Heart attack mesenterial vessels. Features of manifestation and treatment of mesenterial thrombosis

No one is insured against pain in the intestines, the reasons for its occurrence are many, among which is banal poisoning. Because of this, people do not immediately appeal to the doctor, trying to eliminate the unpleasant sensations on their own. However, this symptom should relate much more seriously, since it may be a sign of mesenteric thrombosis, the disease, which in most cases leads to death.

Mechanism for the development of mesenteric thrombosis

Mesenteria - mesenteric fabrics that are fixed internal organs, including the intestines, to the back abdominal wall. These fabrics are "conductors" of vessels, nerve endings and lymph nodes to the subtle intestine. The mesenter vessels are susceptible to thrombosis, since the rest of the blood system.

Thrombosis - blockage of vessels, narrowing their lumes due to blood clots (blood clots) inside them, these plugs interfere with blood nutrients and oxygen to various organs. The thrombus can move together with the bloodstream and settle in certain vessels. The sedimentation of blood clots in the mesenteric veins and arteries is the name of the mesenterial thrombosis. A more common venous type of this disease is developing slower than the thrombosis of mesenterical arteries, and its symptoms are softer.

The disease most often amazes patients older than middle age, since they have a whole "bouquet" of cardiovascular diseases and thrombosis of mesenterial vessels for a long period of life, one of the most common.

Causes and development of thrombosis

Typically, blood begins to turn around when the vessels are defeated, it helps to stop the bleeding, but sometimes this process is activated inside the vessel without mechanical impact on it. So in vessels there are blood clots - it is a blood clot, developing due to its coagulation ability.

Thrombus interfere with normal blood circulation.

There are several reasons for the occurrence of blood clots:

• hypercoagulation (excessive blood coagulation) associated with heredity or acquired due to various diseases;
• the pathology of the inner layer of the wall of the vessel (endothelium) responsible for blood coagulation. In the endothelium contains substances that activate coagulation, they are normally fenced from the blood and stand out only in case of injury. Negative endothelium changes may arise due to injuries, chemotherapy, radiation, operations;
• blood stagnation, which leads to bundle blood on elements that are able to stick together, forming blood clots (the causes of blood stagnation - a sedentary lifestyle, work that does not require motor activity).

Causes of the disease

Thrombosis of mesenterial vessels proceeds under the general "rules" of the development of thrombosis. Doctors revealed its main reasons:

• long-term cardiovascular diseases (heart aneurysm, myocardial infarction, cardiosclerosis, endocarditis, rheumatic heart rate);
• intestinal infections that had a negative impact on the intestinal vessels;
• portal hypertension;
• various injuries;
• education (benign or malignant), which squeeze the intestinal vessels.

Symptoms of mesenterial thrombosis

The clinic of thrombosis of mesenterial vessels is determined by the following factors:

• localization of thrombosis, for example, the thrombosis of the upper mesenteric artery leads to a complete thrombusing of the small intestine;
• degree of ischemia (lack of blood) intestine;
• the characteristics of the blood flow around the affected section of the mesentery.

The development of the disease is accompanied by such symptoms:

• abdominal pain (they can be in the form of seizures or constant);
• nausea and vomiting with bile (most patients are observed after several hours of thrombosis development);
• diarrhea.

The listed symptoms are observed at the initial stage of the development of pathology, they are often confused with clinical signs poisoning, so do not immediately appeal to the doctor. However, after home "treatment", these signs are repeated.

• disorders of the gastrointestinal tract (diarrhea alternates with constipation);
• there is blood in feces in small quantities;
• the seal below the navel (symptom of mondor) associated with blood clusters in the intestinal vessels;
• rolling increases up to peeling shock;
• the pain does not have a clear localization, it may be a grapple-shaped or constant;
• raising arterial pressure by 40-60 units;
• moderate bloating;
• the tension of the abdominal wall muscles, which develops due to the protective reaction of the body for negative changes;
• dryness of the language;
• raising total temperature bodies up to 38 degrees and above;
• lip cyanosis and pallor.

Symptoms can "fade" for a while due to the dying of the nerve cells and breaking the vessels, but this is not a reason to postpone the visit to the doctor, since the state of the intestine is only aggravated, the body is amazed by sharp mesenteric thrombosis.

Clinical signs of chronic mesenteric thrombosis

The chronic form of the disease is divided into 4 stages, each of which has its clinical signs:

I - a person does not feel changes in the work of individual bodies, and the thrombus can identify with angiography;

II - the patient feels pain and unpleasant sensations in the intestine after meals, which is often refused of it;

III - complaints of constant abdominal pain, diarrhea and meteorism;

IV - acute pain In the area of \u200b\u200bthe abdomen (the people got the name "acute belly"), at this stage, peritonitis and gangrene begins to develop.

In the first stage, to identify the disease is very difficult.

Diagnosis of pathology

Diagnosis of the disease is carried out using special equipment:

• lateroscopy helps to identify an increase in the extension loops that remain when turning the body from the sides on the side or move to the upper abdominal areas;
• x-ray abdominal cavity can give the result only on the last stage ailment;
• The ultrasound provides data that makes it clear enough to see changes provoked by thrombosis;
• selective angiography allows the most accurate conclusion (thrombosis of mesenteric vessels is diagnosed if the main arterial barrel is determined on the angiograms).

As an auxiliary method, the finger survey of the rectum is used.

To accurately determine the diagnosis laboratory research The blood is observed with such changes in the total blood pattern:

• sharp increase in the number of leukocytes (up to 40-109 / l);
• high EFA indicator;
• the leukocyte formula is shifted to the left.

Also in order to make correct conclusion The doctor who conducts research asks to respond to the following questions:

• what character had pain (parlor or permanent);
• how sharp were painfulness;
• does the patient suffer from cardiovascular diseases;
• whether disorders were observed from the intestinal and gastric tract.

Angiography

The problem of differentiation of mesenterial thrombosis and ways to solve it

The problem of detection of mesenterial thrombosis is to similarly its symptoms with other human pathologies (appendicitis, ulcer of the stomach and intestine, cholecystitis, intestinal obstruction). For differentiation, they are resorted to laparoscopy, as well as to electrocardiography.

If it is impossible to carry out laparoscopy, experts resort to surgical intervention - laparotomy. It is carried out by cutting through the middle line of the abdomen, which makes it possible to get to the intestine and obtain such data:

• the presence and location of thrombus;
• the level of pulsation artery;
• the degree of thrombosis of the mesenteric artery;
• the magnitude of the area affected by Ganger.

Treatment of the disease

Due to the rapid development of the illness, the features of its manifestation of mesenteric thrombosis can be cured only by surgical intervention.

Without surgery, the patient is subject to fatal outcome.

Reception of painkillers only aggravates the situation, pulling the diagnosis of the disease.

On the early stages Reconstructive intestinal vessels are carried out:

• resection of the upper mesenteric artery with prosthetics;
• embolctomy (removal of blood clot);
• endarterectomy.

With a timely handling of professional medical help, there are good chances of restore the blood supply to individual sections of the intestine, which is carried out:

• squeezing blood clot fingers;
• creating an artificial vessel, bypassing a plot with a thrombus.

If the intestine is amazed by gangrene, prescribe dead tissues or resection within a healthy tissue. Often resort to combined operations.

The overall picture of the postoperative period of this disease today is disappointing: more than half of the patients are subject to death, it dies approximately 80% of the operated people.

The main causes of fatal outcome:

• the complexity of diagnosis of pathology;
• tightening patients with access to a specialist;
• self-treatment.

Prevention of mesenterial thrombosis

Preventive measures should be aimed at preventing pathological processes in the cardiovascular system. Basic measures are:

• sufficient motor activity;
• proper nutrition;
• rejection of bad habits;
• avoiding the development of infectious diseases, in case of their occurrence, you need to immediately contact the doctor;
• regular monitoring of blood pressure changes;
• regular medical examinations.

Mesenteric thrombosis - very dangerous disease, subject to man of death, so when manifesting his symptoms, you need to immediately contact the doctor. Especially careful need to be people with cardiovascular pathologies.

Video: Menitary cell thrombosis

From this article you will learn: the causes and symptoms of mesenterial thrombosis than it is dangerous. Methods of prevention and treatment.

Publication date of Articles: 05/15/2017

Date of renewal of the article: 05/29/2019

Thrombosis of mesenterial vessels is the blockage of the vessels of the mesentery (mesentery) thrombus. Mesenteria is a combination of mesenteric heavy, with which the abdominal organs are attached to the abdominal wall. This is a very dangerous state.

Arteries and veins passing through mesenteria are responsible for the blood circulation of the abdominal organs, first of all, the intestines. And if the thrombus bore a mesenteric artery or vein, it will lead to severe intestinal disorders and in the absence of treatment - to death.

Treat mesenteric thrombosis with surgical intervention. Treatment is carried out by a surgeon.

The disease is accompanied by very high mortality due to its frequency and difficulties of diagnosis.

The reasons

Mesenteric thrombosis, as well as any other, is directly related to cardiovascular and blood diseases. The thrombus is formed during heart failure, inflammatory processes in vessels, after myocardial infarction, with arrhythmias, cardiosclerosis, middle-aneuryms of cardiac partitions and vessels, heart inflammation.

The risk of thrombosis rises at:

• thrombophilia (hereditary predisposition to the formation of thromboms);
• surgical operations and injuries;
• long-term drug intake, which increase the "viscosity" of blood (antitumor drugs, oral contraceptives);
• continuous immobilization of the body (in laying patients or disabled on the wheelchair, when lying in postoperative period);
• pregnancy and postpartum period;
• sugar diabetes;
• obesity;
• smoking.

Regardless of which a thrombus was formed, it can clog any artery or vein, including mesenterical.

The risk that the thrombus will be bought by a mesentery vessel, increases with heavy infectious diseases intestines and his tumors.

Vessel in the context, on an enlarged scale. The process of formation of thrombus during atherosclerosis

Symptoms and Stages

The disease occurs in three stages:

1. Ischemia. When the clearance of the vessel, due to blood cloth, narrowed by 70% or more, develops a lack of blood circulation in the intestine.
2. Intestinal infarction is the fracturing of the intestinal area, which bloodshed in the affected vessel.
3. Peritonitis - inflammation of the peritoneum, the growth of intoxication of the body. This stage can lead to a fatal outcome.

Symptoms thrombosis of mesenterior intestinal vessels:

Thrombosis can occur very quickly, so when the first symptoms appear, call ambulance, since the patient needs an emergency operation. Symptoms characteristic of stage 1 may indicate appendicitis, as well as about acute gynecological diseases. They also need urgent surgical intervention.

Diagnostics

It is very important to distinguish mesenteric thrombosis from other bowl diseases (appendicitis, perforative ulcers duodenal gut), as well as from gynecological diseases (for example, ectopic pregnancy, breaking the cysts of the ovary).

In the presence of the symptoms described in the previous section of the article, ambulance delivers a patient to the surgical department.

Diagnostics conducts a surgeon. It includes the collection of anamnesis and at the moment the symptoms, manual inspection of the patient. Next, a blood test is prescribed, a coagulogram (blood coagulation analysis), urine analysis, abdominal ultrasound, emergency angiography of abdominal vessels.

If the diagnosis was not necessary, it is resorted to laparoscopy - an invasive diagnostic method. The abdominal organs are inspected using an endoscope introduced through the incision of the skin and the front abdominal wall. The procedure is carried out under anesthesia.

Angiography of vessels of the abdominal cavity. The arrow indicates the place of thrombosis of the lower mesenteric artery

Treatment and forecast

Mesenteric intestinal thrombosis is treated with emergency surgical intervention.

It is carried out in several stages:

1. First, thrombus is removed by provoking circulatory disruption.
2. The affected vessel is then reconstructed.
3. If the operation is carried out not at 1, but in the 2 stages of the disease, and the intestinal infarction zone is extensive, then remove the submese part of the organ. At 3 stages, if a strong inflammatory process managed to develop, washing the abdominal cavity.

The outcome of the disease depends on the stage on which it was revealed and began to be treated, as well as from the correctness of the diagnosis.

On 2 and 3 stages of the disease with a bowel infarction, even with successful operation, about 70% of patients die. This may be due to the inxication of the body from inflammatory process, the severity of the operation, as well as with the main disease that caused thrombosis. At the stage of the disease, if removing the thrombus before the necrosis of the intestinal section, the survival is much higher.

Therefore, do not pull with the appeal to the doctor in the occurrence of abdominal pain.

Operation to remove the unrecorded part of the intestine. Anastaskin - a special connection of the "chain sites"

Prevention

It is better to prevent thrombosis of mesenterial vessels than then to treat it. Via preventive Mer You literally save your life.

If you suffer from cardiovascular diseases, or your direct relatives have been inclined to the formation of thrombov - pay special attention.

• First of all, exclude all other risk factors ( excess weight, smoking, sedentary lifestyle, taking oral contraceptives). Treat the heart and vessels in time. With diabetes, observe all the recommendations of the doctor regarding treatment.
• If you are in the risk group of thromboms (suffer from cardiovascular diseases, diabetes, lead a low-wear lifestyle for health state, have an extra weight associated with metabolic disorders from which you cannot get rid of), then in half a year, give blood on a coagulogram. This is necessary to identify blood coagulation disorders. If the risk of thrombosis is increased, you will be prescribed a means that dilute blood and prevent the formation of thrombus.
• In time treat the bowel disease. If you have discovered a tumor, do not tighten with it. In case of passing the course of antitumor medications, periodically give blood test for clotting and take antiagregant or anticoagulants assigned to the doctor.
• If you have transferred surgical interference with the abdominal organs, follow all the recommendations of the doctor in the postoperative period. After analyzing blood, if there is an indication, the attending surgeon can assign you medicines for the prevention of thrombosis. Start moving as soon as possible. Go more if you make a doctor. Activity will help to prevent non-stagnation of blood (which increases the risk of thrombov formation), but also the formation of postoperative adhesions, which can lead to complications in the future.
• After any operations on the vessels (not only on the vessels of the abdominal cavity) and on the heart, take anticoagulants appointed by the doctor or antiagregants.

Folk remedies for the prevention of thrombosis

Do not attempt to replace medicines by folk remedies, since the absence of a prescribed doctor medical treatment It can lead to the formation of blood clots and difficult consequences. Also, folk remedies may have contraindications, so advise consult with therapist, cardiologist and gastroenterologist.

Components	How to cook	How to use
Black elderberry (flowers) AIR (roots) Vasilek (flowers) Field Horst Nather (roots) Forest strawberry (leaves) Lovers (leaflets) Kanchin Konsky (Flowers) Lilac (sheets) Leaves Kalina Walnut leaves Plantain (leaflets)	Take 1 g of each plant. Fill 450 ml of room temperature water. Let it brew for 6 hours. Put on the fire, heat up to 100 degrees (up to boiling) and immediately remove. Put in heat. Wait for an hour. Perfect.	Dosage: 1/3-1 / 2 glasses depending on weight. Receptions per day - 3. Taking time - 20 minutes after eating.
Truck Roots Aira Coltsfoot (leaflets) Tatarnik (flowers) Leaves strawberries Flowers Korovyaka Flowers of Chestnut Konsky Birch leaves Prethassa Motherwort	Take 1 g of each specified component. Fill 420 ml of boiling water. Prepare a water bath. Put the decoction not to do it and hold 15 minutes. Remove from water bath and place in a warm place. Let it brew for 120 minutes. Perfect.	Dosage - 1/3 cup. Number of receptions per day - 3-4 Time of reception - 20 minutes after the meal.

Take these medicinal charges under the supervision of the attending physician.

According to statistics, in general surgical practice, pathology is found not as often as purulent inflammatory diseases, however, the severity of clinical manifestations makes diagnosis, treatment and prevention of mesenteric thrombosis is very relevant in modern surgery.

The reasons

Thrombosis is a typical pathological process and regardless of the localization of the pathogenetic mechanism of its formation will always be the same. The following triad of factors play a key role in the development of intestinal vascular vessels:

• The tendency to thrombophilia or hypercoagulopathy from the blood plasma of the patient.
• Damage to the endothelial layer of vessels.
• Change blood flow with laminar on turbulent or twin.

The combination of all three mechanisms sharply increases the risk of blood clots or thrombus formations in the vessel. The overlap of the lumen by more than 75% becomes the cause of the first clinical manifestations of intestinal thrombosis.

Symptoms

Depending on the level of localization of the blood clots, the mesenteric bromboosis of the intestine will manifest itself various clinical options. There is a close connection between the lesion zone and the characteristics of the intestinal blood supply:

• Occlusion at the level of the upper mesenteric artery is the defeat of the entire delicate intestine and the right half of the thick.
• Occlusion of segmental mesenterical arteries - necrosis of individual sections of the small intestine, for example, a ileal segment or a blind intestine.
• The occlusion of the lower mesenteric artery is compensation of blood flow due to collateral (additional) blood flow or necrosis of the left part of the colon.
• Thrombophlebitis or thrombosis of mesenterial veins - isolated necrosis of the small intestine.

It is important to note that the symptoms of the defeat of the parties described digestive tract Developed for 1-2 days, and the expression dynamics of symptoms is directly proportional to the volume of the affected intestine.

Stages

Depending on the pathological process stage, certain symptoms will arise and prevail:

• Ischemia. In the first hours after thrombosis, the victim begins to experience a strong pain syndrome. The pain can be so pronounced that leads to reflex vomit. At the beginning, painful syndrome is an approached character, and after a few hours the sensations become permanent. Most patients have a single liquid stool.
• Intestinal infarction. In this stage, the processes of ischemia become irreversible, which leads to the emergence of local abdominal symptoms. The abdominal pain is more distinct, the general intoxication of the body begins to appear as a result of stagnant phenomena in the intestine. The body temperature rises.
• Peritonitis. Stage is terminal. The first signs of peritonitis can appear 16-20 hours after the start of thrombosis. The necrosis of the intestine walls leads to its insolvency, the tightness and the contents of the intestine are lost to actively penetrate into the free abdominal cavity, thereby causing acute intoxication of the body.

Diagnostics

Differential-diagnostic search plays an extremely important role in surveying the victim with suspected mesenteric thrombosis.

In the first hours, the disease has a lot in common with such states as:

• abdominal form of myocardial infarction;
• pancreatitis and pancreonenecosis;
• stomach ulcer;
• intestinal obstruction.

To form a preliminary diagnosis, a thorough collection of the abstract analysis of the disease and analysis of the clinical picture is carried out. To confirm the diagnosis, resort to special instrumental and diagnostic research: angiography of intestinal vessels and diagnostic laparoscopy or laparotomy. Angiography allows you to accurately discover the intestinal thrombus and its localization.

The importance of first aid

It is important to quickly deliver the victim in medical institution For diagnostic survey. At home, to help the victim with a suspicion of the intestinal thrombosis is impossible.

Easy the patient's condition can spasmolyts and painkillers, but it should be understood that they can also distort the clinical picture of the disease. The earlier the patient will be delivered to the surgical hospital, the better the forecast will be.

What doctor treats bromboosis of the intestine?

The treatment of pathology is engaged in a general surgeon. Direction general Surgery Engaged in emergency and planned treatment of any pathology of the gastrointestinal tract. Mesenteric thrombosis refers to an emergency pathology.

Treatment

After the clinical diagnosis and determination of the thrombosis stage, specialists are determined with therapeutic tactics, which can be both conservative and operational (surgical).

Conservative

May exclusively at early diagnosis At the stage of ischemia, when disorders of the digestive tract are functional and reversible. Anticoagulants and anticoagulants and anticoagulants are used to compensate for mesenteric circulation.

Surgical

Operational treatment is shown when the effect of conservative therapy has no proper success, positive dynamics in clinical picture Not observed or during the diagnosis, explicit irreversible processes were revealed - intestinal necrosis.

Already during the examination of the patient, it is prepared for surgical intervention. To do this, the blood type, rezes-affiliation is determined and premedicated for anesthesia and soothing.

Surgical treatment can be:

• vascular correction - thrombectomy;
• resection of the affected intestine;
• combined treatment;
• treatment of peritonitis.

Volume operational intervention It is determined by intraoperative, depending on the volume of the intestine.

Rehabilitation

Rehabilitation activities play an important role in the subsequent recovery of the patient. With extensive intestinal lesions and a pronounced peritonitis, an intestinal stoma can be formed a patient, which undoubtedly reduces the standard of living, but allows to restore the intestine.

In the first 5-7 months after treatment, the patient needs strictly observing the medical diet. Limited and intensive exercise stress for 12-16 months.

Complications

With sharply flowing mesenterical thrombosis, the rate of rendering medical events directly affects the development of complications. So, with the late provision of qualified assistance, the patient may develop the following life-degrading states:

• spilled peritonitis;
• toxic shock;
• polyorgan deficiency;
• sepsis.

Prevention

The patient necessarily rises to a gastroenterologist and cardiologist. This is necessary to eliminate repeated episodes of mesenteric thrombosis. Also in persons suffering from atherosclerosis, intestinal diseases and of cardio-vascular system The preventive purpose is prescribed coursework with the use of anticoagulants, antiagregants and antispasmodics.

Summing up, it is important to once again note that thrombosis of mesenterical or mesenteric arteries is an acute surgical disease requiring immediate correction and treatment. Symptoms of pathology can be masked under no less serious diseasesWhat requires careful diagnosis before the start of treatment and necessarily in the conditions of the hospital.

Useful video about mesenteric thrombosis

Thrombosis of mesenterial vessels (code on the ICD-10 - K55.0) is called blockage blood clots Escape arteries and intestinal veins. This disease predominantly affects people of middle and older. It refers to very difficult pathologies, it develops lightning, sometimes a fatal exodus is possible.

The mesentery is a connecting tissue, with which the intestines is attached to the back of the peritoneum. It does not give intestinal loops to bother.

The intestine is bloodshed in the upper and lower arteries of the mesentery. Thrombosis occurs in the upper-barrack artery more often, it accounts for up to 90% of all cases of this pathology. She is heavily suited most organ

This vessel nourishes the following departments:

• thin, ascending rim, blind intestine;
• hepatic bending;
• two thirds of the transverse border.

Therefore, during its thrombosis, severe lesions are developing.

Lower mesenteric artery blood supply to the remaining departments. These include:

• riming downward;
• left third cross-binding;
• sigmoid gut.

This artery accounts for up to 10% of all cases of intestinal vessels.

Causes of the occurrence and pathogenesis

The main cause of the development of mesenteric thrombosis is the embolization (closing of the lumen of the vessel) thrombus. It is formed in the middle part abdominal aorta And gradually spreads down, first narrowing the lumen of the upper artery of the mesentery.

Then the thrombus mechanically overlaps the clearance of the vessel (artery or vein). The influx of blood on it to the tissues is stopped. This causes them irreversible destruction. If the blood supply is not in a timely manner, the mesenteric heart attack develops.

The formation of thrombosis contributes such vascular pathologies as:

• stenosis of the mitral valve;
• cardiac aneurysm;
• bureau of the intersdial wall;
• arrhythmias;
• endocarditis;
• cardiosclerosis;
• myocardial infarction.

The thrombus, taking off from the places of its formation, move along vessels, are delayed in some of them, and then break the lumen. These diseases are primary reasons The development of thrombosis. Most often, the clomes in the mesenteric artery migrate from the aorta.

In addition to cardiovascular pathologies, some other states and diseases provoke the appearance of thrombov. They contribute to the formation of secondary mesenteric insufficiency, which causes thrombosis. It can be:

• pancreatitis;
• acute heavy intestinal infections;
• heart deficiency with low arterial pressure;
• cirrhosis;
• stenosis of the enlightenment of vessels of mesenteria due to the formation of atherosclerotic plaques;
• portal hypertension syndrome high degree congestive phenomena;
• tumors, squeezing vessels;
• liver steatosis;
• hereditary predisposition;
• diabetes;
• increase blood clotting.

Enhance the risk of developing a mesenteric thrombosis of abdominal injury, operations on abdominal organs, hormone therapy, smoking, pregnancy and hypodynamia, as well as a reception of a number of drugs (contraceptives, antitumor drugs).

Characteristics of the steps to narrow the vessel

Based on the degree of circulatory disorder in collateral and main vessels, three degrees of lesion are distinguished:

1. Compensation - It is characterized by chronic ischemia of bowel tissues. Blood circulates only by collateral vessels.
2. Subcompensation - It is characterized by partial blood supply to organ tissue.
3. Decompensation - This stage is characterized by the onset of irreversible changes, is considered very heavy. Foci of fours of the fabrics are formed, since their food is missing. It is divided into two phases:
   • The first is no more than two hours, is considered reversible.
   • Four hours later, the second phase begins, the gangrene of the affected departments of the intestines develops. If you do not give a sick medical care on time, a fatal outcome is possible.

Classification of forms in the table

	Types of mesenterial thrombosis	Characteristic
Process flow	acute	suddenly develops a bowel infarction with subsequent necrosis
	chronic	gradually develop functional intestinal disorders without its necrosis
Localization of blood supply disorders	arterial	bloodflow is broken in mesenteric arteries, which in most cases leads to the intestine of the intestine for 6-8 hours
	venous	bleeding in mesenteric veins is broken, the heart attack is formed for quite a long time - from several days to several weeks
	mixed	bleeding is broken first in the arteries, and then - in the veins of mesen
The degree of violation of blood supply	with blood flow compensation	blood supply is carried out due to unaffected vessels
	with subcompensation of blood flow	blood supply is not fully carried out
	with decompensation of blood flow	there is no blood supply to the intestinal sections, the intestine is coming
Prevailing symptomatics	ileisny	rhythmic pain and grapple-shaped as intestinal obstruction
	pancredito-shaped	pronounced pain on the navel, nausea and vomiting, purple stains on the torso
	appendicular	symptoms of appendicitis
	holyistoid	pain in the upper right half of the abdomen, nausea
	angiospastic	symptoms of "abdominal toads", which subsided after taking nitroglycerin
	ulcery	according to symptoms, it is similar to a perforated gastroduodenal ulcer

Clinic: Symptoms of development in stages

The clinical manifestations of acute mesenteric thrombosis are distinguished by the phased appearance of symptoms. It depends on the stage of the disease.

The three stages of this disease are distinguished:

1. Ischemia - It is distinguished from other stages what the process is reversible. But clinical manifestations grow rather rapidly.

   There is a process of decay of tissues, since blood supply is sharply reduced in the affected areas. Symptoms grow quickly.

   An intense increasing pain in the abdominal cavity appears. The character of pain is different, from constant to grapple-shaped.

   For this stage, vomiting is characteristic. In the vomit masses, an admixture of bile and blood is found. They have a hut smell. Patients often have a liquid chair, provoked by the reinforcement of peristaltics.

   All these symptoms are similar to Ostly intestinal infection, so often exhibited wrong diagnosis and need care The patient does not turn out.

2. Infarction - For him, a typical lack of blood flow in the walls, as a result of which areas of the necrosis of the tissue of this organ arise. There are signs of severe intoxication. There is an indomitable vomiting. There is a change of frequent liquid stool on constipation. In the cartoons, blood streaks are found.

   Strong pains sneeze, it means that nerve endings die away. Characterized threaded pulse, unstable pressure. The abdomen of the patient is soft, somewhat will break. Local seal is detected in the navel area. Sometimes patients have a shock state.

3. Peritonitis - Characterized by the formation of open defects in the intestinal wall, its contents falls into the abdominal cavity. This stage develops in the period from seventeen hours to one and a half days from the beginning of the disease. The patient's belly will be offered abdominal wall Tense. The peristalistic disappears, the gases are not departed, the body temperature is increased.

The development of the disease occurs quickly, therefore it is impossible to waste time. We must immediately call an ambulance or consult a doctor.

Diagnosis of thrombosis of the intestinal mesenterior vessels

The patient should be necessarily examined by the surgeon. He asks about the complaints, finds out how the disease flowed when it began. Determines the nature of the pain syndrome, the character of the chair. This allows you to suspect the development of mesenteric thrombosis.

The diagnosis is confirmed by the following research methods:

1. Selective angiographywhich helps to reveal the level of blockage of the vessel by Trombus and the nature of the defeat. This further determines the tactics of operational intervention.
2. Laparoscopy It is used to clarify the character, the volume of intestinal damage. In the absence of technical capabilities for its holding, diagnostic laparotomy is made.
3. General blood analysis Defines signs of inflammation. For this disease, leukocytosis is characterized, elevated ESP.
4. Coagulogram It is assigned to determine the blood coagulation indicators. An increase in the number of platelets is revealed and changing the indicators in the coagulation system.
5. CT, MRI The intestines are carried out to identify the tumor processes of the abdominal organs.
6. For biochemical analysis blood The increase in reactive protein is detected.

The patient is prescribed urine analysis for differential diagnosis With kidney disease.

Differential diagnosis with sharp pathologies

Differentiate mesenteral thrombosis is primarily with acute pathologies Belly:

• acute appendicitis;
• pancreatitis;
• cholecystitis;
• intestinal obstruction

From these diseases, mesenteral thrombosis is distinguished by the presence of changes in the blood coagulation system and an increased amount of blood platelets.

In second place, the disease is differentiated with other acute pathologies that are not related to the gastrointestinal tract:

• myocardial infarction (abdominal form);
• lower Pneumonia;
• urolithiasis disease;
• pyelonephritis;
• adnexitis;
• ovarian cyst;
• ectopic pregnancy.

Properly determined the diagnosis helps the presence of blood coagulation pathology, laparoscopy data (the presence of changes in the intestinal wall), finding blood clots in the vessels of the mesentery during angiography.

Emergency assistance and treatment standard

Mesenteral thrombosis refers to emergency surgical pathologies. Treatment only operational, conservative therapy is not carried out.

Relatives of the patient must cause an ambulance, which should immediately take the patient in the hospital. The brigade should deliver a patient to the surgical hospital duty for immediate survey and subsequent operational intervention.

On the way, hemodynamics, blood pressure correction, is performed. The patient categorically impossible to give antisruses before the arrival of the doctors, as this will change the picture of the disease and make it difficult to formulate the correct diagnosis, they also deteriorate the blood supply to collateral vessels and take the disease.

Algorithm of surgical intervention

Emergency operation is the only way to save the life of the patient. It is carried out as follows:

• after performing access to the intestines, it is inspected all over;
• then determines the pulsation of blood vessels at the boundaries of the lesion;
• they produce blood flow (remove the thrombus, stitch the vessel);
• methods are used to improve the blood supply to the organ of sections with insufficient blood supply (thrombecomy);
• excised the affected intestinal zones and make a crosslinking of fragments;
• washing the abdominal cavity.

According to emergency testimony, if necessary, perform reconstructive operations on the vessels of the abdominal cavity. Shunting is produced, connect the mesenteric artery with aorta below the stenzated area.

Rehabilitation after thrombosis of mesenteric arteries and veins

The period of recovery after the operation is quite long, takes up to six months:

1. After the operation, it is important to restore blood coagulation indicators in the patient. To ensure satisfactory hemodynamics along the intestines vessels, heparinotherapy is used during the week, then transferred to indirect anticoagulants.
2. To reduce diarrhea, the patient recommends Loperamide and other drugs that reduce the peristaltics.
3. A diet is recommended for the adaptation of the intestine to new conditions. The patient feeds in fractionally, often and small portions. Exclude products causing increased gas formation (milk, bean, coarse fiber), reduce the content of animal fats, prohibit canned products, alcohol.
4. It is forbidden to raise objects weighing more than 5 kilograms for two weeks.

It is allowed to make a gentle abdomen massage to improve the peristaltics (clockwise).

Mortality statistics, forecast after surgery

The frequency of occurrence of the intestinal mesente vessels is growing lately, now it is 1: 500,000 / year. The outcome of the disease after the operation depends on the severity of the process. In patients with necrotic intestinal changes, mortality comes to 80%.

Statistical information:

• mortality among untapped patients in the case of an acute mesenterial infarction reaches 100%;
• among the operated patients - 80-90% with fatal outcome;
• the frequency of the disease is 1 person out of 50000 per year;
• 2 times more often this disease occurs in older women;
• most often diagnosed thrombosis of the upper mesenteric artery - in 90% of cases, lower artery or mesenteric veins are tensions.

• introduction of direct anticoagulants for blood dilution;
• when it is possible to achieve improved indicators on a coagulogram, the patient is transferred to thrombolytics, disagrements, indirect anticoagulants

With the reversible stage of the intestine ischemia, it is possible to avoid the operation if you spend it on time.

Download national clinical recommendations . All-Russian Surgical Forum, Russian Society of Surgeons, Russian Society of Angiologists and Vascular Surgeons, Russian Scientific Society of X-ray Diagnostics and Treatment. Moscow, April 6, 2018.

Download. Moscow, 2014.

Download article 2017 Authors: Yaroshchuk S.A., Baranov A.I., Katashava L.Yu., Leschin Ya.M. GBUZ Ko Novokuznetsk City Clinical Hospital № 29, GBUZ Ko Novokuznetskaya City Clinical Hospital No. 1, Novokuzetsk State Institute of Improvement Doctors - Branch of FGBOU DPO RMPPO Rosspolva Russia, Novokuznetsk, Russia.

Possible consequences

Complications of mesenteric thrombosis are considered intestinal necrosis and peritonitis. Complications may appear after the intestinal surgery:

• employment of postoperative scars;
• postoperative hernia;
• spike intestinal loops.

These complications are treated at the surgeon.

Methods of prevention

The prevention of intestinal thrombosis includes:

• compliance with the motor regime and diet;
• overweight control;
• regular check of the coagulogram;
• refusal of alcohol, smoking;
• prevention of infectious diseases;
• pressure control;
• regular visit to the doctor.

At the direction of the doctor assigned a life reception indirect anticoagulantov, disagrement.

Before use folk remedies Be sure to consult with the attending physician. It is possible to use herbs that drank blood: pepper mint., Yarrow, Melissa, Immimentant, Barberry leaves, sage. With these means it is impossible to replace conventional drugs.

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Mesenteric thrombosis is a disease threatening life. If the patient has a tendency to thrombosis, it is necessary to monitor blood indicators and regularly attend the doctor.

The intestinal blood supply goes through the vessels of the mesentery. The mesentery is a web on which the intestine is suspended. And the mesenteric vessels are blood supply to each intestine in segments. Thrombosis of the mesenteric artery - A very dangerous disease that threatens the patient's life. Many people sometimes do not suggest the scale of the tragedy and about how dangerous late treatment of mesenteric artery thrombosis.

In the mesenteric vessel can be atherosclerotic plaques and in situations of dehydration of the body, or when a person has hanged blood clotting, these plaques can block the clearance of the vessel. At that moment, when the blood supply of the intestine is terminated, it does not come with nutrients and oxygen and necrosis occurs. As a result, the contents of the intestine falls into the abdominal cavity and occurs peritonitis. This pathology is accompanied by unbearable painful sensations in the abdomen.

If the iliac-thick-current artery fails, then sharp pains are felt from the right side of the abdomen. Pain sensations at the bottom of the abdomen signals the defeat of the lower segment of this artery. Such a defeat is accompanied by nausea and bloody vomit. Depending on which vessel struck the blood clots, thrombosis is top and lower Arteries. In most cases, the disease is developing in the middle of aorta, as a result, the resulting thrombus overlap the clearance of the arteries of the mesentery and the human mesenterian ischemia is diagnosed.

Symptoms of the disease

The symptoms of the development of thromboms in the mesenteric artery are:

. sharp loss of body weight;

Severe pain in the abdomen;

Nausea and vomiting;

Stool violation.

As a result of examination of such patients, pathological processes in the abdominal cavity are very often detected, testifying to the presence of necrosis. Than dangerous thrombosis of the mesenteric artery? After the lumen of the mesenteric artery is overlapped with blood closures, the blood flow stops and the muscles are reduced. If at this time to provide first aid, then irreversible processes leading to peritonitis can be avoided. Already in a couple of hours after the obstacles of the hole of the artery, the pathology of the intestinal walls and its necrosis occurs.

Formation of thrombov B. upper departments The mesenteric artery is characterized by a more slow downside of the disease. In this case, patients detected collateral network blood vesselsthat, in turn, prevents the formation of intestinal gangrene. After the intestinal wall becomes fine and loses its elasticity, all products of metabolic products fall into the abdominal cavity. It is this that leads to the fact that the intestinal wall, soaking with blood, exposed to heart attack and, subsequently, necrosis. Intestinal infarction can be hemorrhagic, anemic, and mixed.

How does necrosis develop when thrombosis arteries of mesenter?

Bloodstock violation on this vessel occurs in several stages:

. ischemia with hemorrhagic impregnation, which is formed in case of violation of not only arterial, but also venous blood flow;

Intestinal walls continue to absorb blood, and liquid having a hemorrhagic consistency accumulates in the peritoneum;

The amount of blood in the veins and arteries of the abdominal cavity is significantly reduced, which leads to a decrease in the thickness of the intestinal walls;

The liquid in the abdominal cavity already has a serous-hemorrhagic consistency;

These processes lead to the formation of gangrene (heart attack) and peritonitis.

In parallel with necrosis, another number of related pathologies are observed:

. the central blood circulation is disturbed;

Anemia;

Compression of blood vessels.

Due to the fact that the intestinal walls became thin, their barrier function was broken, and in the abdominal cavity they actively begin to multiply the bacteria. The area of \u200b\u200bthe affected portion of the intestine depends on what area of \u200b\u200bthe arteries of the mesentery is a thrombus. Thrombosis of the first artery segment (near the mouth) is the cause of necrosis in thin intestines. Most often, such pathology is accompanied by necrotic processes in the blind and colon on the right side. And only a small cut tochyan It has normal blood circulation.

Thrombosis of the second segment of the mesenteric artery leads to pathological changes in the skinny and iliac. At the same time, the blind intestine and the ascending part of the large intestine retain normal blood circulation. Normally, the intestinal functioning is carried out at the expense, those of its departments that remained intangible and unharmed. Thrombosis of the lower section of the mesenteric artery leads to the pathologies of only the iliac. To properly establish the area of \u200b\u200bthe defeat, it is necessary to carefully examine the patient's pain. Top artery thrombosis has characteristic symptoms: Puritinity pain in a grapple-shaped character, localized in the aircraft region.

If the tombosis was subjected to lower and upper mesenteric arteries, then the most important thing is to detect it in time. Because the late diagnosis of the mesenteric artery thrombosis can have sad consequences, up to death. It should be noted that this pathology is accompanied by the development of atherosclerosis, rheumatism and nodule periatery. Specialists of our clinic will be able to diamitude to the pathology of the mesenteric artery, as well as localization of necrosis. This will help to take all time. necessary measures And save lives and health to the patient. Our clinic has the most modern medical equipment that will help conduct a survey and establish the cause of vascular deformation.