Bowel ischemia: chronic and acute form
Intestinal ischemia occurs due to insufficient supply of oxygen and nutrients in the wall. The reason for the disease is a blockage or narrowing of the lumen of blood vessels. The disruption of blood flow causes permanent or temporary damage to the tissues and metabolic disorder. The probability of development of necrosis depends on the extent of the failure of local blood circulation. Sudden disruption of blood flow is a threatening condition that requires immediate surgical intervention.
There are the following types of ischemia of the intestine:
- mesenteric (chronic, acute);
- mesenteric venous thrombosis.
Each bowel disease is associated with impaired activity of the cardiovascular system, has its own characteristic symptoms.
Chronic mesenteric ischemia
Disease develops for a long time on the background of atherosclerosis. The gradual narrowing of blood vessels leads to the development of numerous anastomoses, which provides compensatory blood supply of the intestine. The disease starts with pain in the left iliac region. The symptoms include bloating, diarrhea with blood, fever. The pain symptoms are reversible when violations are mainly associated with the digestion or physical exercise.
In most cases, the symptoms may disappear in a few days. With timely therapy, patients recover in the third week. With a reversible, and often recurrent ischemic colitis patients develop stenosis of the large intestine that disrupts the discharge of gases and normal digestion.
Acute mesenteric ischemia
Disease begins with a violent attack of abdominal pain, pain shock. Patients dramatically decreases the pressure, there is stool with blood. With the rapid development of necrotic processes in the beginning there is active peristalsis of the intestine. With the growth of ischemia peristalsis stops completely. Patients swollen and painful abdomen.
Pathology develops in the colon due to violation of patency of the mesenteric arteries and the barrier function of the intestine. For acute ischemia of characteristic 2 main characteristic:
- the extension of the gut;
- the loss of important electrolytes.
Extension of the intestine develops as a result of hypersecretion, impaired peristalsis, reduce the absorption of water and electrolytes. This leads to the accumulation of large amounts of fluid. Patients with reduced circulating blood volume, causing tachycardia and shortness of breath. The increase in ischemia leads to a sharp permeability of the intestinal wall, cessation of intestinal digestion and absorption in the small intestine. The contents of the infected intestinal microbial flora and becomes a source of toxins.
As a result of accumulation of toxins in the blood, patients develop acidosis, which affects the clotting of blood, heart activity and blood pressure. Appears a marked intestinal bleeding, which worsens the symptoms and leads to collapse. Thus, acute ischaemia of the intestine leads to incompatible with life as acute surgical pathology of abdominal cavity. Save the patient’s life can only be an urgent laparotomy and resection of part of the intestine.
Mesenteric venous thrombosis
Pathology develops due to thrombosis of the mesenteric veins. In surgical practice venous circulation is found in 2 times more often than arterial. Ischemia of the intestine usually occurs on the background of blood clotting that develops in cancer, infectious processes, blood diseases and after injuries. In some cases, ischemia is formed after surgical interventions, of typhoid fever.
When venous thrombosis the intestinal damage is not extensive. The prevalence of ischemic and necrotic processes in the intestine depends on an extensive network of collateral vessels. In its clinical presentation mesenteric venous thrombosis is similar to that of mesenteric embolism of the arteries. However, venous blood flow in the treatment recovers faster.
Diagnosis and treatment
During acute ischemia the diagnosis is established only during surgical intervention while opening the abdominal cavity. Chronic ischemia detected after carrying out duplex scanning that allows you to assess the condition of the blood vessels, the degree of impaired blood flow. The definitive diagnosis is based on selective angiography.
In acute ischemia and necrosis of the intestine shown urgent surgical intervention. The sooner it is done the better the results of treatment. During the surgery is resection of the affected bowel and the removal of the embolus from an artery. With extensive necrosis of the intestine carry out Subtotal resection with anastomosis. After such surgery, patients receive a complex rehabilitation.
In the case of chronic ischemia are shown of vascular surgery, the goal of which is restoration of patency of the affected vessel. Conservative treatment aims to eliminate symptoms. Patients are prescribed:
- holinoliticheskie funds;
- drugs that enhance peristalsis;
- b vitamins, ascorbic acid;
- iron preparations;
The prognosis of acute ischemia is serious enough. In case of untimely provision of surgical care can occur death. After successful operations in patients disappear main symptoms, there is a good appetite returns efficiency, normalize bowel function.