Necrosis of the intestine is called an extremely serious pathology, characterized by irreversible necrosis of the soft tissues of the gastrointestinal tract on a significant( from the pylorus to the caecum) site.
Pathology requires immediate treatment, since the decomposition of affected tissues is fraught with the spread of the necrotic process to nearby organs. The lack of medical care inevitably ends in a fatal outcome.
Types
Depending on the etiology of the onset of bowel necrosis, there may be:
- Ischemic ( synonymous with the term "intestinal infarction").The cause of the ischemic necrotic process is a blockage of large blood vessels( arteries and veins) that supply blood to the intestines. With acute impairment of blood flow, the patient develops gangrene and peritonitis rapidly, and mortality approaches 100%.
- Toxigenic , arising from microbial infestation of the intestine of the fetus to be borne by coronaviruses, fungi of the genus Candida, rotaviruses, bacteria of the genus Clostridium.
- Tropha-neurotic , provoked by certain diseases of the central nervous system.
The presence of clinical and morphological features is the basis for the following types of bowel necrosis:
- Coagulation ( or dry), which develops due to protein coagulation( coagulation) and tissue dehydration. Atrophied bowel tissues, becoming dense and dry, begin to separate from healthy structures. The impetus to the emergence of this type of pathology, which has no special clinical manifestations, is chronic arterial insufficiency. The most unfavorable variant of resolving coagulation necrosis is its transformation into a pathology of a moist species.
- Collisional ( wet).A characteristic manifestation of wet necrosis is the active reproduction of putrefactive microflora in the cells of dead tissue, provoking the development of extremely painful symptoms. Since colliquated necrosis is fraught with the development of gangrene, its treatment requires mandatory surgical intervention.
- Stranded , due to acute intestinal obstruction, which can be triggered by occlusion of the intestinal lumen by a foreign body or intestinal contents experiencing difficulties with evacuation. Quite often, the cause of intestinal obstruction is pathological processes occurring in the structures of the intestinal walls. Another factor contributing to the emergence of this pathology is the squeezing of the intestinal tube from the outside( as a rule, rapidly growing tumors that hit nearby organs).Strangulation obstruction of the intestine can arise as a result of a significant narrowing of the intestinal lumen and thrombosis of the mesenteric vessels, which cause circulatory disorders, the development of necrosis of the intestinal walls and peritonitis( inflammation of the peritoneum).
Photo of small intestinal gangrenous necrosis
- A fairly common type of bowel necrosis is the gangrene , characterized by the presence of a message with the environment, the development of an infectious process provoked by putrefactive bacteria and leading to the rejection of dead tissue. Gangrene has two forms: dry and moist. Dry gangrene is characterized by impaired blood circulation, moist - the presence of edema, venous and lymphatic stasis( impaired flow of blood from the veins and lymphatic fluid from the lymphatic capillaries and vessels).
Causes of necrosis of
tissues Infectious, mechanical or toxic factors, which are most often represented by the authors of
1. , are the culprits of irreversible necrosis of intestinal tissues. Disorders of blood circulation in vessels feeding intestinal walls and leading to intestinal infarction. The cause of cessation of blood flow can become thrombosis( clogging of the lumen of the blood vessel by the formed thrombus) or embolism( blockage, provoked by a foreign body or air bubble penetrated into the bloodstream).In any case, the death of cells in the bloodless tissues occurs as a result of their intoxication with products of decomposition, acute shortage of oxygen and nutrients.
- As a rule, occlusion of vessels feeding the intestinal wall occurs in patients suffering from severe cardiac muscle diseases. In the risk group are mainly elderly women.
- The realities of our time are such that infarction of the intestine, which is often the culprit of necrosis, is increasingly affected by young people. According to statistics, in every tenth case, the patient is a patient who has not reached the age of thirty. Violation of blood flow can cause total necrosis, resulting in a fatal outcome in half of patients suffering from a heart attack of the small or large intestine.
- One of the most dangerous pathologies is thrombosis of mesenteric vessels, blood supply and thick, and small intestine, since in this case not some part of the intestine will go out of action, but the whole organ will be completely destroyed. The insidiousness of the mesenteric infarction is the complete asymptomatic of its course in the early stages of the disease. Clinical manifestations of pathology are absent until the development of total necrosis, which kills 70% of patients.
2. Intestinal obstruction resulting from the inversion of the intestines of the is a dangerous condition in which compression and twisting of the blood vessels of the intestinal walls( together with the most affected bowel) is observed. Curvature of the intestines is most often affected by the loops of the large intestine;The small intestine suffers from it much less often. The impetus for its occurrence can become overflow of the intestine, overeating and strong tension of the abdominal muscles, accompanying any excessive physical activity( for example, lifting a heavy object or a high jump).
3. Effects of pathogenic microflora. A vivid representative of this pathology is necrotizing enterocolitis, which is found mainly in newborn infants and affects the mucous membranes of the intestine. A characteristic feature of necrotizing enterocolitis is not total, but focal development. In the absence of timely treatment, the necrotic process, initially localized in the epithelial layer, can spread to the entire thickness of the intestinal wall. In the case of intestinal damage by bacteria of the genus clostridium, the necrotic process rapidly develops, leading to pneumatosis( a rare pathology characterized by the accumulation of gases with the formation of cavities - air cysts) and gangrene of the intestine, fraught with perforation of the intestinal walls. Pathologies that follow this scenario often end in a fatal outcome.
4. Dysfunction of ( malfunctioning) and diseases of the central nervous system, provoking dystrophic changes in the structures of the intestinal walls( up to the onset of necrosis).
5. Allergic reaction of to the presence of foreign bodies in the organs of the digestive tract.
6. Exposure to certain chemicals.
7. Surgical operations on the stomach.
Symptoms of intestinal necrosis
Dying of tissues with intestinal necrosis is accompanied by:
- increased fatigue;
- general weakness and malaise;
- decreased immunity;
- by high body temperature;
- lowering blood pressure( hypotension);
- by the pulse;
- by the presence of nausea or vomiting;
- dry mouth;
- significant reduction in body weight;
- with cyanosis and pale skin;
- sensation of numbness and lack of sensitivity in the affected organ;
- quickened urge to empty the intestines;
- by the appearance of blood in the excrements;
- is a violation of the liver and kidneys.
If a blood flow disorder occurs not in the artery but in the vein of the affected bowel, the patient will experience an undefined discomfort in the abdominal region, and an increase in the temperature of his body will be insignificant.
Necrosis, affecting the intestinal wall, leads to a change in their odor and color: they become white or whitish-yellow. In patients with intestinal infarction, blood-soaked necrotic tissues are dyed dark red.
In patients with necrosis, which occurred on the background of the turn of the intestines, the symptomatology is different:
- They often enter intestinal contents into the stomach, provoking the emergence of vomiting, characterized by a specific smell of vomit.
- Against the background of a complete lack of stool, there is an active separation of gases, in spite of which the stomach of the patient swells, becoming asymmetric. During the physical examination of the patient, a specialist who conducts palpation of the abdomen can detect the presence of abnormally soft areas.
The condition of patients with necrosis caused by exposure to pathogenic microorganisms or circulatory disturbance is greatly complicated by the adherence of clinical manifestations of peritonitis:
- color of the skin becomes grayish;
- observed a drop in blood pressure;
- heart rate increases( tachycardia develops).
In the development of intestinal necrosis, the stages:
- of prednecrosis, characterized by the presence of changes in tissues that are reversible.
- Tissue deaths. The pathology that entered this stage of development is accompanied by the death of the affected cells;the affected areas of the intestine change their color.
- Decay of tissues.
- Diagnosis of intestinal necrosis begins with a careful collection of anamnesis, including a study of the nature of stool, the frequency of excrement, the establishment of factors that promote increased gas production and bloating, clarification of the nature of abdominal pain and the frequency of their occurrence.
- In the course of a physical examination of a patient providing for obligatory palpation of the abdomen, the gastroenterologist can detect a painful area with no clear boundaries at the site of necrotic zone localization.
Diagnosis of
- Diagnosis of bowel necrosis begins with a careful collection of anamnesis, including a study of the nature of stool, the frequency of excrement, the establishment of factors that promote increased gas production and bloating, clarification of the nature of abdominal pain and the frequency of their occurrence.
- In the course of a physical examination of a patient providing for obligatory palpation of the abdomen, the gastroenterologist can detect a painful area with no clear boundaries at the site of necrotic zone localization.
However, a diagnostic examination of the patient requires the implementation:
- of a general blood test. At the initial stage of the pathology, it can be within the norm. In the final stages of bowel necrosis, he will indicate the presence of leukocytosis and a high rate of erythrocyte sedimentation( ESR).
- Biochemical blood test.
- Coagulograms - a special study of the blood coagulation system. On the presence of acute ischemia of the intestine may indicate an increased level of D-dimer - a small fragment of protein, formed as a result of the breakdown of fibrin and located in the blood after the destruction of thrombi.
To produce an error-free diagnosis, a whole complex of instrumental studies is required, requiring the following:
- Radiography. This procedure is most informative in the second and third stages of intestinal necrosis, while at the initial stage the pathology, even accompanied by a pronounced clinical symptomatology, is not always detectable.
- Radioisotope scanning, assigned in cases when the radiography has not yielded any results. Before the procedure, a drug containing a radioactive substance - an isotope of technetium - is injected intravenously into the patient's body. After a few hours, the radioactivity zones appearing in the patient's body are recorded. The site of the intestine, affected by the necrotic process and therefore devoid of blood circulation, will look like a "cold" spot in the picture.
- Angiography or magnetic resonance angiography - computer procedures involving the introduction into the bloodstream of a specially colored substance and taking pictures with a computer or magnetic resonance imager. These diagnostic procedures make it possible to identify problem areas of the intestine that have occluded vessels.
- Doppler ultrasound, performed using the Doppler apparatus, which allows to establish the blood flow velocity in the arteries of the intestine and on the basis of the data obtained, to reveal possible disorders in the blood supply of any part of the large or small intestine at the earliest stages of pathology.
- Contrast radiography, which is used to detect the width of the lumen of the blood vessels of the intestine. Before carrying out the radiographs, the contrast agent is administered intravenously.
- Diagnostic laparoscopy of the intestine is an operative technique of research that allows a specialist to assess the condition of this organ without resorting to large incisions of the anterior abdominal wall. In the abdominal wall of the patient, using a thin tube( trocar), three small punctures are made. A trocar is introduced with a telescope tube equipped with a light source and a miniature video camera connected to a monitor with a large magnification. Thanks to these devices, the physician can see the organ under investigation and monitor the progress of the manipulations performed. Two other trocars are necessary for the introduction of special tools( manipulators).During laparoscopy, a biopsy and puncture of the intestinal vessels can be performed. Samples of tissues are subjected to further histological examination.
- Colonoscopy - an endoscopic examination of the large intestine, carried out using an optical probe or a special device - a flexible and soft fibrocolonoscope. Thanks to the considerable( up to 160 cm) length of his tube, an endoscopist can examine the large intestine throughout its entire length. Fibrocolinoscope has a source of cold light( not burning intestinal mucous membranes during the procedure) and a portable optical system that transmits a magnified image to a special screen, allowing the specialist to perform any actions under the control of vision. Considering the considerable painfulness of the procedure, it is performed under local anesthesia, using a dicaine ointment and special gels containing lidocaine: Luan, Xylocaine, Catejel, etc.
- A practice called "diagnostic operation" has recently become firmly established in the practice of many modern clinics. Having found out necrotic tissues during his execution, the specialist starts to remove them immediately.
Treatment of
The doctor involved in the treatment of necrosis will first of all take into account:
- a variety and form of pathology;
- stage of the disease;
- presence or absence of concomitant diseases.
Complete recovery of a patient suffering from necrosis of the intestine, which can lead to the restoration of lost health, it is possible, but for this disease should be detected in one of the early stages.
There are different methods of treating this serious pathology, the choice of which depends on the preferences of the treating specialist. Regardless of the etiology of the onset of intestinal necrosis, the patient suffering from it should be immediately hospitalized in a surgical hospital.
The absence of symptoms of peritoneal inflammation( peritonitis) is the basis for the initiation of conservative treatment conducted under the guidance of a surgeon. Conservative therapy involves the introduction of the patient:
- electrolytes;
- protein solutions;
- antibiotics, preventing active reproduction of putrefactive bacteria;
- anticoagulants( drugs that reduce blood clotting), preventing thrombosis of blood vessels.
Simultaneously with medical treatment, all( and upper) and lower sections of the digestive tract are washed using special probes.
To reduce the burden on affected areas, intubation( intubation) of the intestine is performed, a procedure in which a thin tube is inserted into the intestinal lumen to draw the contents out of the strained and overcooked gut.
In the small intestine tube is injected through:
- nose;
- mouth;
- gastrostomy( an artificially formed opening in the anterior wall of the stomach and stomach);
- ileostomu( withdrawn and fastened surgically on the front wall of the stomach of the small intestine).
Intubation of the large intestine is carried out through the anal canal or through the colostomy( unnatural anus, created by removing the end of the sigmoid or colon to the abdominal wall).
Great importance is attached to detoxifying the body and eliminating the consequences of its dehydration.
If conservative treatment did not produce the expected result, the patient undergoes a resection - a surgical operation to remove a part of the intestine affected by necrosis. In the course of resection, a separate necrotic loop and a whole section of the small or large intestine can be removed.
Small intestinal resection is a category of rare surgical interventions necessary in cases when necrosis is a consequence of intestinal obstruction or fusion of the walls of this organ.
Resection of the large intestine may require the imposition of colostomy - an artificial anus necessary for the release of stool.
During a long postoperative period, the patient is prescribed a course of antibiotics and detoxification therapy, and also corrects the probable digestive disorders.
Prognosis and prophylaxis
The prognosis of recovery for all types of intestinal necrosis is favorable only if the pathology is diagnosed early.
In the most favorable position are patients, in which the necrotic area becomes covered with tissues forming a dense capsule.
The most adverse cases are cases accompanied by the formation of abscesses, the melting of which is fraught with the occurrence of internal bleeding.
There is no specific prevention of bowel necrosis. To prevent the occurrence of this pathology, it is necessary:
- Properly eat.
- Eliminate the likelihood of drug and food poisoning.
- Timely treatment of diseases of the gastrointestinal tract, cardiovascular and central nervous system.
- Forever stop smoking tobacco. It is established that smoking significantly speeds up the process of blood coagulation and promotes an increase in its density, provoking clogging of the intestinal arteries. All these processes lead to the adhesion of platelets and the formation of thrombi. Thus, malicious smokers are at risk for developing bowel necrosis.
- To lead an active way of life, contributing to an increase in the elasticity of blood vessels and reducing the risk of blood clots.
- Regularly engage in sports that help to optimize blood circulation, activate the immune system and strengthen the health of each person engaged in it.
- Monitor weight without obesity. The body of the owner of excess weight needs more oxygen than the human body with a normal weight. This factor also contributes to the development of thrombosis in any part of the human body. To satisfy the increased need for oxygen, the body tries to accelerate blood circulation. As a result, the blood vessels narrow, and the risk of clogging their lumens increases. In addition, excess weight contributes to the increase in the level of cholesterol in the blood, reflected in the acceleration of its coagulability.
- To be engaged in the prevention of diseases that cause the formation of thrombi( essential hypertension, atherosclerosis).
- To be attentive to your health, listening to inner feelings. In the presence of anxiety symptoms, you should immediately contact a qualified specialist.