Mesenteric intestinal infarction is a surgical emergency resulting from insufficient arterial or venous mesenteric flow. Diagnosis can be difficult and often it is done too late.
Mortality from this condition is quite high, despite the great advances that have been made in recent years, both in diagnosis and treatment. Early diagnosis and bowel resection are essential to improve patient survival.
Those who survive the initial acute event of a mesenteric intestinal infarction and to the primary operation usually have a small or thin intestine.
Causes of mesenteric intestinal infarction
There are many etiological factors that are associated with the development of mesenteric intestinal infarction. These can be divided into primary intravascular pathology and extravascular secondary pathology.
Regarding the first, may occur due to an occlusion of the superior mesenteric artery, by a thrombosis of the superior mesenteric vein or by a low mesenteric flow -non-occlusive mesenteric infarct-. The occlusion of the artery can be caused by:
On the other hand, Extravascular secondary pathology causes an obstruction of the blood flow to the intestine. It can occur due to the following circumstances:
- Bowel volvulus and / or of the mesentery.
- Strangulated hernia of the abdominal wall.
- Vascular trauma, including electrocution.
The signs and symptoms of mesenteric intestinal infarction may manifest suddenly or gradually. The disorder is presented differently in each person; Thus, not always that you suffer these symptoms means that the person has an intestinal infarction.
However, there are similar characteristics identified. When the intestinal infarction is acute and appears suddenly, Some symptoms that are triggered are:
- Abdominal pain.
- Feeling of an urgent need for bowel evacuation.
- Frequent and forceful bowel movements.
- Blood in the stool.
- Nausea and vomiting.
- Mental confusion in older adults.
As for the symptoms of chronic infarction or the one that develops gradually, we can distinguish the following:
- Cramping or feeling full after eating, usually in the first hour.
- Abdominal pain that progressively worsens.
- Unintentional thinning.
If the doctor suspects that the individual may be suffering from a mesenteric intestinal infarction, he may undergo several diagnostic tests based on the symptoms and signs. The purpose is to confirm or rule out the diagnosis. Among these exams, we can highlight:
- Blood testAlthough there are no specific blood markers to indicate mesenteric intestinal infarction, the laboratory study of a blood sample that indicates, for example, an increase in the white blood cell count, might suggest this problem.
- Diagnostic imaging tests: They can help the doctor visualize internal organs and rule out other causes of signs and symptoms. Some of these techniques are x-rays, ultrasounds, CT scans and magnetic resonances.
- Endoscopy: It is the use of a device called endoscope, which is inserted through the mouth and, thanks to a camera, allows the doctor to observe the inside of the digestive tract. This camera can also be inserted through the rectum.
- Use of dye to track blood flow through the arteries: During angiography, a long, thin tube-catheter-is inserted into an artery in the groin or arm. Then, it is passed through the artery to the aorta and a dye is injected that flows directly to the intestinal arteries.
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Treatment of mesenteric intestinal infarction
The treatment of this disease is to restore a sufficient supply of blood to the digestive tract. In this case, Surgery may be necessary to remove a blood clot, to unblock an artery or to repair or remove a damaged section of the intestine.
At the same time, The treatment may also consist of the administration of antibiotics and other medications to prevent the formation of clots, dissolve them or dilate blood vessels.
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If an angiography is done in order to make a diagnosis, you could extract, at the same time, a blood clot or open a narrowed artery with angioplasty.
This technique consists of use of an inflated balloon on the end of a catheter to compress fat deposits and stretch the artery. In this way, a wider path can be formed so that blood flows much better.
Ultimately, Another technique is to place a metal tube resembling a spring in the artery, called stent, to try to keep the artery open. All these are measures that the doctor will evaluate according to the severity of the patient's situation.