Mesenteric ischemia

As a most acute mesenteric occlusion of a vessel is called bowel, leading to infarction and necrosis of the corresponding section of the intestine, where both the embolization of an artery and a vein thrombosis which may be responsible. From a Mesenterialgefäßverschluss older cardiovascular biased people are usually affected.

In the corresponding arteries affected are in about 85 % of the cases to the superior mesenteric artery, the rest is distributed roughly equally to celiac artery and inferior mesenteric artery. Occlusions of the inferior mesenteric artery extending clinically milder and have a better prognosis, since it has a much smaller coverage area.

Stadiums

The mesenteric infarction can be life threatening and typically proceeds in three phases:

Initial stage: severe cramping abdominal pain, possibly hemorrhagic diarrhea, and shock, often without guarding and with a lack of pressure pain. This stage is also characterized by an increasing deterioration of the patient. The abdominal pain occur mainly in Periumbilikalbereich. Just two hours after the closure begins the necrosis of the intestinal segment affected, so this always requires acute action!

Latency stage: Phantasmal lessening of pain over several hours, decreasing intestinal peristalsis ( " lazy peace " )

Stage of irreparable bowel necrosis: paralytic ileus, peritonitis and severe Allgemeinintoxikation to death.

Diagnosis

• Acute abdomen with increasing deterioration of the patient's
• Leukocytosis > 20000/μl
• Metabolic acidosis, lactic acidosis ( sensitive parameter )
• Color-coded duplex sonography
• Abdomenübersichtsröntgen is possibly indexed

In NOMI ( nonokklusive mesenteric ischemia), the " non-occlusive form ", whose importance is increasingly recognized, a conservative, that is medicated treatment can be considered.

In the occlusive form, ie the closure of a vessel, a Vascular surgical intervention is indicated emergently to revascularize by a restoration of the blood flow path to intestinal infarction risk, ie restore the supply of blood. Necrotic parts of the intestine must be resected.

The prognosis is poor with a mortality of 90%. This is mainly due to the fact that the diagnosis is usually too late ( difficult differential diagnosis).