superior mesenteric artery thrombosis
Introduction
Introduction to superior mesenteric artery thrombosis Superior mesenteric arterial thrombosis (superior mesentericarteria lthrombosis) occurs in the elderly, and its formation gradually occurs on the basis of severe arteriosclerotic occlusion, so the onset is concealed. Due to the establishment of collateral circulation caused by long-term chronic mesenteric ischemia, clinical acute ischemic symptoms are mild, but oliguria and metabolic acidosis may gradually appear as the condition worsens. When there are symptoms and signs of peritoneal inflammation, the patient has more Enteral necrosis and perforation occur. basic knowledge The proportion of illness: 0.03% Susceptible people: no specific people Mode of infection: non-infectious Complications: peritonitis shock
Cause
Cause of superior mesenteric artery thrombosis
(1) Causes of the disease
Superior mesenteric artery thrombosis occurs on the basis of atherosclerosis. These patients often have diffuse arteriosclerosis, such as coronary arteriosclerosis, severe peripheral arterial disease, and abdominal aorta and atherosclerotic disease. After mesenteric vascular grafting, changes in vascular trauma and blood clotting can also contribute to thrombosis.
(two) pathogenesis
Atherosclerosis occurs at the beginning of the superior mesenteric artery, the course of the disease gradually develops, the blood vessels gradually narrow and thin, the blood flow is slow, and the thrombosis occurs. Due to the slow progression of the disease, the superior mesenteric artery, the celiac artery, and the inferior mesenteric artery are in the process. It can form a collateral circulation, avoiding immediate necrosis of the intestine, but there will be symptoms of intestinal ischemia during the process of maintaining more blood supply for digestive function. After thrombosis, intestinal necrosis can occur, characterized by intestinal The range of necrosis is extensive and can be affected from the duodenum to the left colon, and the mortality rate is high.
Prevention
Prevention of superior mesenteric artery thrombosis
Pay attention to rest, work and rest, life in an orderly manner, and maintaining an optimistic, positive and upward attitude towards life can be of great help in preventing diseases.
Complication
Superior mesenteric artery thrombosis Complications peritonitis shock
Intestinal necrosis, acute peritonitis and toxic shock are common complications of mesenteric artery thrombosis.
Symptom
Symptoms of superior mesenteric artery thrombosis Common symptoms Loss of diarrhea, atherosclerosis, feces, and more diffuse after eating... Acute abdomen weight loss shock nausea peritonitis
The superior mesenteric artery thrombosis is slow onset, and there are many chronic intestinal insufficiency or atherosclerotic diseases such as abdominal aortic atherosclerosis and coronary atherosclerosis.
1. Abdominal pain: A long period of time before onset, diffuse abdominal cramps appear after eating, which can be radiated from the upper abdomen to the back. 20% to 50% of patients have a positive correlation between abdominal pain and food intake. ~3h long, but there are also manifestations of full discomfort or dull pain after eating, nausea, vomiting, sometimes severe cramps can be accompanied by nausea and vomiting, as the symptoms progress, the episodes become more frequent, the duration of pain is gradually prolonged, Patients often do not dare to eat because of fear of abdominal pain. Insufficient blood supply to the intestine may have chronic diarrhea. The amount of feces is large, foamy, and a large amount of fat is lost in the feces.
2. Nausea, vomiting, diarrhea: Sometimes severe cramps can be associated with nausea and vomiting, with progressive exacerbations of symptoms, frequent episodes, and prolonged pain duration. Patients often do not dare to eat because of fear of abdominal pain. Insufficient blood supply to the intestine may have chronic diarrhea, a large amount of feces, a foamy shape, and a large amount of fat loss in the feces.
3. Weight loss: Due to chronic diarrhea, large amounts of nutrients are lost, and patients can lose weight and malnutrition.
4. Acute abdomen performance: Once the thrombus is formed, the blood supply to the intestinal tract is interrupted, and severe abdominal pain can occur, which may be accompanied by frequent vomiting, vomiting is bloody, and intestinal peristalsis is enhanced; bloody stool is less common than mesenteric artery embolism, further Development will lead to symptoms such as intestinal necrosis and peritonitis, and even lead to shock.
5. Signs: Early malnutrition is the main sign. Sometimes systolic vascular murmur caused by arterial stenosis can be heard in the upper abdomen. There is no special diagnostic significance in clinical practice, because normal people can sometimes hear it, and later intestinal necrosis occurs. Signs of peritonitis and signs of shock.
Examine
Examination of superior mesenteric artery thrombosis
The white blood cell count can be increased, the hematocrit is increased, and acidosis is caused.
1. Abdominal X-ray film: In the early stage, the intestine has a mild or moderately enlarged inflation. In the late stage, due to the large amount of fluid in the intestinal cavity and abdominal cavity, the general density can be increased.
2. Selective celiac angiography: complete occlusion of the vessel can be found within 3 cm of the beginning of the artery. Because of the presence of collateral circulation, the distal artery of the obstruction can have varying degrees of filling.
3. CT scan: On the enhancement and perfusion dynamic map, the superior mesenteric artery thrombosis can be displayed, which is characterized by small bowel dilatation, annular thickening of the intestine, and a "halo-like" change, also known as double halo sign, severe intestinal ischemia. At the time, the boundary of the intestinal wall is unclear and blurred, and high-density bloody ascites is combined in the intestinal or abdominal cavity.
Diagnosis
Diagnosis and diagnosis of superior mesenteric artery thrombosis
diagnosis
1. History: elderly patients, previous atherosclerotic disease with coronary or peripheral arteries, history of mesenteric vascular grafting, history of vascular trauma, or hypercoagulable state.
2. Clinical manifestations: abdominal cramps after eating, chronic diarrhea, malnutrition or weight loss.
3. Auxiliary examination: Celiac angiography shows atherosclerosis and thrombosis at the beginning of superior mesenteric artery, which is an important basis for diagnosis. CT examination can help diagnosis.
Differential diagnosis
1. Mesenteric artery embolization When the superior mesenteric artery thrombus completely blocks the blood vessel, it is difficult to distinguish it from mesenteric artery embolism. Arterial thrombosis is more common in atherosclerotic elderly, and arterial embolism is common in rheumatic heart disease with atrial fibrillation. Patients; the site of onset of the disease is different, arterial thrombosis often occurs in the beginning of the superior mesenteric artery, and arterial embolism is more common in the entrance of the superior mesenteric artery; celiac angiography can be identified.
2. It must be differentiated from acute abdomen such as gastrointestinal perforation, acute intestinal obstruction and acute pancreatitis.
