Mesenteric thrombosis( mesotrombosis) is the process of occlusion of mesenteric vessels or mesentery. They are a special film in which the internal organs are located. Acute deterioration of blood circulation occurs against the background of the development of the embolus( clot), overlapping the lumen. This leads to irreversible changes and the rapid death of the affected areas. In such conditions, rapid elimination of the thrombus is required.
Features of the disease
Prevalence of pathology is not gender dependent.
- The most vulnerable to her are the older people.
- Newborns can develop only if there are secondary diseases predisposing to mesotrombosis.
Often it is observed in congenital heart diseases.
Next, we'll talk about acute mesenteric thrombosis of the intestinal vessels and its other types.
More details about the pathogenesis of mesenteric vascular thrombosis and the causes of its appearance, will tell the following video:
Forms and stages of
There are 3 degrees of pathology, the severity of which depends on the extent of the lesion:
- Subcompensated form. Its signs are similar in many respects to arterial mezenteric insufficiency of a chronic type.
- Decompensated degree. It is considered to be the heaviest. If therapy is not performed in a timely manner, a number of complications arise. This time is considered the first 2 hours after the onset of the onset of absolute ischemia. After 4-6 hours from its beginning, the prognosis is already more unfavorable, and the restoration of blood flow is no longer able to prevent the development of gangrene of the intestine.
- Compensated form. This type of pathology proceeds chronically.
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- The acute stage begins after the embolism, and manifests with the signs of an "acute abdomen".
- The chronic course of the disease at first does not occur asymptomatically, then some disorders in the functioning of the stomach may occur( flatulence, pain).
- At the last stage, the pathology worsens.
Causes of
The reasons for the appearance of primary embolism include, for the most part, problems associated with cardiac pathologies:
- beat beat beat,
- stenosis of the valve( mitral),
- aneurysm,
- myocardial infarction.
The formation of a blood clot( i.e., an embolus) occurs against a background of increased coagulability of the blood. Rarely its formation begins in mesenteric vessels, more often it comes here from the aorta. Provoke an overlap of the lumen and injury. For example, strikes in the stomach, because of which the rupture of the mesenteric arteries is possible.
Secondary thrombosis occurs gradually, against the background of such pathological conditions as:
- The presence of tumors, anomalies in the development of the diaphragmatic stem, which the artery is squashed.
- Surgical operations to prevent occlusion of the aorta. Blood at the time of removal of the thrombus with great speed passes into the lower limbs. With mesenteric obstruction, many obstructions arise, which can lead to intestinal infarction, the appearance of necrosis foci, and the development of perforation. Characteristically, the trunk of the artery often remains unscathed.
- Atherosclerotic stenoses. More often, large vessels are exposed to this, leaving at an acute angle from the main artery. When the lumen is blocked, the blood flow decreases, and there is a risk of blockage of the mesenteric vessels. This is possible with a damaged plaque covering the lumen, which provokes necrosis. According to statistics, this very reason becomes the most frequent provoking factor of thrombosis in the intestine.
- Reduction of blood pressure on the background of worsening of cardiac activity.
Other pathologies may provoke mesenteric thrombosis, but all of them lead to intestinal ischemia.
Mesenteric thrombosis of the intestine has its symptoms, we'll talk about them later.
Symptoms of thrombosis of mesenteric vessels
Symptomatic largely depends on the stage of the lesion, as well as on the height at which the lumen of the artery was blocked. It includes the following manifestations:
- Intoxication in the development of inflammation or gangrene, which is characteristic of the decompensated form. Signs of the appearance of intoxication - vomiting, jumps of blood pressure, leukocytosis, filiform pulse.
- Liquid stool accompanied with intestinal colic is inherent in the compensated stage, and with subcompensated in the stool there is also blood. With a decompensated form, it is completely absent, so the analysis is done only after the enema.
- Symptoms of peritonitis are observed when the lumen is closed in the small intestine. They also appear when perforating the gut or gangrene.
- Severe and sudden pain, prolonged with subcompensation. It can be weakened by decompensation, since the nerve endings die off.
- With necrosis, peristalsis in the intestine gradually disappears. This feature is inherent only for decompensated ischemia, since when it is subcompensated, it works in an enhanced mode.
The most difficult to differentiate mesotrombosis from the acute stage of pancreatitis. A common clinical picture for these diseases is typical, however, for thrombosis, there is a liquid stool and vomiting of the hue of the coffee grounds. The character of the pain also differs. It is diffuse, it does not feel particularly local soreness in the pancreas.
On what diagnosis is provided for thrombosis of mesenteric vessels, read on.
Diagnostics of
Diagnostic measures should be aimed not only at determining mesotrombosis in time, but also in identifying the root cause of its development. That's why a special role is played by the collection of anamnesis. The more fully the symptoms are described to the doctor, the easier it is for him to choose a cure.
- Selective angiography establishes the degree and nature of the lesion, which is important when selecting the intervention technique and providing emergency care.
- Also use ultrasound, radiography.
- One of the best diagnostic techniques is laparoscopy. Diagnosis with mesotrombosis should be carried out quickly, in the next 2 hours. Laparoscopic method allows you to quickly establish the nature of pathology.
Let's now talk about the treatment of thrombosis of mesenteric vessels in children and adults.
Treatment
Surgical intervention
Treatment of mesotrombosis is possible only through surgical intervention. Conservative treatment is prohibited, since mesenteric insufficiency is able to develop at lightning speed, and this is fraught with total vasospasm. Of course, the patient will be injected with antispasmodics to alleviate the condition, but recovery can only be achieved through surgical intervention. It is worth noting that a timely injection of antispasmodics can translate ischemia into a less dangerous stage.
Surgery is urgent and this is the only way to save the patient's life. Surgery is preceded by intensive training. Intervention itself is never complete without examination and palpation of the veins, as well as the determination of pulsation at the border of the affected bowel.
There are several scenarios for the elimination of acute mesotrombosis:
- resection of an already altered gut;
- if necrosis is absent, then complete restoration of blood flow;
- in the presence of changes in the gut improve the blood supply of the subcompensation site.
Embollectomy, in which trunk vessels are reconstructed, help restore blood supply. With a complete blockage of the lumen or in the presence of emergency indications, a reconstructive operation is performed. The intervention is direct, the shunt is created in the area of stenosis. If there was a gangrenous change, then this area is cut off, but the restoration of blood flow still remains in the first place.
The following video will tell you about how the operation is performed for mesotrombosis:
Medication method
Medicines are prescribed already in the postoperative period. The basis of therapy is anticoagulants, which will prevent the formation of blood clots. If the blood flow has not been restored, then they are appointed especially cautiously.
On the fact that you do not have to go to the clinic with a diagnosis of "thrombosis of mesenteric vessels," you should think about preventing the disease. About this - further.
Prevention of
The main method of prevention is the timely identification of any pathologies that can lead to its development. If patients are likely to develop a disease, anticoagulants are used.
Complications of
- In untimely treatment, the likelihood of complications increases to 100%, which negatively affects the prognosis.
- In the postoperative period, complications are not always dangerous. There may be intestinal adhesions that provoke pain, pus appears on the scar.
About what the terms of death from mesenteric thrombosis and general prognosis for the disease, read further.
Forecast of
- Positive is the forecast with timely handling and, accordingly, timely intervention.
- If there was no referral to the hospital in the acute phase within 12 hours, the likelihood of a fatal outcome is up to 90%.Because of the complexity of the surgery, there is a risk of death after surgery.
- The elderly patients suffer the worst of both the disease and the treatment. The probability of a fatal outcome in this case is great, even if the rehabilitation course is passed.