intestine and peritonitis. For the treatment of acute mesenteric ischemia are used thrombolytic drugs that dissolve the clot. These drugs are introduced through the catheter angiography. However, this method is not efficient, in addition, there are contraindications to him: the presence of fresh bleeding gastric ulcers and 12 duodenal ulcer, recent intracerebral hemorrhage, and others. In the case of the risk of necrosis of the intestine have a doctor remove the clot surgically.
It should be said that the treatment of mesenteric ischemia is dependent on many factors, such as the effectiveness of a method, the risk of complications and duration of treatment.
CARDIOVASCULAR SURGERY in MC Imedical – ISRAEL
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CLINIC CARDIOVASCULAR SURGERY NIDERBERG – GERMANY
CENTER FOR CARDIOVASCULAR MEDICINE SURGERY JSC – MOSCOW
Examination and treatment in GERMANY – Institute "DIAGNOSTIX"
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