What is intestinal thrombosis, what are the causes, symptoms and treatment of mesenteric infarction? Mesothrombosis of intestinal vessels: causes, forms, course, diagnosis and therapy Acute mesenteric thrombosis with intestinal necrosis.

Thrombosis of mesenteric vessels (ICD-10 code - K55.0) is the blockage of mesenteric arteries and intestinal veins by blood clots. This disease predominantly affects middle-aged and older people. It is a very serious pathology, develops at lightning speed, and can sometimes lead to death.

The mesentery is a connective tissue cord through which the intestine is attached to the posterior wall of the peritoneum. It prevents intestinal loops from twisting.

The intestine is supplied with blood by the superior and inferior mesenteric arteries. Thrombosis occurs in the superior mesenteric artery more often, accounting for up to 90% of all cases of this pathology. It supplies blood to most of the organ.

This vessel feeds the following departments:

small, ascending colon, cecum;
hepatic flexure;
two thirds of the transverse colon.

Therefore, when thrombosis occurs, severe lesions develop.

The inferior mesenteric artery supplies blood to the remaining sections. These include:

colon descending;
left third of the transverse colon;
sigmoid colon.

This artery accounts for up to 10% of all cases of intestinal vascular thrombosis.

Causes and pathogenesis

The main reason for the development of mesenteric thrombosis is considered to be embolization (closure of the lumen of the vessel) by a thrombus. It forms in the middle part of the abdominal aorta and gradually spreads downwards, first narrowing the lumen of the superior mesenteric artery.

Then the thrombus mechanically blocks the lumen of the vessel (artery or vein). The blood flow through it to the tissues stops. This causes their irreversible destruction. If the blood supply is not restored in a timely manner, mesenteric infarction develops.

The formation of thrombosis is facilitated by such vascular pathologies as:

mitral valve stenosis;
cardiac aneurysm;
dissection of the intercardiac wall;
arrhythmias;
endocarditis;
cardiosclerosis;
myocardial infarction.

Blood clots, breaking away from the places of their formation, move through the vessels, linger in some of them, and then break the lumen. These diseases are the primary causes of thrombosis. Most often, blood clots migrate to the mesenteric arteries from the aorta.

In addition to cardiovascular pathologies, some other conditions and diseases provoke the appearance of blood clots. They contribute to the formation of secondary mesenteric insufficiency, which causes thrombus formation. It can be:

pancreatitis;
acute severe intestinal infections;
heart failure with low blood pressure;
cirrhosis;
stenosis of the lumen of the mesenteric vessels due to the formation of atherosclerotic plaque;
portal hypertension syndrome with a high degree of congestion;
tumors compressing blood vessels;
liver steatosis;
hereditary predisposition;
diabetes;
increased blood clotting.

The risk of developing mesenteric thrombosis is increased by abdominal trauma, surgery on the abdominal organs, hormone therapy, smoking, pregnancy and physical inactivity, as well as taking a number of drugs (contraceptives, antitumor drugs).

Characteristics of stages of vessel narrowing

Based on the degree of circulatory impairment in the collateral and main vessels, three degrees of damage are distinguished:

Compensation– it is characterized by chronic ischemia of intestinal tissue. Blood circulates only through collateral vessels.
Subcompensation- it is characterized by a partial blood supply to the tissues of the organ.
Decompensation– this stage is characterized by the onset of irreversible changes and is considered very severe. Foci of tissue death form, since there is no blood supply to them. It is divided into two phases:
- The first lasts no more than two hours and is considered reversible.
- After four hours, the second phase begins, during which gangrene develops in the affected parts of the intestine. If you do not provide medical assistance to the patient in a timely manner, death is possible.

Classification of forms in the table

	Types of mesenteric thrombosis	Characteristic
Process flow	spicy	intestinal infarction suddenly develops followed by necrosis
Process flow	chronic	functional disorders of the intestine gradually develop without necrosis
Localization of blood supply disturbance	arterial	blood flow in the mesenteric arteries is disrupted, which in most cases leads to intestinal infarction within 6-8 hours
	venous	blood flow in the mesenteric veins is disrupted, the infarction takes quite a long time to form - from several days to several weeks
	mixed	blood flow is disrupted first in the arteries, and then in the veins of the mesentery
Degree of blood supply disturbance	with blood flow compensation	blood supply is carried out due to unaffected vessels
	with subcompensation of blood flow	blood supply is not complete
	with blood flow decompensation	there is no blood supply to the intestinal areas, intestinal infarction occurs
Prevailing symptoms	ileus	pain is rhythmic and cramping, as with intestinal obstruction
	pancreatic-like	severe pain above the navel, nausea and vomiting, purple spots on the body
	appendicular	appendicitis symptoms
	cholecystoid	pain in the upper right half of the abdomen, nausea
	angiospastic	symptoms of “abdominal toad”, which subside after taking nitroglycerin
	ulcer-like	symptoms are similar to a perforated gastroduodenal ulcer

Clinic: symptoms of development by stage

Clinical manifestations of acute mesenteric thrombosis are characterized by the gradual appearance of symptoms. It depends on the stage of the disease.

There are three stages of this disease:

Ischemia– it is distinguished from other stages by the fact that the process is reversible. But clinical manifestations increase quite rapidly.
The process of tissue breakdown is underway, since the blood supply is sharply reduced in the affected areas. Symptoms increase quickly.

Intense increasing pain appears in the abdominal cavity. The nature of the pain varies, from constant to cramping.

This stage is characterized by the appearance of vomiting. An admixture of bile and blood is found in the vomit. They have a fecal smell. Patients often have loose stools caused by increased peristalsis.

All these symptoms are similar to an acute intestinal infection, so the diagnosis is often incorrect and the necessary assistance is not provided to the patient.
Heart attack– it is typically characterized by a complete absence of blood flow in the walls, resulting in areas of tissue necrosis of this organ. There are signs of severe intoxication. There is uncontrollable vomiting. There is a change from frequent loose stools to constipation. Blood streaks are found in the stool.
Severe pain subsides, which means that the nerve endings die. Characterized by a thread-like pulse and unstable pressure. The patient's abdomen is soft and somewhat swollen. A local compaction is detected in the navel area. Sometimes patients go into shock.
Peritonitis– characterized by the formation of open defects in the intestinal wall, its contents enter the abdominal cavity. This stage develops from seventeen hours to one and a half days from the onset of the disease. The patient's abdomen is distended, the abdominal wall is tense. Peristalsis disappears, gases do not pass away, body temperature is increased.

The development of the disease occurs quickly, so there is no time to waste. You should immediately call an ambulance or see a doctor.

Diagnosis of thrombosis of intestinal mesenteric vessels

The patient must be examined by a surgeon. He asks about complaints, finds out how the illness progressed and when it began. Determines the nature of the pain syndrome, the nature of the stool. This allows one to suspect the development of mesenteric thrombosis.

The diagnosis is confirmed by the following research methods:

Selective angiography, which helps to identify the level of blockage of the vessel by a thrombus and the nature of the lesion. This further determines the tactics of surgical intervention.
Laparoscopy used to clarify the nature and extent of intestinal damage. If there is no technical capacity to carry it out, a diagnostic laparotomy is performed.
General blood analysis detects signs of inflammation. This disease is characterized by leukocytosis and increased ESR.
Coagulogram prescribed to determine blood clotting indicators. An increase in the number of platelets and changes in parameters in the coagulation system are detected.
CT, MRI intestines is carried out to identify tumor processes in the abdominal organs.
At biochemical blood test an increase in reactive protein is detected.

The patient is prescribed a urine test for differential diagnosis with kidney disease.

Differential diagnosis with acute pathologies

It is necessary to differentiate mesenteric thrombosis primarily from acute abdominal pathologies:

acute appendicitis;
pancreatitis;
cholecystitis;
intestinal obstruction

Mesenteric thrombosis is distinguished from these diseases by the presence of changes in the blood coagulation system and an increased number of platelets in the blood.

Secondly, the disease is differentiated from other acute pathologies not related to the gastrointestinal tract:

myocardial infarction (abdominal form);
lower lobe pneumonia;
urolithiasis disease;
pyelonephritis;
adnexitis;
ovarian cyst;
ectopic pregnancy.

The presence of blood coagulation pathology, laparoscopy data (presence of changes in the intestinal wall), and the presence of blood clots in the mesenteric vessels during angiography help to establish a correct diagnosis.

Emergency care and standard of care

Mesenteric thrombosis is an emergency surgical pathology. Treatment is surgical only, conservative therapy is not carried out.

The patient's relatives must call an ambulance, which must immediately take the patient to the hospital. The team must deliver the patient to the on-duty surgical hospital for immediate examination and subsequent surgical intervention.

Along the way, hemodynamics and blood pressure are corrected. The patient should absolutely not be given antispasmodics before the doctors arrive, as this will change the picture of the disease and make it difficult to make a correct diagnosis; they also worsen the blood supply through the collateral vessels and aggravate the disease.

Algorithm of surgical intervention

Emergency surgery is the only way to save the patient’s life. It is carried out as follows:

after accessing the intestine, it is examined along its entire length;
then the pulsation of blood vessels at the boundaries of the lesion is determined;
blood flow is restored (the blood clot is removed, the vessel is sutured);
methods are used to improve the blood supply to the organ in areas with insufficient blood supply (thrombectomy);
the affected areas of the intestine are excised and the fragments are stitched together;
washing the abdominal cavity.

For emergency indications, if necessary, reconstructive operations are performed on the vessels of the abdominal cavity. A bypass is performed, connecting the mesenteric artery to the aorta below the stenotic area.

Rehabilitation after thrombosis of mesenteric arteries and veins

The recovery period after surgery is quite long, taking up to six months:

After surgery, it is important to restore the patient’s blood clotting parameters. To ensure satisfactory hemodynamics in the intestinal vessels, heparin therapy is used for a week, then transferred to indirect anticoagulants.
To reduce diarrhea, the patient is recommended to use Loperamide and other drugs that reduce peristalsis.
A diet is recommended to adapt the intestines to new conditions. The patient eats fractionally, often and in small portions. Avoid foods that cause increased gas formation (milk, legumes, coarse fiber), reduce the content of animal fats, and prohibit canned foods and alcohol.
It is prohibited to lift objects weighing more than 5 kilograms for two weeks.

It is allowed to do a gentle abdominal massage to improve peristalsis (clockwise).

Mortality statistics, prognosis after surgery

The incidence of vascular thrombosis of the intestinal mesentery has been increasing recently; it is now 1:50,000/year. The outcome of the disease after surgery depends on the severity of the process. In patients with necrotic changes in the intestine, mortality reaches 80%.

Statistical information:

mortality among non-operated patients in the case of acute mesenteric infarction reaches 100%;
among operated patients – 80-90% with a fatal outcome;
incidence of the disease – 1 person out of 50,000 per year;
This disease occurs 2 times more often in older women;
Thrombosis of the superior mesenteric artery is most often diagnosed - in 90% of cases; thrombosis of the lower artery or mesenteric veins is ten times less likely.

administration of direct anticoagulants to thin the blood;
when it is possible to achieve an improvement in coagulogram parameters, the patient is transferred to thrombolytics, disaggregants, and indirect anticoagulants

With the reversible stage of intestinal ischemia, surgery can be avoided if it is performed on time.

Download national clinical guidelines. All-Russian Surgical Forum, Russian Society of Surgeons, Russian Society of Angiologists and Vascular Surgeons, Russian Scientific Society of Specialists in X-ray Endovascular Diagnostics and Treatment. Moscow, April 6, 2018.

Download . Moscow, 2014.

Download article, 2017 Authors: Yaroshchuk S.A., Baranov A.I., Katasheva L.Yu., Leshishin Ya.M. GBUZ KO Novokuznetsk City Clinical Hospital No. 29, GBUZ KO Novokuznetsk City Clinical Hospital No. 1, Novokuznetsk State Institute for Advanced Training of Physicians - branch of the Federal State Budgetary Educational Institution of Further Professional Education RMANPO of the Ministry of Health of Russia, Novokuznetsk, Russia.

Possible consequences

Complications of mesenteric thrombosis include intestinal necrosis and peritonitis. Complications may occur after intestinal surgery:

suppuration of postoperative scars;
postoperative hernia;
adhesions of intestinal loops.

These complications are treated by a surgeon.

Prevention methods

Measures to prevent intestinal thrombosis include:

compliance with physical activity and diet;
excess weight control;
regular check of coagulogram;
giving up alcohol and smoking;
prevention of infectious diseases;
pressure control;
regular visits to the doctor.

As directed by the doctor, lifelong use of indirect anticoagulants and disaggregants is prescribed.

Before using folk remedies, be sure to consult your doctor. You can use herbs that thin the blood: peppermint, yarrow, lemon balm, immortelle, lingonberry leaves, sage. These products cannot replace conventional medications.

Video “Live Healthy!”

Mesenteric thrombosis is a life-threatening disease. If a patient has a tendency to develop blood clots, it is necessary to monitor blood counts and regularly visit a doctor.

Mesenteric thrombosis is a circulatory disorder in the mesenteric vessels of the intestine.

In most cases, this is a complication after myocardial infarction, atrial fibrillation or slow sepsis. The disease occurs due to embolism and thrombosis of the mesenteric vessels.

The pathology affects elderly and middle-aged people, since atherosclerotic changes occur in the vessels throughout life.

A thrombus blocks the lumen of arteries or veins, which disrupts the nutrition of the intestinal walls, leading to infarction of the affected tissues.

Venous thrombosis is observed much less frequently than arterial thrombosis. In rare cases, blockage of veins and arteries is diagnosed at the same time; this form is called mixed.

ICD-10 code

According to the international classification of diseases (ICD code 10), mesenteric thrombosis is coded as K55.0. The pathology is included in acute vascular diseases of the intestine.

Why is blood flow disrupted?

The lumen of the vessels can be blocked primarily or secondary. In the first case, the causes are injuries, thrombosis and embolism, and in the second, the disease develops as a result of prolonged changes in the walls of blood vessels or outside them.

Primary reasons include:

Injuries – strong blows to the abdominal area;
Myocardial infarction;
Cardiac aneurysm and other pathologies of the cardiovascular system.

Pathological factors can be different (embolism, trauma or thrombosis), but they all lead to intestinal ischemia.

The following are considered secondary causes:

Stenosis of atherosclerotic origin;
A decrease in cardiac activity, in parallel, a drop in blood pressure occurs;
Tumors of the small or large intestine that compress the arteries;
Surgeries on the aorta performed to reconstruct the vessel.

How does the blood supply work?

Arteries and veins are located almost parallel. Two large vessels depart from the abdominal aorta: the superior and inferior mesenteric arteries. They completely supply the intestines with blood.

The blood supply pattern is distributed as follows:

In 90% of cases, mesenteric thrombosis is observed in the superior mesenteric artery, in 10–15% of cases the masses close the lumen in the inferior artery.

Emboli can close the lumen of the mesenteric artery by entering it from the heart (if a mural thrombus breaks away), from the thoracic and abdominal aorta, or in the event of injury.

Thrombotic masses can also form in the veins. Their formation is caused by inflammatory processes in the intestines, congestion in the underlying vessels, and any other factors that increase blood viscosity.

What are the types of ischemia with mesenteric thrombosis?

In medical practice, there are three degrees of severity of the disease. They depend on the diameter of the mesenteric vessel lesion and the disruption of collateral flow.

Decompensated form– the most difficult stage. A time period of up to 2 hours is a reversible time when blood supply can be restored. The interval from 4 to 6 hours is partially reversible, the prognosis is not always favorable, deterioration can occur at any time, since the arterial and venous blood flow is completely disrupted. Over 6 hours, intestinal gangrene is observed.
Subcompensated blood supply disorder– this form can be confused with other diseases. Acute vascular insufficiency is expressed by similar symptoms.
Compensated degree– chronic ischemia, in which the function of blood flow is taken over by collaterals.

Symptoms of mesenteric thrombosis

Signs of thrombosis depend on the level at which the mesenteric arteries are blocked and on the form of intestinal ischemia.

Clinical manifestations are characterized by the following symptoms:

Thrombus zone

Diagnostics

The sooner an accurate diagnosis is made, the greater the chance of a positive treatment outcome for the patient. The doctor needs to collect an anamnesis of the disease, ask the patient about the nature and time of onset of pain, and the frequency of stool. This will help determine the choice of surgical treatment.

The blood test shows pronounced leukocytosis (more than 20 * 10 9 l). Abdominal x-ray shows small bowel fluid levels.

The main diagnostic methods are:

Laparoscopy– one of the decisive methods, it allows you to quickly examine the intestines, establish mesenteric obstruction and determine the stage of ischemia, because the surgeon has no more than two hours in reserve;
Ultrasound of the abdomen– the procedure helps in differential diagnosis to exclude the possibility of other diseases;
Selective angiography– a procedure that establishes the levels of arterial occlusion is necessary to provide emergency care. But many surgeons agree that it is inappropriate to spend time on angiography; if the course progresses rapidly, mesenteric thrombosis will end in death.

Intestinal laparoscopy

If it is not possible to perform laparoscopy, then surgeons perform laparotomy - an operation during which a large incision is made in the midline of the abdomen.

During the laparotomy process, doctors perform the following manipulations:

The vessels are palpated to determine the location of the thrombus (each mesenteric artery and vein should be examined by the surgeon);
The boundaries of viable intestinal tissue are identified;
Completely examine the abdominal organs, assessing their condition;
The pulsation of the arteries is detected, establishing the state of the blood supply to the intestines.

Differential diagnosis

Mesenteric thrombosis is easily confused with other diseases, which is associated with a vague clinical picture.

The pathology is similar to the following diseases:

Acute pancreatitis;
Acute cholecystitis;
Appendicitis;

Similar symptoms are characteristic of acute intestinal obstruction.

Diagnosis of mesothrombosis - insertion of a catheter

How is mesothrombosis treated?

The disease is amenable to surgical treatment only. The operation is performed under endotracheal anesthesia. At the first signs of pathology, the patient requires emergency care.

Antispasmodic and painkillers erase symptoms and make diagnosis difficult, which delays the possibility of surgery and leads to death.

Surgical intervention consists of important, mandatory parts:

The surgeon examines the intestines, palpates the mesenteric vessels;
The doctor must determine the pulsation in the arteries located at the borders of the affected intestines.

During the operation, the surgeon, if necessary, performs a resection - removes a section of necrotic intestine, then sutures the upper and lower borders.

If there are no necrotic changes yet, then the doctor must find a way to restore blood supply to the intestines and relieve ischemia from the affected area.

Restoring blood supply can occur in two ways:

The surgeon gently squeezes the blood clot out of the vessels (artery or vein) with his fingers;
A bypass shunt is created between the extreme boundaries of the thrombosed area.

During the recovery period after surgery, the patient is prescribed anticoagulants and blood thinners (“Heparin”). Therapy with these drugs is carried out under regular monitoring of the thrombosed index and INR.

If the necrotic part of the intestine is removed (for example: part of the ascending or small intestine), and normal blood supply is not restored, then in 80% of cases the situation ends in death.

Forecast

The disease is detected during operations much more often than is registered. The fact is that the clinical picture of mesenteric thrombosis is similar to many other pathologies. It is disguised as appendicitis, cholecystitis, intestinal obstruction. There is not always enough time to make the correct diagnosis.

According to pathologists, mesenteric thrombosis accounts for up to 2.5% of cases. If the operation was performed within the first hours from the moment the blood clot occurred, then there is a high probability of recovery.

If surgery was performed after 12 hours, then the probability of death is up to 90%.

Video: Mesenteric thrombosis - intestinal infarction

Thrombosis of mesenteric vessels is a condition when the arterial or venous bed of the intestine is blocked as a result of a blood clot entering or forming in it. Partial or complete blockage of the lumen of a vessel by a thrombus disrupts blood circulation in this organ, so-called ischemia develops.

If the blockage of the veins or arteries is not resolved, then a pathological condition occurs - intestinal infarction, which requires resection of the organ. But sometimes even surgical intervention cannot always save the patient’s life.

📌 Read in this article

Thrombosis of mesenteric (mesenteric) veins

Venous thrombosis can occur acutely or have a subacute or chronic course. Previously, this pathology was considered the main cause of ischemia. However, over the past decades, the proportion of detected intestinal arterial thrombosis has increased significantly. This is associated with the widespread introduction of new, more informative research methods, which has improved the differential diagnosis of thrombosis of mesenteric vessels.

Three veins (superior and inferior mesenteric and splenic) carry nutrient-rich blood from different parts of the intestine to the liver. A blood clot that forms in any of these veins blocks blood flow, which can lead to tissue damage and death. Clinical manifestations largely depend on the location of the blockage - in which part of the intestine the ischemia occurred.

Symptoms

The main signs of intestinal vein thrombosis are usually abdominal pain (especially after eating), bloating and diarrhea. The following symptoms may also appear: vomiting, fever, bloody stool.

As soon as the patient begins to suspect that he has thrombosis of the mesenteric vessels, the clinical picture of which is usually acute, he should immediately seek medical help. Delay in treatment can lead to serious complications, the development of peritonitis, which sometimes ends fatally.

Causes

Swelling of the mesentery, which can occur with various pathologies of the gastrointestinal tract, contributes to the formation of blood clots in the veins.
The mesentery is a duplication of the peritoneum, through which the intestine is attached to the posterior wall of the abdomen; the arteries and veins of this organ are located here. Most often, mesenteric edema occurs in the following situations:

abdominal trauma;
infectious diseases of the abdominal organs, such as appendicitis, colitis, diverticulitis;
autoimmune intestinal pathology (ulcerative colitis and Crohn's disease);
chronic and acute pancreatitis - inflammation of the pancreas;
cirrhosis of the liver, fatty degeneration of this organ;
hormone replacement therapy or birth control pills;
excessive tobacco smoking;
some cancers of the digestive system.

Diagnostics

Thrombosis of mesenteric vessels, diagnosed on the basis of acute abdominal symptoms and using medical imaging methods, carries a huge risk to human life. The most commonly used is CT (computed tomography), but sonography or MRI (magnetic resonance imaging) are also used.

Mesenteric angiography is an X-ray examination, considered the most informative method, which with a high percentage of probability allows you to determine the localization of a blood clot.

Treatment

Anticoagulants (blood thinners) are the main treatment for this pathology. If a patient has a blood clotting problem, for example, thrombophilia, during the examination, then he will have to take anticoagulants constantly so that venous thrombosis of the mesenteric vessels does not occur again.

Sometimes a medicine that “dissolves” a blood clot can be delivered directly to the site of blockage. This is done through a procedure called thrombolysis, where a flexible tube (catheter) inserted directly into a vein delivers a drug to the blood clot. The blood clot is also removed surgically.

Watch the video about mesenteric thrombosis:

Thrombosis of mesenteric arteries

A blood clot enters the intestinal artery as a result of an embolism. A broken fragment of a blood clot, which originally formed either in the heart or in the vessel itself, moving with the blood flow, gets stuck in a narrow place and clogs the lumen of the artery.

Risk factors

Conditions in which there is an increased tendency to thromboembolism in the arterial bed are considered risk factors for this pathology:

elderly age;
smoking;
thrombophilia: antiphospholipid antibodies, etc.;
valvular/cardiac disorders: artificial valves, ventricular aneurysm.

Symptoms

Sudden occlusion of the mesenteric arteries is usually accompanied by the appearance of the so-called acute abdomen clinic. The following symptoms are usually encountered:

severe abdominal pain;
bloating and feeling of fullness;
diarrhea;
nausea;
vomit;
heat.

Diagnostics

If the doctor suspected that the intestinal arteries are blocked by a thrombus, there is a suspicion of thrombosis of the mesenteric vessels, he may prescribe the following research methods:

CT scan of the abdominal cavity;
ultrasonography;
magnetic resonance imaging;
MRA (magnetic resonance angiography);
arteriography of abdominal vessels.

Angiography

Treatment

Thrombosis of the mesenteric arteries is a condition requiring emergency medical care, it can be compared in urgency with myocardial infarction or stroke. If treatment is started at the initial stages of the pathological process in the intestine, then the mortality rate according to statistics does not exceed 30%. In the case of starting therapy 8 hours after the onset of symptoms of the disease, with every hour of delay, mortality increases exponentially.

Each patient with suspected acute thrombosis of the intestinal arteries, as a rule, receives treatment in accordance with the principles of intensive care even at the stage of undergoing diagnostic procedures.

To stabilize hemodynamics, large amounts of fluid are administered intravenously (the patient is constantly under a dropper), anticoagulants are prescribed (usually heparin), and antibacterial treatment is also carried out (antibiotics, for example, cephalosporins + metronidazole).

Further treatment of thrombosis of mesenteric vessels largely depends on the patient's condition and diagnostic findings. Once the site of occlusion has been determined (that is, where the thrombus is located in the artery), the following techniques for its removal can be applied:

- Endovascular procedures: transfemoral intraluminal - a large blood clot from the mesenteric artery is removed using a catheter inserted into the femoral;
  -intraarterial administration of drugs (papaverine, heparin);
- Surgical treatment: immediate surgical intervention is performed when a large occlusion is diagnosed (a large section of the intestine is cut off from the blood supply), the endoscopic procedure has failed, a clinic of peritonitis (inflammation of the peritoneum) has appeared.

As a rule, such an operation is performed by two teams of surgeons - vascular (removes a blood clot) and abdominal (resects the affected part of the intestine and performs an anastomosis).

After discharge from the hospital, anticoagulants are usually given to prevent further clots.

Acute thrombosis of mesenteric vessels of both veins and arteries leads to sudden intestinal ischemia, which, if treatment is not started in time, ends in infarction of this organ. The mortality rate in this situation can reach 40–70%. Timely seeking medical help (within hours after the onset of symptoms) significantly improves the unfavorable prognosis of this disease.

Features of the blood supply to the intestines

The intestinal loops are in a “suspended” state and are secured in place by a dense mesenteric ligament. Arterial and venous vessels pass between the leaves. They are located almost parallel. The arteries (superior and inferior mesenteric) arise from the abdominal aorta and divide the blood supply into sections:

The superior mesenteric artery carries blood to the small intestine, cecum, ascending colon, and most of the transverse colon. It carries out 90% of the blood supply, so the lesions are more widespread and clinically severe.
The inferior mesenteric artery supplies a much smaller area (30% of the transverse colon, descending, sigmoid, rectum).

Between the main arteries there are “spare” collateral vessels. Their task is to help blood supply to the damaged area. A feature of intestinal collaterals is that they pump blood in only one direction: from the area of the superior artery to the inferior mesenteric. Therefore, in the case of upper-level thrombosis, no help can be expected from anastomoses.

Venous drainage from the intestine goes to the portal vein. Difficulty occurs when it narrows due to liver disease. Collateral circulation is formed by a group of portocaval anastomoses between the portal and vena cava. The small intestine is in the worst position. It does not have a developed collateral network.

Where do blood clots and emboli come from?

Through the arterial system, the embolus can reach the mesentery:

from the heart in case of detachment of a parietal thrombus from the wall of a post-infarction aneurysm, during atrial fibrillation, from the inner layer (epicardium) during sepsis, destruction of valves;
from the thoracic and abdominal aorta during vessel dissection, softening of atherosclerotic plaques;
is formed in the mesenteric artery after traumatic damage to the inner layer.

Venous blood, having the opposite direction and a tendency to decrease speed and increase viscosity, is more susceptible to the formation of its own thrombotic masses. The formation of blood clots in the veins is caused by:

inflammatory bowel diseases, affecting the entire wall, also involve venous vessels, local thrombophlebitis is formed;
drop in blood pressure caused by various situations;
portal hypertension in liver diseases;
congestion in the underlying vessels due to portal vein thrombosis;
any reasons that increase blood viscosity (diseases of the hematopoietic system, condition after splenectomy, long-term use of hormonal drugs to prevent pregnancy).

If the patient has a heart defect in which the right and left chambers communicate with each other (for example, patent foramen ovale), then a thrombus from the lower extremities can freely pass through the vena cava, the right atrium into the left ventricle and aorta, and then descend to the intestinal arteries .

Types of intestinal vascular damage

The classification of pathology includes different aspects of the mechanism of damage.

The reasons are distinguished:

arterial thrombosis and embolism;
venous thrombosis;
secondary thrombosis of mesenteric vessels in diseases of the aorta;
impaired vascular patency due to compression by germinating tumors;
consequence of vascular ligation during surgery.

Depending on the degree of blood flow disturbance, stages are distinguished:

compensatory,
subcompensations,
decompensation.

The pathological consequences of thrombosis can be:

ischemia of the intestinal wall;
site of infarction;
diffuse peritonitis.

Light areas are viable tissues, dark areas are the infarct area.

In surgery, a stage of functional acute obstruction of the mesenteric vessels is distinguished, in which there is no organic lesion, and the pathology is caused by a temporary spasm.

The maximum damaging factor is abdominal trauma. Compensation does not have time to fully develop. Protective mechanisms increase blood clotting are activated, which aggravates the patient’s condition.

During operations on the aorta (narrowing of the isthmus, change in position for congenital defects, replacement of the aneurysm site with a graft), doctors know the possible mechanism of thrombosis of the mesenteric vessels: restored full blood circulation leads to a high flow rate through the thoracic aorta into the abdominal area and the femoral artery to the legs. In this case, partial “robbing” of the mesenteric vessels occurs due to the additional suction action of the jet. Small blood clots may form in the capillaries supplying the intestinal wall.

Stages and forms of blood supply disorders

Any circulatory disorders cause intestinal ischemia.

In the compensated stage, the damaged lumen of the vessel is completely replaced by the flow of blood through collaterals. This form is characteristic of chronic ischemia with a gradual course of the disease.

Subcompensation also depends on collaterals, but has clinical manifestations.

During decompensation, the entire period is divided into 2 phases:

in the first 2 hours, reversible changes are possible with complete restoration of blood supply to the damaged area;
after 4–6 hours, the irreversible phase of gangrenous changes begins.

Clinical signs of thrombosis

Symptoms of acute thrombosis of mesenteric vessels are determined by the level of circulatory blockage and the form of ischemia.

Abdominal pain is intense in the subcompensation stage. Localized throughout the abdomen or in the navel and lower back. During the transition to decompensation (after 4–6 hours), the nerve endings on the intestinal wall die off, and the pain decreases. Such an “improvement” does not correspond to the actual extent of the pathology.
Intoxication of the body is manifested by nausea, vomiting, and decreased blood pressure. Noteworthy is the discrepancy between the general severe condition and moderate abdominal pain.
Peritoneal phenomena: the abdomen is tense, swollen, dense muscles are felt on palpation. The symptom is more typical of small intestinal thrombosis. During the stage of decompensation, peristalsis disappears, although in the subcompensated form it retains increased activity.
Stool disorders - frequent diarrhea mixed with blood is possible in the initial stages of ischemia. With decompensation, when there is no intestinal motility, diarrhea stops.
A state of shock is characterized by pale skin, thread-like pulse, tachycardia, cyanosis of the lips, and a drop in blood pressure.

Any, even short-term, pain in the abdomen requires attention.

Signs of pre-thombosis caused by arterial insufficiency can be identified by questioning and clarifying the patient’s complaints:

pain in the abdomen along the intestines becomes more intense after eating or long walking;
tendency to unstable stool, alternating diarrhea and constipation;
unclear weight loss.

Thrombosis of mesenteric veins is milder and slower. More often it is a chronic process.

Diagnostics

In order to make a correct diagnosis, it is important for the doctor to get answers to questions about the initial manifestations, duration of pain, and characteristics of the stool.

The decisive method is diagnostic laparoscopy, which allows you to examine the intestines and clarify the stage of ischemic changes and the localization of the area.

Leukocytosis with a shift of the formula to the left does not provide certain information, since it is characteristic of many diseases. An elevated level of the enzyme lactate dehydrogenase indicates the presence of necrotic tissue.

Ultrasound of the abdomen and fluoroscopy can provide some assistance in differential diagnosis. Preparing the patient and wasting time on angiography is not rational.

Inspection of the intestine allows you to detect a blood clot or ischemic area

If laparoscopy is not possible, doctors proceed to laparotomy - an operation with a large incision in the midline of the abdomen:

examine (perform an audit) the abdominal organs and intestines;
palpate the mesenteric vessels to identify a thrombus;
assess the sufficiency of arterial pulsation;
determine the boundaries of viable tissues.

Treatment

Treatment of thrombosis of intestinal vessels is possible only with immediate surgery. The introduction of painkillers and antispasmodics erases the clinic and delays the diagnosis.

For vein thrombosis, fibrinolytic therapy is indicated in the first 6 hours.

During the operation, the doctor must find ways to:

in the absence of necrotic changes, restore the patency of blood flow through the vessel to relieve ischemia from the affected area of the intestine;
remove the altered intestine or part of it and sew the upper and lower ends.

Restoring blood supply is carried out in the following way:

squeezing out a blood clot with your fingers;
creation of a bypass shunt between the upper and lower levels of the stenosis, bypassing the thrombosed area.

In the postoperative period, the patient is prescribed large doses of Heparin to thin the blood.

An angiogram of the intestinal arteries in an emergency is difficult because it requires patient preparation

How does the chronic form of thrombosis manifest?

The chronic form of thrombosis should be considered in patients with heart failure complicated by myocardial infarction. The clinic distinguishes 4 stages:

I - the patient has no complaints, the thrombus is an accidental finding during angiography;
II - typical complaints of pain along the intestines after eating, the person refuses food because of this;
III - constant pain, flatulence, impaired absorption of the small intestine, diarrhea;
IV - the occurrence of intestinal obstruction, which manifests itself as an “acute abdomen”, with peritonitis and gangrene.

Forecast

Mesenteric thrombosis, according to clinical studies, is observed much more often than the number of cases diagnosed. This pathology is masked by various acute conditions: cholecystitis, renal colic, appendicitis. The limited time for diagnosis does not always allow the disease to be detected.

Fatal cases, according to pathologists, are 1–2.5% of hospital mortality. These are thrombosis in the stage of infarction and diffuse peritonitis. Late surgery (after 12 hours) means high mortality (up to 90%).

A good prognosis for recovery with surgical treatment of chronic thrombosis in the first two stages. Timely seeking surgical help for abdominal pain allows the patient to be operated on in a favorable time frame and prevent perforation of the intestinal wall.

Mesenteric thrombosis is a serious condition of the body that occurs as a result of blockage of blood flow in the mesenteric vessels by blood clots.

Mesentery, or mesentery, are cords in the abdominal cavity that hold the organs attached to the wall. If a blood clot occurs in an artery or other vessel, the entire area is cut off from blood supply, which can lead to peritonitis and even death.

This disease usually occurs in older people due to atherosclerosis of the vessel walls. But it can also occur in children if they have other diseases in the body that provoke increased thrombosis.

In 90% of cases, a blood clot forms in the upper artery, which is responsible for the “delivery” of blood to the ascending colon, small intestine and cecum.

Blockage of this vessel has serious consequences - extensive damage to the abdominal organs and even intestinal necrosis are possible.

In the lower region, the mesenteric artery is blocked by blood clots only in 10% of cases.

As a result, tissue damage occurs in the following places:

left side of the transverse colon;
descending colon;
sigmoid colon.

How are the intestines and heart connected?

Thrombosis of the intestinal mesenteric vessels is a condition that occurs suddenly, but has prerequisites for its manifestation.

The primary causes include heart disease and the general condition of the body's blood vessels - thromboembolism, atrial fibrillation and other disturbances in cardiac activity.

In all these conditions, the flow of blood through the vessels is disrupted in one way or another. Blood clots can form in any part of the body, but they also tend to move around.

As a result, the clots settle in a certain vascular area, causing the blocking of further blood supply to the organs located there. As a result, the necessary nutrition of the vessel walls is missing, blood circulation in the area is inhibited or stops altogether.

If a blood clot breaks off, it can block several vessels along its path - once in a certain area, it prevents oxygen and nutrients from reaching the organs.

Because of this, there is a risk of death, since the organs in this area begin to die without normal blood supply, and their further problematic functioning affects the entire body.

Causes of the disease

Mesenteric thrombosis (otherwise known as mesothrombosis) occurs in patients who have just suffered from acute or chronic forms of cardiovascular pathologies.

Clots and thrombi form after damage to the heart muscle and vessel walls - in acute conditions, arrhythmias, inflammation, infections and aneurysms.

One of the severe manifestations is embolism of mesenteric vessels (formation of a clot and its rupture), which occurs as a result of the following heart diseases:

A heart attack, due to which the blood is more susceptible to clotting, and changes in the speed of its flow through the vessels occur.
Aneurysm.
Mitral valve stenosis.
Heart rhythm disturbance.

Such violations lead to the formation of an embolus - a blood clot that breaks off and moves along the vascular branches of the body. As a result, it enters the mesentery area, clogging large vessels (veins, arteries) and stopping the blood supply to the abdominal organs.

Thrombosis of the superior mesenteric artery is more common than its inferior “sister” and occurs due to physical trauma and secondary insufficiency in the mesentery.

Among the injuries, it can be caused by blows to the abdomen, followed by peeling of the internal walls of blood vessels and intima, which block further blood flow.

The causes of secondary vascular (both venous and arterial) insufficiency include the following pathologies:

Stenosis that occurs as a result of atherosclerosis at the attachment points of the arteries to the aorta (branches at an angle): the speed of blood flow changes (decreases), the plaque that closes the vessel is damaged. The final condition is extensive necrosis.
Deterioration of heart function with decreased pressure in the arteries. The result is stagnation in the blood vessels.
Steal syndrome, which occurs during aortic repair operations; the accelerated blood flow, after freeing the vessel from the thrombus, is directed downward, sucking blood from the mesenteric branches into the main artery. The consequence is intestinal necrosis due to intestinal infarction.
Tumors in the womb, compressing vessels - mainly the upper artery. The inferior artery in this area is much less likely to be damaged.

There are also general conditions of the body that can give rise to the formation of blood clots:

hereditary vascular pathologies - thrombophilia;
increased blood viscosity due to long-term use of drugs;
changes in endothelial cells due to chemotherapy, radiation, etc.;
pregnancy;
obesity;
smoking;
diabetes;
Coxsackievirus, leading to heart failure.

Forms and stages of development

The clinical picture of the condition includes three stages of its development:

Ischemia with severe symptoms - pain, vomiting, frequent loose stools.
Intestinal infarction with symptoms such as: constipation, severe pain, bloating, pale skin and bluish tint to the lips.
Peritonitis is severe intoxication due to inflammation of the peritoneum with high fever, severe pain and tension in the abdominal wall.

The classification of thrombosis at the ischemic stage also includes several forms and types of severity:

Decompensation is complete ischemia, the most severe form of the disease, progressing over a couple of hours.
Subcompensation - there is collateral blood flow, the overlap is not complete.
Compensation is a chronic form, the main blood flow is carried out through collaterals.

The conditions of infarction and peritonitis are more severe and almost always lead to severe tissue necrosis, and can also result in the death of the patient.

Thrombosis is also divided into arterial and venous forms.

Venous insufficiency (for example, thrombophlebitis), as a rule, is segmental in nature - they affect the entire area of the mesentery. Nevertheless, this type of thrombosis is eliminated more easily than arterial thrombosis and rarely leads to death.

A mixed form is also possible - blood clots form both in a vein and in one of the arteries of the area simultaneously. This phenomenon is very rare and can only be detected during surgery.

Ischemia

Ischemia is an acute lack of blood circulation due to blockage of a vessel by a thrombus by more than 70 percent.

Intestinal ischemia has the following manifestations and symptoms:

attacks of pain that develop into a constant painful state;
severe diarrhea;
vomiting with bile - bile impurities occur immediately, during the first day after blocking the vessel.

These signs are typical for ordinary food poisoning, so the patient, as a rule, is in no hurry to see a doctor. Delaying treatment leads to serious consequences in the form of serious operations and disability.

Heart attack

Intestinal infarction is necrosis of its area caused by circulatory disorders.

Symptoms of this stage include:

Constipation due to intestinal obstruction - pathological changes occur in the walls of the intestines, their functions are inhibited.
Blood in the stool is a negligible amount for this form of thrombosis.
Pain shock or just a strong pain syndrome in the area.
Bloating and severe vomiting.
Mondor's sign - detected by palpating the area below the navel and is an accumulation of blood in the intestinal loops.
There may be an increase in pressure when the upper artery is affected.
The person turns pale, his lips turn blue.

At this stage, the patient feels some relief when the vessel ruptures. However, this condition is even more dangerous than the ischemia stage, since it leads to the development of peritonitis.

Most often, ischemia develops into intestinal infarction after the patient has suffered a myocardial infarction. The formation of a blood clot during this condition leads to its further rapid movement to the mesenteric zone. After this, a total blockage of the artery or vein occurs, so the blood, accumulating in front of the “obstruction,” ruptures the vessel with its pressure. Because of this, some areas of the intestine begin to die.

Thrombosis of the mesenteric vessels can quickly lead to peritonitis - the last and most dangerous stage of the condition.

Its symptoms include:

elevated body temperature;
sharp pain in the abdominal cavity - goes away for several hours, then returns;
tension in the abdominal wall.

Typically, peritonitis occurs during thrombosis of the small intestine - gangrene develops in the area, and intestinal perforation occurs. This condition has an increased risk of death for the patient.

Diagnostic methods

Mesothrombosis requires an early and accurate diagnosis:

A complete examination of the patient by the doctor - collecting anamnesis, analyzing symptoms, determining an accurate diagnosis based on the degree of manifestation of symptoms.
Manual inspection allows you to diagnose intestinal damage.
Angiography is a type of computed tomography that allows you to quickly obtain images of the vessels of the abdominal cavity. Emergency procedure.
A blood clotting test is ordered.
An ultrasound may be performed.
If there are difficulties in making a diagnosis, laparoscopy under anesthesia is used - an endoscope is inserted through the incision, allowing you to examine the affected area from the inside.

How is the operation performed?

Thrombosis of the mesenteric arteries requires invasive treatment methods - surgery is mandatory.

The need for surgery is due to the high mortality rate if the clot is not removed in time. It is impossible to influence it with medication or alternative medical methods in such an acute condition, since complications arise within a couple of hours.

The patient is taken to the hospital urgently, since the condition develops very quickly and death can occur within the first 5-12 hours after symptoms are detected.

Surgical intervention includes:

Removal of the blood clot itself, which blocks the blood flow.
Reconstruction of a vessel affected by the consequences of thrombosis.
Removal of dead parts of organs is only at stage 2 (infarction), when the lesion has already led to necrosis.
Drainage of the abdominal cavity - if the operation is performed at the stage of peritonitis, and the inflammatory process has spread to the entire abdominal cavity.

Prognosis and possible complications

Prompt management of symptoms and accurate diagnosis of the condition helps avoid serious complications.

Thrombosis of the mesenteric artery in 70 percent of cases costs the patient’s life if the treatment occurred at the stages of a heart attack or peritonitis.

Even after surgery, the patient risks dying from too rapid restoration of blood flow or the spread of damage to internal organs (necrosis).

Among elderly patients, death is not uncommon, even if rehabilitation has already been completed.

This is due to the fact that the body’s recovery processes at this age proceed too slowly.

Preventive measures

Prevention of mesothrombosis includes full treatment of diseases that cause this condition.

In addition to medications, it necessarily includes: good nutrition, quitting smoking and alcohol, and physical exercise. Compliance with the frequency of doctor's examinations is mandatory.