Bowel infarction
Introduction
Introduction The cause of acute obstruction of the superior mesenteric artery is mostly cardiac emboli occlusion obstruction of the artery, or arteriosclerosis secondary to thrombus obstruction of the lumen, eventually leading to the corresponding tissue infarction, the severity depends on the arterial basis The severity of the lesion, infarction, degree, and collateral circulation.
Cause
Cause
Lesions of the blood vessels themselves and hypoperfusion are the two major factors that cause most acute superior mesenteric infarction, followed by bacterial infections. On the basis of the original extensive arteriosclerosis, it can also occur in the case of dissection aneurysm, systemic lupus erythematosus, long-term oral contraceptives or hypercoagulable state, resulting in acute superior mesenteric ischemia, thrombosis or embolism.
Examine
an examination
Related inspection
Gastrointestinal CT examination of fiberoptic enteroscopy gastrointestinal disease ultrasound examination of gastrointestinal imaging
The esophageal embolization of leukocytes often exceeds 20×109/L, serum amylase increases, and CPK increases with the progression of the disease, and gradually recovers at 72h. Serum lactate dehydrogenase (LDH) and its isoenzyme LD ratio, serum inorganic phosphorus increased. Aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and CPK have reference value for the diagnosis of superior mesenteric artery thrombosis.
Abdominal X-ray examination
Abdominal plain film can be seen in the small intestine in the early stage; when the disease progresses to intestinal paralysis, the small intestine, colonic flatulence, intestinal wall edema, thickening; intestinal necrosis when the intestinal gas leaks into the intestinal wall, accumulates under the serosa, the flat piece can be seen through Light bands or light-transmissive rings, sometimes gas shadows are also visible in the portal vein.
Angiography
In patients with suspected acute mesenteric ischemia, the plain film excludes other acute abdomen. Regardless of the abdominal signs, angiography should be performed early. This can not only identify whether large vessel occlusion is caused by thrombosis or embolization, but also diagnosis. Non-occlusive ischemia, degree and extent of vascular stenosis.
The embolus tends to embolize in the distal or branch of the beginning of the superior mesenteric artery trunk. The contrast agent is filled on the proximal side of the embolization and the distal blood vessel is not developed. Thrombosis usually occurs within 3 cm of the initial part of the artery, with a sudden interruption of the blood vessel, accompanied by reactive vasoconstriction, and a generally smaller diameter. Because of the formation of collateral circulation, the distal end of the obstruction can have different degrees of filling; non-occlusive mesenteric ischemia and superior mesenteric artery and its branches have different manifestations: diffuse stenosis, the beginning of most branch of superior mesenteric artery Stenosis, stenosis and dilatation of the superior mesenteric artery branch, arterial arch, insufficient filling of blood vessels in the wall.
CT examination
It can directly display blood clots in the intestinal wall and blood vessels, which is superior to X-ray film and tincture examination.
Doppler ultrasound
It can measure the blood flow of portal vein and superior mesenteric vein, and has certain diagnostic value for judging intravascular thrombosis.
Radionuclide check
Monoclonal antibodies labeled with platelets of radionuclide indium or strontium, injected into the human body after gamma photography, can show the ischemic area of acute mesenteric occlusion. At present, the technology has been gradually used in clinical, and it is estimated that there is a good development prospect.
Diagnosis
Differential diagnosis
Intestinal obstruction refers to the passage of the contents of the intestines. In general, the intestinal tract is not smooth. Here, the intestine usually refers to the small intestine (jejunum, ileum) and the colon (ascending colon, transverse colon, descending colon, sigmoid colon). Acute intestinal obstruction is one of the most common surgical acute abdomen and can be encountered frequently in emergency rooms. The main clinical symptoms of intestinal obstruction are abdominal pain, vomiting, bloating, and stopping the exhaustion and defecation.
