Intestinal infarction: what is it? Symptoms and Causes

Intestinal infarction - one of the most complex abdominal pathologies, in most cases it requires surgical intervention. In case of delayed detection of a problem and making an incorrect diagnosis high probability of death. Every patient should be aware of this and carefully study the most important symptoms in which an appeal to a medical institution is mandatory.

Clinical classification of intestinal infarction

Depending on the severity of the disease, medicine classifies the disease into two types of course.

1. Non-occlusive. A milder form of the disease, drug treatment is possible without surgery. Blockage of blood vessels is incomplete, gangrene does not develop. Intestinal motility changes, severe consequences can occur only in the absence of treatment or its incorrectly chosen method.
2. Occlusal. A very severe stage of the course of the disease, the walls of the intestines are completely disconnected from the bloodstream. The development of gangrene is inevitable, any delay in surgical intervention is fraught with death.
   

   Embolism is the most common cause of occlusive bowel infarction

Classification due to the state of the circulatory system

Depending on the state of the circulatory system, an intestinal infarction can have three stages in the development of changes.

Table. Classification of intestinal infarction by the state of the circulatory system.

Stage name	Short description
Compensation of mesenteric vessels	The easiest stage of the course of a heart attack, it is possible to restore physiological functions without any negative consequences. Patients can recover spontaneously and are unaware of the danger of their situation. Sometimes mild conservative therapy is sufficient. Due to such mild consequences of this stage, medicine does not have accurate statistics, most cases are simply not recorded.
Subcompensation of mesenteric vessels	As a result, a decrease in the volume of blood supplied to the intestinal tissue may appear a number of diseases: ulcers on the walls, abdominal toad, colitis, enteritis. If the treatment has not started or does not correspond to the actual cause, then the patient's condition is inevitable worsens, there may be bleeding due to micro-breakthroughs of the small intestine, cellulitis, stenosis, etc. etc.
Decompensation of mesenteric vessels	The last and most difficult stage of the disease. Gangrene and complete rupture of the intestines begin, purulent peritonitis, severe sepsis of a surgical nature spreads. It is at this stage that patients most often end up on the operating table, but the likelihood of recovery is minimal.

Signs of intestinal infarction

The main symptom of an intestinal infarction is pain syndromes. They have different intensities, taking into account the stage of development of the pathology.

1. Ischemic stage. The strongest pain sensations, in terms of intensity, can only be compared with volvulus. Even today, medicine does not have effective remedies to eliminate such pain, even drugs do not help. The state of the mute is relieved by antispasmodics, but their effect is short-lived and does not completely relieve the syndrome. The patient cannot hold back screams, is very restless, pulls his legs to his stomach, panics and fears death. The duration of this stage is from six to twelve hours. On external examination, a strong blanching of the skin is noticeable, if patients have heart problems, then its cyanosis may increase. Due to the fact that the mesenteric artery is completely blocked, the pressure increases sharply, the jump reaches 80 mm Hg. Art. And this is against the background of the fact that the pulse slows down noticeably. The leukocyte count increases to 12 × 10⁹/л. The tongue turns white, but the abdomen remains soft, there is no swelling.
   

   Intense abdominal pain - a symptom of the ischemic stage of intestinal infarction

2. Infarction stage. It begins immediately after the end of the acute pain stage and lasts 12-24 hours. In the intestines, necrosis begins, due to which the activity of pain receptors gradually stops. This leads to the fact that the pain is reduced. The patient is happy, is in the stage of euphoria, it seems to him that all the troubles are behind him. Unfortunately, even inexperienced doctors often think that all problems have been solved, and no special help is needed anymore. Another feature is that intoxication of the body leads to inappropriate behavior of patients, they can laugh for no reason, increase activity, etc. The pressure is normalized, the pulse returns to normal values. You can see the catastrophic development of the disease only on the basis of a general blood test. The number of leukocytes at this stage can reach 40 × 10⁹/л.
   

   At the stage of intestinal infarction, necrosis occurs in it

3. Peritonitis stage. Comes 18–36 hours after arterial occlusion, pain gradually increases, it is difficult for the patient to move, and on palpation the condition worsens. At this stage, the chances of survival are minimal, even urgent surgical measures have 50% of deaths. If surgery is done later, then the percentage of deaths is 100%. At this stage, endotoxicosis, dehydration develops, and metabolic acidosis begins in the body. Patients become more mobile, go into a delusional state.
   

   Phases of the course of peritonitis

In the initial stages, there is reflex vomiting; the presence of blood in the feces is important for the diagnosis. As already mentioned, at the first stage of the disease, the patient experiences very severe pain, comparable to the symptoms of volvulus. But there is one difference. With a heart attack, intestinal patency is preserved, with volvulus there is no evacuation function. Moreover, the removal of feces can occur on an instinctive level, stool retention indicates that the disease has already passed into the stage of peritonitis.

Causes

The course of the disease is associated with the structural features of the intestinal circulatory system. The blood supply to the intestine comes from the vessels of the mesentery. It resembles a thin web to which parts of the small intestine are attached. Each segment of the intestine feeds on its own vessels autonomously and is almost independent of adjacent areas, the interlacing of the circulatory system of the segments is very insignificant and is observed on a very limited space. The mesenteric circulation is called mesenteric, the blockage of the vessels is called mesenteric thrombosis. If an intestinal infarction develops, then the number of deaths increases sharply, life counts for hours.

Immediate causes of the disease

Most often, pathology occurs due to a violation of the patency of the arterial mouth, it is in these places that there is an anatomical decrease in the diameters of the vessels in which atherosclerotic plaques accumulate. The upper artery is divided into three segments, with blockage of each, an infarction of the corresponding part of the intestine occurs.

For the intestine, a more correct concept of tissue necrosis is used, the term infarction indicates only that the cause of the disease is blockage of blood vessels. The consequence is more correctly called intestinal gangrene.

Factors provoking the onset of pathology

There are many reasons for a heart attack, most of them are related to the general health of patients. The disease can be triggered by the following factors.

1. High blood clotting. This can be either a general condition or temporary dehydration. Thick blood often forms blood clots, which clog the blood vessels. Blood clotting is also influenced by polycythemiaDuring this disease, the bone marrow produces an increased number of red blood cells. As a result, the risk of blood clots increases.
   

   High blood clotting

2. Heart failure. All internal organs suffer from this disease, the amount of blood in the intestinal vessels is significantly reduced. The intestinal tissues are starving, but cases of gangrene are very rare.
   

   Heart failure

3. Tumors and injuries. Tumors can completely stop the flow of blood to the intestines, the process develops relatively slowly. Doctors have time to make the correct diagnosis and choose the most effective treatment. Abdominal trauma can lead to rupture of the mesenteric arteries, the complexity of the course of the disease depends on the size of the lesion.
   

   Colon injury is an example of an injury that can trigger an intestinal infarction

It does not matter where the blood clot formed, in all cases there are risks that it will block the arteries feeding the small intestine.

Why a large number of deaths

The intestine in working condition is constantly filled with chyme, during necrosis its walls break and the contents enter the abdominal cavity. As a consequence, the development of a general infection of the body, an extensive inflammatory process occurs, poisonous decay products enter the bloodstream. The liver, kidneys, spleen cannot cope with such huge loads and completely cease to function. The result is death.

Modern medicine has developed methods for accurate diagnosis, effective methods of treatment and principles of surgical interventions, but in our country this does not allow to increase the percentage of favorable outcomes of heart attack treatment intestines. Why? Everything is very simple. The clinical characteristics of intestinal infarction in the initial stages of development are very similar to other milder ones. pathologies of this organ, ordinary therapists or general surgeons cannot put an accurate diagnosis. To do this, they must have deep professional knowledge, extensive experience and the most modern diagnostic equipment. Rarely a clinic can boast of having all three components.

It takes only a few days for the development of extensive necrosis, but the intensity of pain decreases during this time, the patient and the doctor lose their vigilance. It is the loss of time that causes high mortality. You should know that from myocardial infarction patients die much less often than from intestinal infarction, although many consider the first diagnosis almost a death sentence. The fact is that with thrombosis of the heart vessel and tissue necrosis, the contents of the intestine do not enter the blood, the risks of intoxication of the body are minimal.

Diagnostics

As already mentioned, only a timely and correct diagnosis of the disease gives the patient a chance for life. The account goes not for days, but for hours, a lot depends on the qualifications of the doctor. But he must have access to modern medical equipment. What survey methods are considered the most appropriate?

1. Angiographic examination. Unfortunately, such examinations can only be performed by the most modern medical institutions. Contrast agents are injected into the blood, two projections are made, which makes it possible to see the actual state of the mesenteric arteries. Pathology is detected regardless of the stage, the method is considered the most effective.
   

   Angiography is the most effective method for diagnosing changes in blood vessels in intestinal infarction

2. Laparoscopy. A less effective, but more affordable method, such equipment is available in many surgical hospitals. It is used before the start of emergency interventions by the surgeon. If the disease has passed into the stage of gangrene, then in the internal cavity there is a hemorrhagic effusion, fibrinous formations are clearly visible.
   

   Laparoscopy (peritoneoscopy) is an endoscopic examination of the abdominal cavity through a puncture of the abdominal wall

Treatment

The vast majority of cases require an immediate surgical solution, you should not take risks and waste time using medical methods. Conservative methods of treatment, as evidenced by many years of medical practice, have shown complete futility, only surgery gives patients a chance to survive.

During the operation, several tasks are solved:

• restoration of blood circulation of mesenteric vessels;
• removal of damaged areas of the small intestine;
  

  Removal of sections of the small intestine is one of the methods of surgical treatment for intestinal infarction

• minimization of the negative consequences of peritonitis.

At the beginning of surgical operations, the doctor must make access to the site of pathology and conduct a revision of the intestine, correctly assess its viability and the number of affected segments. Next, a revision of the state of the vessels is done, if possible, the blood flow is restored. After that, the dead parts of the intestines are removed, a drainage is installed to remove fluid from the cavity. After the operation, the dynamics of the small intestine is corrected, special measures are taken to normalize gas exchange, and the acid-base parameters of the body are restored.

The severity of the condition after surgery can be complicated by sepsis, pneumonia, etc. The success of the operation depends on the timeliness of the surgical intervention, the slightest suspicion of a heart attack intestines should be the basis for the immediate sending of the patient to specialized medical institutions. Only such an active medical tactics gives the patient a chance for a favorable outcome. Unfortunately, the further quality of life will never be the same level as before the illness and surgery.

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