Intestinal gangrene: symptoms, treatment (surgery) and prognosis for life. Causes of necrosis and symptoms of damage to the intestinal walls Gangrene of the small intestine

Gangrene– this is the necrosis of body tissues that come into contact with the external environment (skin and underlying tissues, trachea, bronchi, lungs, intestines, appendix, gall bladder). In this case, the affected tissue becomes black, brown or dark blue.

Facts about gangrene:

The black color is due to the fact that hemoglobin accumulates in the necrosis zone, from which iron is released and converted into salt - ferrous sulfate. This compound gives color.
Most often, gangrene develops in the areas of the body that are furthest from the heart - the tips of the fingers and toes. This is due to the fact that the blood to the areas is forced to travel a longer path, blood flow disturbances are more likely.
Any diseases of the heart and blood vessels increase the risk of developing gangrene, since this disrupts blood flow in distant parts of the body. Therefore, most often gangrene occurs in people with cardiovascular pathology, the elderly.
The first descriptions of gangrene can be found in the works of ancient doctors - Hippocrates and Celsus. They also offered their own methods of treatment.
The name of the pathology comes from the Greek word graino, which literally translates as “gnaw”. The ancient name for gangrene is “Antonov fire.”
Before asepsis and antiseptics were introduced, there was hospital (hospital) gangrene, which had a severe course. Often, entire epidemics of this form of the disease broke out in hospitals.

Features of anatomy, blood supply and innervation of the arms and legs

Features of blood supply to the hands:

From the aorta, the largest artery originating from the heart, the right and left subclavian arteries depart from the right and left.
Reaching the axillary fossa, the subclavian artery passes into the axillary artery.
The axillary artery gives off the brachialis, which supplies the muscles and skin of the shoulder and the humerus.
In the area of the elbow joint, the axillary artery splits into two branches: ulnar and radial.
In the area of the hand on the palmar and dorsal side, the radial and ulnar arteries join to form arches. Arteries extend from these arches to each finger, which then break up into capillaries.
The outflow of blood from the arm occurs into the superior vena cava.

If swelling of the finger occurs as a result of inflammation or other reasons, the vessels in it are severely compressed. This leads to impaired blood flow and is another factor contributing to the development of gangrene.

Features of blood supply to the legs:

Reaching the lower abdomen, the aorta, the largest artery in the body, originating from the heart, divides into two iliac arteries: the right and left.
The right and left iliac arteries descend into the pelvis, where they each divide into the internal and external iliac arteries.
The internal iliac artery, as its name suggests, remains internal and supplies blood to the pelvic organs. And the outer one descends to the lower limb.
In the thigh area, the external iliac artery becomes the femoral artery. Here it gives off branches that supply blood to the skin, muscles, and femur.
In the area of the knee joint, in the popliteal fossa, the femoral artery passes into the popliteal artery.
The popliteal artery then divides into two branches - the anterior and posterior tibial arteries. They give off small branches that supply blood to the lower leg area, tibia and fibula.
Then, on the foot, the terminal sections of the tibial and peroneal arteries unite and form vascular arches, from which the arteries extend to the toes.
The outflow of blood from the lower extremities occurs through the system of superficial and deep veins into the inferior vena cava.

The blood in the veins of the legs is affected by gravity, so it is difficult for it to rise up to the heart. Its correct flow is ensured by the normal tone of the venous wall and muscles, and the presence of special valves in the veins. When these mechanisms stop working normally, a condition known as venous insufficiency develops. Blood stagnates in the lower extremities, this leads to swelling, poor circulation and is one of the factors contributing to the development of gangrene.

Classification of gangrene

Depending on the processes occurring in the affected tissue:

Dry gangrene

Wet gangrene

Most often, dry gangrene develops as a result of a gradual increase in circulatory disorders over a long period of time.

As a rule, the feet are affected.

The body’s defenses have time to work: the affected area is clearly demarcated from healthy tissues. It acquires a black or dark brown color, as if “dries out”, and decreases in volume.

Dry gangrene is not life-threatening:

the affected tissue practically does not disintegrate (it simply loses fluid and “dries up”, mummifies), so toxic substances are formed slowly and in small quantities - the body manages to inactivate them;
the focus of tissue necrosis is clearly demarcated.

Wet gangrene usually develops quickly.
Almost always wet gangrene is the result of infection.

Corpse decomposition begins:

the affected area swells and increases in size;
the skin acquires a bluish, dark purple color;
intensive tissue breakdown occurs.

The body's defenses do not have time to delimit the area of necrosis from healthy tissue. Toxic substances formed as a result of cell breakdown enter the bloodstream in large quantities, are not inactivated, poison the body, and disrupt the functioning of organs.

The patient's condition worsens.

Gangrene in the internal organs (lungs, intestines) occurs as a wet type.

The main types of gangrene depending on the causes:

infectious – caused by pathogenic microorganisms;
allergic – caused by severe inflammation as a result of an overreaction of the immune system;
toxic – as a result of the action of toxic substances that enter the body from the outside or are formed within it during various diseases;
as a result of impaired blood flow - usually caused by cardiovascular diseases, diabetes, etc.

Causes of gangrene

Circulatory disorders

Impaired blood flow in the vessels is the most common cause of gangrene. Most often, the legs are affected: fingers, feet. Usually, the disruption of blood flow develops slowly, so dry gangrene occurs.

Diseases of the cardiovascular system that can cause gangrene:

severe heart pathologies in which severe blood flow disturbances develop;
atherosclerosis, leading to significant partial or complete blocking of the lumen of the vessel;
vessel thrombosis;
thromboembolism - a condition when a piece of a blood clot breaks off, is carried by the bloodstream into a smaller vessel and clogs it;
obliterating endarteritis - a disease in which the lumen of the arteries of the legs narrows, often develops in smokers;
incorrectly applied plaster cast: if it is circular (solid), then as a result of increasing edema, compression of blood vessels and disruption of blood flow may occur;
a tourniquet that was placed on the limb for too long, which was applied to stop bleeding;
prolonged compression by various debris and heavy objects during disasters.

Infection

Infectious gangrene develops during wounds. Ideal conditions are when the wound channel has a small hole and a large length: gunshot and stab wounds. In patients with diabetes mellitus and vascular pathologies, gangrene can develop even due to a small wound.

Bacteria that cause infectious gangrene:

coli;
enterobacteria;
Proteus;
Clostridia are bacteria that live in oxygen-free conditions and are causative agents of gas gangrene.

All these microorganisms are constantly present in the soil.

Burns and frostbite

Impacts that can lead to the development of gangrene:

temperature more than +60⁰C – burns;
temperature less than -15⁰C for quite a long time – frostbite;
electric shock - resembles a burn, since as a result of the passage of electricity, the tissues heat up and literally burns them;
chemical burns with acids: lead to the development of dry gangrene, since as a result of the action of acids, proteins coagulate and become insoluble in water;
chemical burns with alkalis: lead to the appearance of gangrene, reminiscent of wet (but this is not exactly the same thing), since under the influence of acids the tissues soften, a large amount of liquid accumulates in them.

Factors that lead to gangrene:

Destruction of tissues and impaired circulation as a result of the direct action of high and low temperatures, acids, alkalis, and electric current.
Development of inflammation. It is necessary so that the destroyed tissues can resolve. But the inflammatory process can be so strong that it itself has a damaging effect.
Attachment of infection. When tissues are destroyed and the body's defenses are weakened, infection develops much more easily.

Mechanical injuries

The development of gangrene can be caused by severe tissue destruction due to crushing, ruptures, and strong prolonged compression (this compresses the vessels and disrupts blood flow). Usually, with extensive tissue destruction, an infectious process occurs.

Symptoms of gangrene

Symptoms of wet gangrene

Then the skin becomes bluish, dark blue, black with a green tint. Dark red spots appear.
The affected limb swells and increases in size.
Blisters filled with blood appear on the skin.
There is no clear boundary between healthy and diseased tissue. Gradually, the area of necrosis (death) spreads (usually from the foot above), as the infection affects more and more tissue.
Tissues that have a dirty gray color are exposed.
An unpleasant putrid odor appears. It is caused by the formation of tissue decay products and bacterial activity.
The general condition of the patient is disrupted: body temperature rises, headache, weakness, increased fatigue, chills, pallor and dry skin occur.
The pulse becomes weak and frequent.

If the patient is not provided with timely assistance, then necrosis spreads to neighboring areas, covers the entire limb, and the patient’s condition becomes very serious. Death occurs as a result of poisoning of the body with toxic products.

Symptoms of dry gangrene

Dry gangrene is not as severe as wet gangrene, there is no threat to the patient’s life:

Initially, severe pain occurs in the affected limb. It becomes pale and then acquires a marble-bluish tint.
Then the affected part of the limb decreases in size and becomes black or dark brown in color. The pain goes away, all sensitivity disappears in the area of necrosis.
There is a clear boundary between the area of necrosis and healthy tissue. New areas are not involved.
The patient's condition remains normal, since with dry gangrene practically no toxins enter the blood.
Eventually, the affected part of the limb dries up and becomes mummified. Occasionally, it can detach on its own - this outcome is equated to self-healing.

Symptoms of certain types of gangrene

Gas gangrene

Gas gangrene is caused by anaerobic bacteria, that is, bacteria that can only exist in oxygen-free conditions. Their spores are found in the soil. The main causative agent is a microorganism called Clostridium Perfringens.

If the wound is deep enough and narrow enough, then favorable conditions are created at its bottom: oxygen does not penetrate here, and clostridia can multiply freely.

Symptoms of gas gangrene:

6 hours after receiving the wound, the patient's condition worsens. Weakness and fever appear, the pulse becomes weak and frequent.
Swelling occurs in the wound area. Its edges look lifeless.
If muscles are visible in the wound, they look as if they were boiled.
The affected limb becomes swollen, acquires a gray-bluish color, and blisters with blood appear on it.
If you press on the skin in the wound area, you can feel a specific crunch (as a result of the presence of gas bubbles in the tissues), and gas will begin to be released from the wound.
An unpleasant sweetish-putrid odor emanates from the wound.
The patient's condition quickly deteriorates - if help is not provided in time, death will occur due to poisoning of the body with toxins of clostridia and decaying tissues.

Fulminant gangrene of the scrotum (Fournier's gangrene)

Fulminant gangrene of the scrotum is a rare but dangerous type of disease. It develops as a result of infection during injury to the scrotum or genital area.

Symptoms:

There may be no symptoms for 2 to 7 days after the injury.
Then there is constant severe pain in the genital area. Swelling may be noticeable.
Swelling and redness appear on the skin, and the pain intensifies.
The affected area of the skin in the genital area becomes dark, gangrene develops. Pus begins to come out.

With fulminant gangrene of the scrotum, approximately a third of patients die. And if the testicle is affected, more than half of the patients die.

Lung gangrene

With gangrene of the lung, an area of necrosis appears in the lung tissue, which has no clear boundaries and gradually spreads to healthy tissue.

Possible causes of lung gangrene:

Infection, which can enter the lungs in different ways:
- if vomit or stomach contents enter the respiratory tract;
- for pneumonia and other diseases of the respiratory system;
- with penetrating chest wounds;
- transfer from other foci of inflammation through the blood and lymph flow.
Pulmonary embolism- a condition in which a detached fragment of a blood clot enters the bloodstream, reaches the vessels of the lungs and clogs one of them. Part of the lung tissue stops receiving the required amount of blood and dies. An infection sets in.

Symptoms of lung gangrene:

Increase in body temperature to 39-40⁰C. Fever.
Headache, insomnia.
Poor appetite, weight loss.
Pain in the affected half of the chest. It becomes stronger during deep inhalation, frequent deep breathing.
After a few days a persistent cough occurs.
A lot of sputum (up to 1 liter per day) is discharged, dirty gray in color with an unpleasant odor. She clears her throat with a “mouth full.”
Shortness of breath, pale skin with a gray tint.
In severe cases of the disease - frequent weak pulse, decreased blood pressure, decreased amount of urine.

Lung gangrene is a serious disease. If it occurs at lightning speed, the patient’s condition quickly deteriorates, and death occurs within the first few days.

Intestinal gangrene

The main causes of intestinal gangrene:

bacterial infections;
disruption of blood flow in the vessels supplying the intestine, for example, with atherosclerosis;
strangulated hernia - during strangulation, the vessels are compressed and blood flow is disrupted;
inflammatory process - for example, gangrenous form of acute appendicitis.

Symptoms of intestinal gangrene:

blood in the stool;
bloating;
increased body temperature;
disturbance of general health, weakness, lethargy, pallor.

A patient with intestinal gangrene should receive immediate assistance. Otherwise, such a serious complication as peritonitis, an inflammation of the abdominal cavity, may develop.

Diagnosis of gangrene

Which doctor should I contact if signs of gangrene occur?

If symptoms resembling gangrene occur, it is best to consult a surgeon. He will conduct an examination, prescribe an examination, and, if necessary, refer you to a more specialized specialist.

Specialists involved in the treatment of different types of gangrene:

gangrene caused by diseases of the cardiovascular system and impaired blood flow - vascular surgeon;
infectious gangrene - surgeon (department of purulent surgery);
gangrene as a result of burns, frostbite - traumatologist;
gangrene of the lung - thoracic surgeon (surgeon who treats diseases of the chest organs);
intestinal gangrene – abdominal (general) surgeon (surgeon who treats diseases of the abdominal organs).

What happens in the doctor's office during an appointment?

Questions your doctor may ask if you suspect gangrene:

Where did it all start? What happened immediately before symptoms began?
Was there an injury? How did the wound heal?
What diseases does the patient suffer from? The doctor is especially interested in diseases of the cardiovascular and nervous systems.
Does the patient have diabetes?
Was the affected area hypothermic?
What symptoms are you worried about at the moment? When do they arise and intensify?
What was your body temperature in the last few days? What is the general health of the patient?

During the appointment, the doctor examines the affected limb, assesses the condition of the skin, the presence of swelling and thickening, and color. Then the doctor performs palpation. If gas gangrene occurs, then when pressing on the skin, the surgeon feels a specific crunching sound caused by the presence of gas bubbles.

In a hospital setting, a doctor can perform a simple test: tie a thread around the affected limb. If swelling increases during gangrene, then after a while the thread becomes “tight” and digs into the skin.

Usually, after examining the patient in the office, identifying signs of gangrene, the doctor sends him to the hospital. There, an examination is carried out and the most appropriate treatment tactics are selected.

Examination for gangrene

Study title	Description	How is it carried out?
General blood analysis	A general clinical routine test that is prescribed to almost all patients for any disease. With gangrene, a general blood test reveals inflammatory changes: an increase in the number of leukocytes.	Blood for research is taken in the standard way from a finger or from a vein (usually if you plan to do a biochemical blood test at the same time). If the test result is needed urgently, it can be ready in the clinic within a few minutes.
Blood chemistry	Helps clarify some nuances, in particular regarding the cause of gangrene: in diabetes mellitus – increased glucose levels; with atherosclerosis – increased cholesterol levels.	Blood for analysis is taken from a vein on an empty stomach.
Blood test for sterility	A test that helps detect blood poisoning (sepsis) in infectious gangrene. It is possible to establish the pathogen and its sensitivity to different types of antibacterial drugs.	Blood for research is taken from a vein and then placed on a special nutrient medium. If growth of colonies is observed, they are examined under a microscope and their sensitivity to antibacterial drugs is checked.
Bacteriological examination of the contents and discharge from the wound.	The analysis allows us to identify the causative agent of infectious gangrene and its sensitivity to antibacterial drugs.	Swabs are taken from the wound and inoculated onto a nutrient medium. Then the grown colonies of microorganisms are studied under a microscope and their sensitivity to antibacterial drugs is determined.
X-ray of the muscles in the affected area	X-rays help confirm gas gangrene. In the pictures the muscles look porous.	Conventional x-rays are taken in different projections.
Examination for gangrene of the lung
Chest X-ray	Lung gangrene appears on x-rays as an area of darkness.	X-rays of the chest are taken in two projections: frontal and lateral.
Computed tomography of the chest	CT is a more accurate technique compared to radiography. The images can provide layer-by-layer sections or a three-dimensional image of the lung, in which the area of necrosis is clearly visible.	Computed tomography for gangrene of the lung is carried out according to the standard method using a computed tomograph.
Ultrasound examination of the chest	During an ultrasound examination of the chest, a focus of necrosis in the lungs, an accumulation of inflammatory fluid between the lung and the chest wall, can be detected.	The doctor lays the patient on the couch, lubricates the skin with a special gel and conducts an examination using an ultrasonic sensor.
Bronchoscopy	A study during which a bronchoscope, a special flexible endoscopic instrument with a miniature video camera, is inserted into the trachea and large bronchi. The doctor examines the lumen of the bronchi from the inside, and may reveal: inflammation; blocking of the bronchial lumen by an area of necrosis.	During the examination, the doctor inserts a special flexible instrument – a bronchoscope – into the patient’s airways. In adult patients, bronchoscopy can be performed under local anesthesia. In children - only under general anesthesia.
Microscopic examination of sputum	With gangrene of the lung, the following is found in the sputum: leukocytes(white blood cells); red blood cells(red blood cells); fragments of dead lung tissue.	The sputum that the patient coughs up is collected and examined under a microscope.
Bacteriological examination of sputum	An analysis that allows you to identify pathogens and determine their sensitivity to antibacterial drugs.	The patient's sputum is placed on a special nutrient medium, and then the colonies of bacteria grown on it are studied.
Examination for intestinal gangrene
X-ray of the abdomen	On X-rays (taken without contrast), the doctor can detect signs of intestinal destruction and peritonitis. This is an indication for emergency surgery.	Plain X-rays without contrast are taken in a direct projection (from the front).
Laparoscopy	Laparoscopy is an endoscopic examination, during which the doctor can examine the abdominal cavity from the inside and identify affected areas of the intestine. Carried out according to indications.	Under anesthesia, punctures are made in the patient's abdominal wall, through which endoscopic equipment is inserted: a miniature video camera and special instruments. Laparoscopy is equivalent to surgery and is performed in the operating room under sterile conditions.

Treatment of gangrene

All types of gangrene are treated in a hospital. The patient must be constantly under the supervision of doctors.

Treatment depending on the type of gangrene:

Type of gangrene	Treatment tactics
Gangrene resulting from poor circulation.	Depending on the condition of the affected limb, the doctor may first prescribe medication aimed at restoring normal blood circulation: bed rest; novocaine blockades (injection with novocaine solution) - prevent vasoconstriction and circulatory disorders; vitamins and drugs that improve blood circulation in small vessels; in the presence of blood clots, drugs that dissolve them. According to indications, surgical interventions on blood vessels are performed: thrombus removal; removal of atherosclerotic plaque; the imposition of a new message between the vessels (shunt); replacement of the affected area of the vessel with a graft or synthetic prosthesis. If irreversible changes have already occurred in the tissues, amputation is indicated.
Dry gangrene	Since dry gangrene is not accompanied by a violation of the general condition and does not pose a threat to the patient’s life, at first the doctor adheres to a wait-and-see approach. Treatment is prescribed to improve blood flow. When a clear boundary between living and dead tissue becomes visible, amputation is performed. The limb is amputated slightly above this limit. The operation is carried out as planned, that is, its date is set in advance, and the patient is examined.
Rapidly growing wet gangrene	Wet gangrene poses a danger to the patient's life, so amputation must be carried out immediately, as an emergency. The limb is crossed above the site of the lesion using the guillotine method - the simplest and fastest way, when all tissue is cut off at once. Antibiotics are prescribed. When the wound is cleared of infection and begins to heal, a second plastic surgery is performed and the stump is closed.
Gas gangrene	For gas gangrene, the surgeon makes “lampas” (longitudinal) incisions at the site of the lesion. All dead and suspicious-looking tissues are removed. Wounds are left open. They are washed with hydrogen peroxide. It is important to ensure an influx of fresh air into the wound, since the causative agent of the disease, clostridia, cannot live and reproduce in the presence of oxygen. Antibiotics are prescribed, and sometimes hyperbaric oxygenation (exposure to oxygen under high pressure in a pressure chamber). If the symptoms of gas gangrene quickly increase and the patient’s condition worsens, an emergency amputation is performed to save life.
Lung gangrene	In the early stages, lung gangrene is treated without surgery (only in a hospital): Intravenous administration through a drip of plasma, blood substitutes, protein solutions and other solutions that help remove toxins from the body. Antibiotics. They can be administered as injections intravenously, intramuscularly, or directly into the bronchi during bronchoscopy. Antiallergic drugs. Inhalations with drugs that expand the lumen of the bronchi. Drugs that reduce blood clotting. Medicines that improve breathing. Immunomodulators. Plasmapheresis is the purification of blood plasma using a special device. Possible outcomes after treatment: Gangrene of the lung turns into an abscess (ulcer). In this case, it can be cured without surgery (not always). In other cases, surgical treatment is necessary - removal of part of the lung.
Intestinal gangrene	If intestinal gangrene is detected, emergency surgery is necessary. The surgeon must remove the dead section of intestine. After the operation, a course of powerful antibiotics is prescribed.

Prognosis for gangrene

With dry gangrene, the prognosis is favorable. The dead part of a limb can sometimes self-ampute—come off on its own without surgery. The general condition of the patient practically does not suffer.

With wet gangrene, there is a threat to the life of the patient. The death of the patient can occur as a result of complications from the heart, liver, kidneys.

With gangrene of the lung, from 20% to 40% of patients currently die. Causes:

development of sepsis (blood poisoning);
dysfunction of all organs due to the action of toxins released from the focus of necrosis;
pulmonary hemorrhage.

Intestinal gangrene can be complicated by sepsis, peritonitis (inflammation of the abdominal cavity). These severe complications can lead to the death of the patient.

Prevention of gangrene

Prevention of gangrene consists in the timely and proper treatment of diseases that lead to its development:

timely and correct treatment of diseases of the heart and blood vessels, accompanied by impaired blood flow;
timely treatment of wounds (prevention of gas gangrene);
timely examination by a doctor, treatment of burns and frostbite;
fight against bad habits, timely treatment of infections of the respiratory system (prevention of lung gangrene).

Intestinal necrosis is a condition in which tissues begin to die and lose their properties. Such a process is most often not reversible, and if tissue necrosis has already occurred, then it will not be possible to restore the lost area. Therefore, such a pathology should be treated in the early stages so that it is possible to save a person.

The causes of necrosis are varied, and may be the result of an illness or an independent factor that has developed for its own reasons.

Types of necrosis

The intestines can be affected in different ways depending on what the necrotic area looks like, the location of necrosis, and the amount of dead tissue. Therefore, the following types of necrosis are distinguished:

Classification	Examples
According to the degree of damage (how much space the necrotic area takes up)	Local - when only one part of any intestine is affected and necrosis does not spread to neighboring parts of the intestinal tract. Total - complete damage to the rectum, small and large intestines occurs, and part of the stomach may even be affected.
According to etiological factors (depending on what caused necrosis)	Ischemic - ischemia or infarction of the intestine occurs due to blockage of the vessels delivering blood to the intestines. If blood does not circulate for a long time, gangrene and even peritonitis can develop, when part of the small or large intestine is destroyed so much that all its contents enter the abdominal cavity, causing inflammation. Toxigenic - rotaviruses, coronaviruses, Candida fungi, clostridia infect the intestinal tract, causing necrosis of its tissues. Trophoneurotic - malfunctions in the functioning of the nervous system lead to improper innervation of the intestinal vessels, and therefore to necrotization of its areas.
According to clinical signs (how the disease manifests itself in development, each type can flow into the next, reflecting the degree of neglect of the disease)	Coagulative necrosis, or dry necrosis, develops due to dehydration associated with arterial insufficiency, which leads to the drying out of the intestinal mucosal wall and its separation from healthy areas. Liquation, or wet, is the next stage of dry necrosis. This stage is characterized by the proliferation of putrefactive microflora in those parts of the intestine that have already undergone necrosis. After it, gangrene often develops if medical assistance was not provided in a timely manner. Strangulation necrosis is most often caused by intestinal obstruction associated with obstruction of feces or the presence of a foreign body in the intestine. Also, the cause of this necrosis is a tumor that compresses the intestines from the outside, preventing blood from circulating normally. Thrombosis of mesenteric vessels and narrowing of the intestinal lumen can also cause this. Gangrene can form at any time during the development of necrosis. The dry form of gangrene is characterized only by impaired blood circulation, but the wet form leads to stasis of the veins and lymphatic capillaries, as well as the appearance of swelling.

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Causes

The following factors can cause intestinal necrosis:

Intestinal obstruction, which is caused by prolonged accumulation of feces due to twisting of the intestines. The small intestine is less likely to suffer from such pathology than the large intestine. With significant physical activity, the large intestine can be severely compressed, which will block blood flow.
Disturbances in the functioning of the central nervous system, which cause destruction of the intestinal walls.
Poor circulation in the intestinal walls can be caused by thrombosis (thrombi form in the intestinal vessels themselves, or migrate from other organs) or embolism (air entering the bloodstream).
Damage to the intestinal tract by pathogenic microorganisms often causes necrosis in babies (especially infants). Their weakened body cannot fight infection, and therefore bacteria and viruses begin to destroy the intestinal walls very quickly.
The body's allergic response to the presence of foreign bodies can cause necrosis.
Chemical poisoning can also provoke necrosis of the tissues of the intestinal tract.
When operations are performed on the stomach, the consequence (complication) may be that the part of the intestine closest to the stomach begins to die.

Symptoms

Signs of intestinal necrosis often appear when the process is irreversible or barely reversible, and therefore you need to know the symptoms of necrosis and immediately call an ambulance, otherwise the consequences of delay can be fatal for a person.

Symptoms of necrosis are as follows:

severe weakness, loss of strength;
rise in temperature;
the pulse quickens and the blood pressure drops;
pale and dry skin;
dry mouth;
thirst;
weight loss;
appetite decreases;
nausea and vomiting appears;
in the later stages, abdominal pain occurs and blood appears in the stool.

Diagnostics

When seeking medical help, the patient will first undergo palpation of the abdomen.

With intestinal necrosis, there will be abnormally soft parts of the abdomen. To confirm the diagnosis, the following is prescribed:

X-ray of the intestine;
angiography or MRI;
radioisotope scanning;
Dopplerography (ultrasound examination of the intestinal arteries);
colonoscopy;
diagnostic laparoscopy.

According to the research results, if necrosis is detected, the patient is urgently sent to the surgical department for emergency care. If the cause of the pathology is not eliminated in time and intestinal function is not restored, the patient will die.

Treatment

Treatment of intestinal necrosis is carried out in the following areas:

Conservative therapy.
Relieving therapy.
Surgical intervention.

The first two directions are mandatory, but surgery is prescribed according to indications, but since necrosis at an early stage is detected only in small quantities, most patients will still need it.

Conservative therapy

A patient with necrosis is given:

antibiotics;
protein solutions;
anticoagulants;
electrolytes.

All this is done to reduce blood clotting, reduce the amount of thrombosis, eliminate infection and support the body.

Relief therapy

To reduce the load on the intestines, the patient’s stomach and entire intestinal tract are washed from all sides. If there is no accumulation of feces and undigested food, the likelihood of squeezing blood vessels will decrease. They can also, if necessary, intubate the large or small intestine, bringing the tube to the anterior wall of the abdomen, which will allow feces to be excreted through it in the future.

Surgical intervention

Most patients are indicated for intestinal resection (the necrotic part), but even this does not always provide a chance of survival. The patient has the damaged part of the intestine removed and the healthy ones stitched together; if this is not possible, then a colostomy is performed.

Laparoscopy may help if necrosis has just begun. Then such a small operation will eliminate the resulting defect without performing a full-fledged operation, which will significantly reduce the risk of infection.

Forecast

The prognosis after surgery is not very comforting; even intestinal resection does not save half of the patients. If conservative methods help and there is a chance to restore the damaged areas, then the survival rate is greater.

But this is only at the early stage of the disease, and only a few seek help during this period.

For everyone else, the chance of recovery is less than 50%, of which another 30% may develop complications.

Prevention

It is impossible to prevent necrosis and protect yourself for life. It is important to monitor your diet and lifestyle, not to let any diseases develop and treat them in a timely manner, listen to doctors and follow all their instructions for the treatment of a particular pathology in order to prevent drug poisoning, exercise and monitor your weight.

These banal rules will not only reduce the risk of many diseases, but will also make you feel lighter and happier.

There can actually be many reasons for the development of gangrene. But it all comes down to one thing - the lack of blood supply in the affected organ, as a result, oxygen does not reach the tissue, and without oxygen, necrosis, or tissue death, occurs.

Diabetes mellitus is the most common cause of gangrene, and the lower extremities, namely the feet, are most often affected.
Atherosclerosis – in the obliterating form of the disease, an atherosclerotic plaque can completely block the lumen of blood vessels, preventing the flow of blood to the organ.
Obliterating endarteritis is an autoimmune vascular lesion that often develops in heavy smokers.
Blockage of blood vessels by a blood clot, and the blood clot can break off after surgery, bleeding, or childbirth.
Thrombophlebitis of the lower extremities.
Raynaud's disease is a syndrome of many diseases in which the innervation of blood vessels is disrupted (systemic lupus erythematosus, scleroderma, severe cervical osteochondrosis).
Myocardial infarction, ischemic stroke, pulmonary infarction and other diseases.

Impact of physical factors:

Mechanical tissue damage:

Injuries and wounds in which the integrity of blood vessels and nerves is disrupted - gunshot wounds, wounds from shell fragments, road accidents, and so on;
bedsores of bedridden patients;
state after an “unsuccessful” operation;
prolonged compression of an organ - being under rubble, in a car after an accident, prolonged application of a hemostatic tourniquet or tight plaster bandage, wearing narrow rings, shoes, pulling unusual objects onto the penis, strangulation of a hernia, and so on.

Infectious pathogens of gangrene:

Anaerobic gas gangrene - the causative agent is the anaerobic bacteria clostridium;
Purulent diseases caused by staphylococci and streptococci: lung abscess, purulent appendicitis, peritonitis, etc.;
protea;
meningococcal infection (meningococcemia);
coli;
tuberculosis (with caseous pneumonia, pleural empyema);
leprosy or leprosy, and others.

Infections can cause gangrene with or without other factors that impair blood circulation (diabetes, wounds, burns, severe intoxication, etc.). In the presence of diabetes mellitus, even slight paresis and wearing tight shoes can lead to tissue necrosis.

In addition, gangrene is caused by toxins:

Photo: wheat affected by ergot.

Classification

Types of gangrene depending on the affected organ

1. Gangrene of the lower extremities: legs, feet, fingers, nails - the most common type of gangrene.

2. Gangrene of the upper extremities: arms, hands, fingers, nails.

3. Gangrene of internal organs: intestines, lungs, gangrenous cholecystitis, gangrenous appendicitis.

4. Gangrene of the genital organs: scrotum (Fournier’s gangrene), penis, labia, perineum.

5. Fetal gangrene – intrauterine fetal death; in this case, the fetus can become mummified; occurs in multiple and ectopic pregnancies.

6. Gangrene in the facial area: noma - death of the soft tissues of the face, gangrene of the tooth, nose, ear.

7. Skin gangrene or bedsore – death of an area of skin without subcutaneous fat.

Dry and wet (putrefactive) gangrene

So the forms of gangrene are divided depending on the clinical course.

Types of gangrene depending on the cause of development

Ischemic gangrene;
infectious gangrene;
anaerobic gas gangrene;
toxic gangrene;
allergic gangrene;
hospital gangrene (developing in a hospital, for example, after surgery).

ICD-10

The ICD is a classification generally accepted throughout the world that allows you to encrypt the diagnosis. This is necessary for statistical calculations, documentation, concealment of the diagnosis at the request of the patient and understanding of the diagnosis by foreign doctors.

Gas gangrene – A 48.0;
Gangrene associated with atherosclerosis – I 17.2;
Gangrene in diabetes mellitus – E 10.5 – E 14.5;
Dry or wet gangrene of the extremities – R 02;
Intestinal gangrene – K 55.0;
Lung gangrene – J 85.0;
Tooth gangrene – K 04.1;
Gangrene in Raynaud's disease – I 73.0.

How does gangrene develop? (pathogenesis)

Stages of development of dry gangrene

1. Long-term circulatory disorders (vascular diseases, ischemia) - cells do not fully receive the necessary oxygen, fluid and nutrients, and accumulate metabolic products.

2. Tissue necrosis or tissue death in an area to which blood does not reach.

3. A protective reaction of the immune system, while immune cells limit dead tissue from healthy tissue, a clear inflammatory roller is formed.

4. Mummification stage. There is a loss of fluid and drying of dead tissue, the organ decreases in size, becomes black. Due to the small amount of fluid and the absence of pathogenic bacteria in the affected area, the processes of decay are inhibited, so a small amount of toxins is formed, which is not dangerous for the patient.

5. Progressive gangrene occurs over time, the body rejects dead tissue - amputation occurs.

6. When infection occurs at any stage, putrefactive processes, that is, wet gangrene, may develop.

1. Acute cessation of blood supply to the organ (trauma, blood clot, frostbite, etc.).

2. The rapid development of tissue necrosis, sometimes lightning fast, within a few hours.

3. Attachment of infection, development of an infectious inflammatory process.

4. Rapid decomposition of dead tissue (decay): swelling, pain, darkening, increase in the volume of the affected area.

5. Immune reaction - immunity cannot limit necrosis from healthy areas, infection spreads and a large amount of toxins enter the bloodstream.

6. Toxins of bacteria and destroyed tissues, getting into the blood, worsen the general condition and lead to disruption of the work of all organs and systems of the body. At this stage, in addition to toxins, bacteria can also enter the blood - sepsis (blood poisoning) develops. Sometimes only a few hours pass before the development of multiple organ failure (failure of vital internal organs), which threatens the patient’s life.

Firstly, blood does not flow to the affected area, and it is this that gives the pink color to our skin. Secondly, decay products accumulate in the tissues, including hemoglobin (a blood protein that carries oxygen and carbon dioxide). The iron contained in it binds with sulfur, which is released from the destroyed tissue of the skin, muscles, and nails. Iron sulfide salt has a black metallic color in the absence of oxygen.

Symptoms and signs, photos

First signs. How does gangrene begin?

The heat exchange of the skin is disrupted, it becomes cold to the touch;
the sensitivity of the skin is impaired, a feeling of numbness appears in the affected area;
weakness and fatigue appear;
movements and their coordination are impaired; if it concerns the lower extremities, lameness appears; if the upper limbs, then everything falls out of hand;
pain and burning appear in the affected areas.

Dry and wet gangrene initially have common symptoms, the only difference is in the timing of their development. Dry gangrene begins gradually, slowly, sometimes over months and years, and the development of wet gangrene occurs over hours or several days. Further treatment depends on the type of gangrene - dry or wet.

Symptoms of dry gangrene of the extremities

With the development of dry gangrene, the fingers, hands or feet first acquire a bright red color or, conversely, they become cyanotic;
then the skin becomes pale, an unhealthy shine, marbling appears, the skin gradually darkens, acquiring a bluish tint, and then completely blackens;
all skin changes during dry gangrene develop from the peripheral parts to the center, to the place of cessation of blood circulation;
a clear boundary is visible between the area of gangrene and the healthy area - the contrast between black and pink skin, and a compaction is also determined - a demarcation ridge or demarcation shaft;
the affected limb decreases in size and becomes deformed;
unlike wet gangrene, there is no putrid smell;
the pain stops and any sensitivity in the affected limb disappears;
there is also no pulse;
with injury and infection of the affected limbs, dry gangrene can become wet, but in most cases this occurs in the initial stages of the disease, when the affected limb has not yet completely dried out.

Photo: dry gangrene of the fingers of the right hand is the result of circulatory problems after a stroke. The distal phalanges of the fingers are reduced in size, dry, black in color, they have been mummified, and there is a clear boundary between gangrene and healthy tissue.

Symptoms of wet gangrene of the extremities

The skin becomes pale, a vascular network of dilated veins appears;
swelling of the affected area appears, due to which it increases in size;
there are no boundaries between the gangrenous and healthy areas, gangrene can spread to other areas;
brown blisters form (due to filling with blood), which quickly open, and in their place wounds form - trophic ulcers, which have a dirty gray color;
when pressing on the bubbles, a characteristic crunch is heard - this is an accumulation of hydrogen sulfide - a product of the breakdown of soft tissues and muscles;
fetid rot is released from the ulcer;
all these manifestations are accompanied by a violation of the general condition, which is associated with intoxication by the decay products of bacteria and necrosis of one’s own tissues.

Photo: wet gangrene of the right foot with “diabetic foot”. An atrophic ulcer with a dirty color is detected, there is cyanosis around it, the skin of the foot is glossy and turns black.

Features of pain with gangrene

With dry gangrene, the pain is at first tolerable, then its intensity intensifies, becoming strong, acute, and debilitating. They do not stop after taking conventional painkillers; they often require strong and even narcotic drugs, which also may not alleviate the torment. The pain is especially worse at night. The patient often takes a forced position, grasping and pinching the affected areas. The condition is alleviated by raising or lowering the limb; for some, it becomes easier while walking.

Temperature and intoxication

With dry gangrene, there are usually no symptoms of intoxication, the general condition of the patient is good or slightly impaired, weakness and fatigue are possible.

Symptoms of intoxication in a patient with wet gangrene:

increase in body temperature to high numbers, sometimes up to o C;
severe chills, tremors of extremities;
rapid heartbeat, more than 90 per minute;
blood pressure drop below 90/60 mm Hg. Art.;
severe weakness, the patient cannot get out of bed;
vomit;
possible confusion, delirium, convulsions;
with severe intoxication and the development of sepsis, other organs are also affected: the brain, kidneys, liver, heart, lungs, blood vessels, a blood clotting disorder occurs - bruises and hemorrhages appear, the patient may die from multiple organ failure (failure of vital organs).

Features of the course of some forms of gangrene

Anaerobic gas gangrene

The causative agent of gas gangrene is Clostridium bacteria.

width – 0.5 – 1.5 microns.

The beginning of the growth of hours, obtaining a culture - 5 days.

People;
rabbits, guinea pigs;
large and small livestock;
other mammals.

it is always wet gangrene;
the presence of large bubbles containing blood and gases formed during the life of clostridia;
when pressing on the skin, a special crunch is heard;
always severe intoxication;
very fast and progressive course.

Photo: gas gangrene of the left leg. The limb is dark in color, swollen, there are large blisters with brown contents and ulcers on the foot.

1. Emphysematous form– characterized by increased formation of gas-containing bubbles, sometimes their sizes reach more than 10 cm in diameter.

2. Edema-toxic form– swelling of the affected organ and intoxication predominate, blisters are small and isolated.

3. Mixed form– this is a combination of clostridia with a coccal infection (staphylococci, streptococci). This form is especially severe, characterized by rapid putrefactive processes and the spread of infection over large areas.

Fournier's gangrene

Fournier's gangrene is necrosis of the scrotal tissue; usually this form of gangrene occurs violently, lightning fast, and always threatens the patient's life.

pain, redness, swelling in the scrotum area;
increased pain syndrome;
the skin of the scrotum becomes black;
ulcers appear with purulent discharge;
severe intoxication.

The prognosis for Fournier's gangrene is unfavorable. In half of the cases, patients die without timely treatment.

Intestinal gangrene

Intestinal gangrene is also, in most cases, the result of circulatory disorders in the intestinal vessels (ischemia, thrombus, wounds and trauma). Gangrene can also occur during an infectious process, for example, with peritonitis, intestinal obstruction, purulent appendicitis, tuberculosis of the mesenteric lymph nodes, and so on.

sudden onset;
sharp, unbearable pain in the abdomen;
weakness;
blood pressure drops below 90/60 mm Hg. Art.;
increased heart rate above 90 per minute;
thready pulse;
possible disturbance of consciousness, up to its loss;
vomit;
diarrhea or constipation; stool may contain blood;
bloating;
when listening to intestinal peristalsis (motility), you can hear pulsation in the abdominal area;
after 2 hours, symptoms of intoxication intensify.

If intestinal necrosis occurs, surgery is urgently required; this threatens the patient’s life. A favorable prognosis is possible if surgical treatment is performed within 2 hours from the onset of the first symptoms.

Gangrenous cholecystitis

Gangrenous cholecystitis is necrosis of the gallbladder. The main cause of such gangrene is gallstones.

usually acute onset;
severe pain in the abdomen, which can radiate to the chest, under the shoulder blade, to the lumbar region, to the right shoulder, the pain intensifies when lying on the right side;
pronounced symptoms of intoxication: temperature above o C, severe weakness, headache, and so on;
nausea and vomiting not associated with food intake;
bloating;
On examination, sharp pain is observed in the area of the right hypochondrium.

Necrosis of the gallbladder must be differentiated from myocardial infarction, peritonitis, acute appendicitis, and even renal colic.

Gangrenous appendicitis

Gangrenous appendicitis is partial necrosis of the appendix (appendix). The main reason for such necrosis is acute appendicitis, which was not promptly recognized and operated on. In rare cases, the cause of gangrenous appendicitis is atherosclerosis.

usually gangrene of the appendix occurs 2-3 days after the onset of symptoms of acute appendicitis;
pain in the left iliac region, which is characteristic of acute appendicitis, subsides;
severe vomiting begins, which exhausts the patient; blood may be present in the vomit;
symptoms of intoxication are expressed (the patient’s serious condition, increased heart rate, decreased blood pressure), but the body temperature is normal, this is a characteristic syndrome for gangrenous appendicitis - “toxic scissors syndrome.”

If the cause of gangrene of the appendix is a circulatory disorder, then pain and intoxication come to the fore, and the body temperature will be high (above C).

Abscess and gangrene of the lung

Lung gangrene is a very serious disease that can result in the death of the patient from sepsis, shock, pulmonary hemorrhage, respiratory and heart failure.

pulmonary embolism (PE) – blockage of pulmonary vessels by a blood clot;
lung abscess - a purulent disease, a complication of bacterial pneumonia;
bronchiectasis;
penetrating gunshot or knife wounds into the chest cavity, fracture of ribs with displacement of fragments;
foreign bodies in the bronchi, including aspiration of vomit;
purulent pleurisy;
sepsis – infection through the blood or septic pneumonia;
pulmonary tuberculosis: caseous pneumonia, fibrous-cavernous tuberculosis, pleural empyema.

Photo: pathological material, lung gangrene.

the development of gangrene of the entire lung is possible, since necrosis very quickly spreads to healthy tissue, but there are cases of bilateral total gangrene, this condition is incompatible with the life of the patient;
sharp sharp pain on one side of the chest, aggravated by deep breathing and any movement, coughing, sneezing and even talking;
severe shortness of breath - difficulty inhaling and exhaling;
intense symptoms of intoxication, the patient’s condition is severe and extremely serious;
a painful cough with dirty, dark-colored sputum that has a foul, putrid odor;
possible hemoptysis or pulmonary hemorrhage;
the skin becomes sharply pale, bluishness of the skin of the face and limbs is observed;
symptoms of heart failure appear (low blood pressure, increased heart rate, swelling, and so on);
Infectious toxic shock may develop (drop in blood pressure, lack of urine, rashes and bruises).

Diagnostics

Usually, to diagnose gangrene of the extremities, an experienced doctor only needs to examine the patient. But still, to diagnose the type of gangrene, the reasons for its development, assess the general condition of the patient, the presence of complications and to determine the treatment method, additional types of research are required. It is more difficult to determine gangrene of internal organs, and laboratory and instrumental methods are indispensable, and sometimes a biopsy of the affected organ is required.

Laboratory research methods for gangrene

A significant increase in leukocytes (more than 9 g / l);
ESR acceleration (more than 20 mm/h);
increase in the level of stab neutrophils (more than 5%);
possible appearance of basophils (1-2%);
decrease in the number of lymphocytes (less than 27%);
increase in the level of platelets (more than 320 g / l).

Increased blood sugar levels in diabetes mellitus (more than 5.5 mmol / l);
increased cholesterol in atherosclerosis (above 8 mmol / l);
a significant increase in the level of AST (aspartate aminotransferase) - several times (especially in the initial stages of gangrene);
decreased albumin level (less than 20 g/l) and increased globulin level (over 36 g/l);
increased fibrinogen level (above 4 g/l);
high levels of C-reactive protein, sialic acids, and seromucoid are characteristic of wet gangrene.

Increased level of white blood cells;
the presence of erythrocytes and "dead" tissue in the sputum;
identifying bacteria, including tuberculosis, it is necessary to find out sensitivity to antibiotics.

Instrumental research methods for gangrene

Photo: gas gangrene of the left foot.

Photo: Plain X-ray of the chest cavity with gangrene of the right lung.

Photo: bronchoscopy for gangrene of the lungs.

Photo: CT arteriography for pulmonary embolism.

This study requires hospitalization of the patient, there are risks associated with the effects of contrast and radiation exposure. With a CT scan, the radiation dose is greater than with conventional radiography.

A safer method than angiography, as it is performed without x-rays and the introduction of a contrast agent. An ultrasound can examine the lumen of the vessel, its inner wall, and even the atherosclerotic plaque that has blocked the vessel. But this method is inferior in visualization to angiography.

Photo: laparoscopy for gangrenous appendicitis.

Complications and consequences of gangrene

Gangrene is a serious pathology that usually does not go away without a trace and has a high risk of developing complications that threaten the patient’s life.

If wet gangrene is not treated in a timely manner, necrosis quickly spreads to healthy tissue. So, if the foot is affected, after a few days gangrene may develop up to the level of the knee. This increases the risk of developing other, more severe complications, including sepsis.

Sepsis can occur with wet gangrene, when bacteria and their toxins enter the bloodstream en masse and spread throughout the body. This condition is life-threatening; the patient may die from toxic shock, cerebral edema, or septic endocarditis (heart damage).

high fever;
drop in blood pressure;
the appearance of rashes throughout the body in the form of bruises;
convulsions;
disturbance of heart rhythm and breathing;
confusion or loss of consciousness and other symptoms.

With the development of sepsis, powerful antibiotic therapy and detoxification are necessary, and the issue of removing organs affected by necrosis is also resolved.

With dry gangrene, the limb dries out (mummifies) and over time may “fall off” on its own. But more often surgical amputation occurs, which is carried out in order to save the patient’s life.

Dry gangrene, especially at the onset of the disease, can be complicated by the addition of bacterial flora. This is manifested by the presence of intoxication and the spread of gangrene to overlying tissues, that is, the boundary between dead and healthy tissues ceases to be defined.

This complication often develops with gangrene of the intestine, appendix and gallbladder. In this case, the infection from the affected organs passes to the serous membrane of the abdominal cavity. Without surgical treatment, this condition can lead to the death of the patient.

Treatment

Gangrene is always an indication for hospitalization in the surgical department of a hospital. Treatment of gangrene must be started urgently.

Treatment of dry gangrene

1. Pain relief, novocaine blockades.

3. Drugs that destroy blood clots: Streptokinase, Actilyse, Retavaza, Levostor, Aspirin, Heparin, etc.

5. Surgical treatment:

intravascular (endovascular) operations;
bypass surgery and stenting of blocked vessels;
amputation of dead tissue - affected limbs are routinely removed above the demarcation line from healthy tissue.

Treatment of wet gangrene

1. Antibacterial therapy.

2. Surgical treatment – removal of all “dead tissue”, amputation if necessary.

3. Detoxification therapy: intravenous infusion of various solutions.

5. Treatment of concomitant diseases: insulin therapy for diabetes, drugs that improve blood circulation, hormones, and so on.

Treatment of gas gangrene

1. Surgical treatment - removal of affected tissue or amputation, local surgical treatment of the wound, access to fresh air for the wound (it is not recommended to bandage the wound).

2. Hyperbaric oxygenation - placing the injured limb in a pressure chamber under high oxygen pressure. Oxygen is detrimental to clostridia, the causative agent of gas gangrene.

4. Antigangrenous serum - a drug containing antibodies to the main types of clostridia.

Treatment of gangrene of the lung, intestines, gangrenous cholecystitis and appendicitis

Treatment of gangrene of the lung:

Antibiotics intravenously and intramuscularly.
Introduction of antibiotics and antiseptics into the bronchi using a bronchoscope.
Detoxification therapy – intravenous drip administration of solutions.
Drugs that dilate the bronchi: inhalations of Salbutamol, Ventolin, Berodual, injections of Eufillin.
Drugs that enhance immunity.
Surgical treatment: removal of part or amputation of the entire lung when a lung abscess (ulcer) forms, freeing the pleural cavity from pus. Surgical treatment is resorted to only if there is no effect from drug therapy.

Treatment of intestinal gangrene:

urgent surgery to remove the affected area of the intestine;
antibiotics.

Treatment of gangrenous cholecystitis and appendicitis:

surgical removal of the affected organ;
antibiotics.

Use of antibiotics

Indications for antibiotic therapy are any wet gangrene.

Penicillins - but there is a high risk of infection resistant to this group of drugs. Benzylpenicillin is not used for intestinal gangrene.
III, IV and V generation cephalosporins: Ceftriaxone, Cefotaxime, Ceftazidime, Cefepime, Ceftaroline and others.
Lincosamides: Clindamycin (Dalacin) - drugs used when the infection is resistant to penicillins.
Aminoglycosides: Amikacin, Gentamicin.
Tetracyclines: Tetracycline, Doxycycline.
Levomycetin.
Metronidazole.

Once the results of bacterial culture and antibiotic sensitivity testing are obtained, therapy can be adjusted.

Use of painkillers

Painkillers are used for any type of gangrene, as patients suffer from unbearable pain. But, unfortunately, even narcotic drugs are not able to alleviate the patient’s suffering, as surgeons joke: “The best pain reliever is amputation.”

1. Narcotic drugs (Morphine, Tramadol, Omnopon) have a good short-term effect, but their use can develop drug addiction, especially with long-term use.

2. Non-narcotic painkillers (Analgin, Ibuprofen, Dexalgin) - have a very weak and short-term effect.

3. Novocaine blockades - the affected areas are injected with novocaine. This method not only reduces the intensity of pain, but also dilates blood vessels, improving their patency.

4. Epidural anesthesia - injection of anesthetics into the spinal canal. Suitable for gangrene of the lower extremities and scrotum.

5. Physiotherapy – neurostimulation of the spinal nerves.

Ointments for gangrene

In traditional medicine, ointments are rarely used to treat gangrene, since they may not only not help, but also cause harm.

Surgical operations for gangrene, main types

1. Endovascular (intravascular) operations: aimed at restoring the patency of a blood vessel:

Thrombolysis is the removal of a blood clot blocking a vessel.
Stenting is the installation of a special device - a stent - into the lumen of a narrowed vessel, which becomes a kind of frame for it, through which blood circulates unhindered.
Bypass surgery is the creation of an artificial vessel through which blood can circulate to bypass the blocked vessel.
Vascular prosthetics is the replacement of a non-functioning vessel with an artificial prosthesis or a transplanted vessel.

2. Necrectomy – excision and removal of “dead” tissue, can only be used for shallow necrosis of the skin and soft tissues. This operation allows you to save the limb, but increases the risk of complications.

Is it possible to cure limb gangrene without amputation?

Half of patients with gangrene undergo amputation of the affected organ. Amputation is not a whim of a surgeon, but an event aimed at saving a life; this is the last thing a doctor resorts to when nothing else helps. It can be avoided with timely consultation with a doctor, a good response to drug treatment, and the elimination of factors that worsen blood circulation in the affected organ.

How to cure gangrene at home? Traditional methods of treatment

Gangrene is not treated at home, as this disease threatens the patient’s life. Every hour counts, the more time of inactivity, the higher the level of amputation. There is no time to experiment with herbs and other traditional medicine.

Gangrene of the leg (diabetic foot): surgical treatment without amputation - video

Forecast

The prognosis for dry gangrene is relatively favorable, since such necrosis does not threaten the patient’s life. Although, if we consider the ability to work, then of course dry gangrene leads to the loss of a limb and disability. In addition, dry gangrene can develop over time on the second limb, in a symmetrical area.

How long do people live with gangrene?

Dry gangrene does not affect life expectancy and rarely causes the death of the patient. However, the patient may die from diseases that cause the development of gangrene, for example, from obliterating atherosclerosis, heart attack, stroke.

Prevention of gangrene

1. Proper nutrition, an active and healthy lifestyle - prevention of atherosclerosis and other vascular diseases.

2. Timely treatment of diseases that impair blood circulation, complete rehabilitation after strokes and heart attacks.

3. Prevention and adequate treatment of diabetes mellitus, timely initiation of insulin therapy.

4. Mandatory treatment of various wounds.

5. Avoiding burns and frostbite of the extremities.

Answers to frequently asked questions

Gangrene in diabetes mellitus. What are the features of sugar gangrene?

Diabetes mellitus is one of the main causes of gangrene. Most often, wet gangrene develops, since “sweet blood” is a good breeding ground for many bacteria. For the same reason, treatment of sugar gangrene is always difficult and in most cases leads to amputation of the limb.

wearing tight shoes;
frostbite – diabetics often do not feel the cold;
various injuries, including those received during pedicure;
foot and nail fungus and other factors of foot injury.

The first signs of gangrene in diabetes mellitus:

pallor of the limbs;
feeling of numbness;
swelling of the foot;
lameness;
the appearance of trophic ulcers;
darkening of the limb.

Treatment of gangrene in diabetes mellitus:

2. Wearing comfortable shoes.

4. Broad-spectrum antibiotics.

5. Drugs that improve blood circulation: Nicotinic acid, Trental and others.

6. Local treatment of trophic ulcers with antiseptics and antibacterial ointments (Streptocidal ointment, Levomekol, Vishnevsky ointment, aqueous solution of Chlorhexidine, Furacilin and others).

7. Surgical treatment:

Intravascular operations aimed at restoring blood flow (thrombolysis, stenting, bypass surgery).
If there is a threat to the patient's life and there is no effect of therapy, amputation of the foot above the level of the lesion is indicated.

Prevention of gangrene in diabetes mellitus:

The main prevention of diabetic foot is to control and maintain normal blood sugar levels. It is also important to pay attention to the condition of your limbs and promptly consult a doctor when the first signs of circulatory problems appear.

Is gangrene contagious and what are the modes of transmission?

Wet gangrene is always an infectious process. Therefore, the logical question would be: “Is this contagious?” In fact, gangrene cannot be contracted from a patient. For this to happen, the person in contact must have other conditions for the development of necrosis: a wound and poor circulation.

Does gangrene occur in children?

Unfortunately, gangrene also occurs in children, but less frequently than in adults. In most cases, this is gas gangrene, which can develop after injury or surgery. Gangrenous appendicitis and gangrene associated with meningococcal sepsis are also common.

Gangrene is a pathological process that is accompanied by necrosis of tissues of the human body, which is manifested by a typical change in the color of the affected areas from black to dark brown or bluish. The proposed definition is quite broad - it implies and describes gangrene, which can occur in any part of the body. One should take into account the fact that the causes of the pathological process can be different (tissue necrosis can be caused by both lack of blood circulation and inflammatory processes, traumatic or temperature damage), its manifestations are quite similar.

In most cases, this kind of change is called nothing more than a necrotic process, and not gangrene. These terms are almost identical with the only difference being that by gangrene we mean the late stages of pathology development.

Necrotizing syndrome is classified into coagulation and coliquation (synonyms are dry gangrene and wet gangrene). It should be noted that coagulation necrosis (“dry” process) is less unfavorable prognostically than coagulation necrosis, since it assumes somewhat slower tissue death and less rapid progression.

In the context of the pathology under consideration, two features of the course of this process should be noted:

Coagulation necrosis often turns into coliquation (as a rule, this occurs under the influence of anaerobic microorganisms);
As a consequence of the previous paragraph, it can be understood that it is coliquation necrosis that develops in the intestines (there is plenty of anaerobic microflora there), that is, wet gangrene, which poses a mortal danger to the patient’s life.

In terms of the reasons that lead to the development of intestinal gangrene, only one thing can be said - the vast majority of them are associated with ischemic processes. That is, trophic starvation is noted in its most banal meaning. Everything happens exactly the same as in any other organs. Impaired blood supply leads to insufficient supply of oxygen and essential nutrients, which in turn causes the development of metabolic disorders that lead to the necrotic process (cell death).

In addition to the fact that oxygen metabolism is disrupted, which actually deprives the cell of the energy necessary for existence, these changes lead to the massive proliferation of anaerobic microflora.

That is, if up to this point there was only tissue death, then after the addition of anaerobic activity, gas gangrene occurs, which manifests itself with much more pronounced symptoms.

Naturally, in the gastrointestinal tract all these processes are more pronounced. Everything becomes extremely clear - with the slightest disturbance in the blood supply and the beginning of cell death, the anaerobic flora (which is especially abundant in the large intestine) receives a signal for increased reproduction. And dead tissue will be an excellent nutrient substrate for these bacteria, which will further accelerate their spread.

Another, completely logical question arises - why does the above-mentioned disruption of blood supply occur, which leads to ischemia, which is the source of all troubles? Perhaps this is precisely the key to solving the problem and, knowing the answer to this question, it becomes possible to avoid the occurrence of a gangrenous process?

Yes, that's exactly how it is. It is the problem with intestinal trophism (and it is called ischemic intestinal disease, by analogy with the heart) that is the most common root cause of gangrenous intestinal lesions. The factors contributing to the development of this condition are the same as those that lead to angina pectoris - blockage of blood vessels (in this case, mesenteric ones) with blood clots or atherosclerotic plaques. Regarding intestinal ischemia, we can say with confidence that in this case, much more often it is the thrombus (arising due to increased blood clotting) that becomes the cause of occlusion, rather than atherosclerotic plaques. This is confirmed by statistical data - atherosclerotic heart disease occurs relatively latently (cholesterol deposits block the lumen of the vessel very slowly) and affects a much larger number of people than occlusion of intestinal vessels, which is much less common, but in the vast majority of cases leads to a necrotic process (a blood clot blocks the lumen of the vessel supplying the intestines is usually completely).

In principle, intestinal necrosis is an analogue of myocardial infarction. Only under the condition that the necrotic process, affecting the gastrointestinal tract, leads to the fact that the intestinal infarction turns into gangrene (due to the action of anaerobes), and the infarction of the muscular lining of the heart is sclerosed (that is, replaced by connective tissue, leaving behind only just a scar).

What other factors lead to the development of gangrenous process in the intestines?

Of course, in the overwhelming majority of cases, it is the disruption of the blood supply that is the etiological factor in the development of intestinal necrosis, which subsequently (over a completely clinically insignificant period of time) becomes gangrene. However, there are several other pathologies that become the root causes of gangrene affecting the gastrointestinal tract. This concerns the traumatic damage that fecal stones can cause in the event of mechanical obstruction. In addition, intestinal atony can lead to the development of static obstruction, which can also become the root cause of injury to the intestinal mucosa with subsequent infection.

How does the process itself proceed, and how does this affect the clinic?

Today, pathophysiologists distinguish two stages of development of ischemic intestinal disease (infarction, this definition is quite appropriate) turning into gangrenous lesions:

The initial stage, which (purely theoretically) is still reversible. That is, it means that the blood clot has just obstructed the mesenteric vessel and no irreversible changes have yet occurred in the tissues. This phase lasts no more than two hours. If during this time the patient undergoes surgery and restores blood circulation, then the occurrence of tissue death can be avoided. The problem is that very few patients with abdominal pain immediately turn to a surgeon, and what percentage of surgeons will be able to diagnose this process? The vast majority of patients will either stay at home and take painkillers, or they will end up in the surgical department, but they will be limited to an appendectomy and all medical care will end there.
Stage of irreversible changes. So, the patient did not receive proper medical care within two hours from the moment of occlusion and the pathological process progresses no matter what. It is impossible to stop gangrene of any organ (not just the intestines). Gangrene that develops in just a few hours leads to the breakdown of necrotic intestinal tissue, and this, in turn, is guaranteed peritonitis. Or sepsis.

Clinical signs by which gangrene can be identified

At the initial stage of development of the process, intestinal ischemia is characterized by the classic symptoms of an acute abdomen. Diffuse pain that will not have a clear localization (this is different from appendicitis - it is characterized by localization of pain in the right hypogastrium, which previously migrated from the upper abdomen). With further progression of pathological processes, an increase in pain will be noted (even if palpation is not performed), a characteristic shade of the skin will appear (gray-green color, it is explained by the breakdown of hemoglobin), vomiting will occur with copious amounts of blood, it will not will bring relief. In addition, symptoms of a generalized inflammatory process will be noted - a sharp increase in heart rate and a drop in blood pressure.

If treatment is started at the stage of decay of necrotic tissue, then infectious-toxic shock will already occur. This is primarily due to the fact that if gangrene already occurs, it completely engulfs the entire organ. It is because of this pathological feature that in this case the symptoms will be more pronounced than in any other diseases accompanied by the symptom of an acute abdomen.

Key points in diagnosing this disease

The only thing that a person far from medicine needs to know about this issue is that in any case it is necessary to get to the hospital as quickly as possible; in no case will you be able to cope with this pathology on your own. In addition, it should be remembered that in no case should you use non-steroidal anti-inflammatory drugs (ibuprofen, nimesil or paracetamol) or antispasmodics (no-shpu) for abdominal pain, because these drugs will only complicate the diagnosis diseases that actually became the primary source of the serious condition.

At the time of hospitalization, it is very important to clarify whether there were any other diseases associated with increased blood clotting. These include thrombophlebitis and varicose veins. This will help direct the diagnostic thought in the right direction, since even when performing laparoscopy, it can sometimes be quite difficult to determine the etiological factor that caused the symptoms described above.

After first aid has been provided to the patient, it will be appropriate to conduct some research and analysis. These include both general clinical ones (general blood and urine analysis, biochemical blood test - renal-liver complex and electrolytes), and some special ones - blood culture on a nutrient medium with determination of sensitivity to antibacterial drugs. Instrumental and functional tests - ultrasound examination of the abdominal organs, electrocardiogram, pulse oximetry (although the last two studies will need to be carried out by the person at the time of his admission to the hospital, since they reflect the functional state of the cardiovascular and respiratory systems).

Principles of treatment of gangrenous process in the intestines

Without a doubt, the only adequate treatment in this case is surgical intervention performed urgently. However, no one canceled the expediency of eliminating infectious agents and relieving intoxication syndrome. It is for these reasons that the following actions are necessary:

Massive antibacterial therapy even before the culture results are obtained is carried out using a combination of the most potent antibiotics, due to the fact that any necrotic (gangrenous) process is accompanied by a generalized inflammatory syndrome. Typically, a regimen consisting of vancomycin, amikacin, and tienam is used. These drugs are the only ones to date that cover all known pathogenic microorganisms. The importance of antibacterial therapy is also confirmed by the fact that with this pathology, death occurs precisely because of septic shock and dysfunction of the cardiovascular system. You should also take into account the fact that manifestations of toxic syndrome are observed even after removal of the affected area of the intestine;
Infusion therapy to detoxify the body. It is recommended to use colloidal and crystalloid solutions in a ratio of 1 to 3. Most often, saline solution, rheosorbilact and albumin 10% are administered. Thanks to this treatment, it is possible to increase the volume of circulating blood, thereby reducing the concentration of toxins. In addition, it is very important to maintain the content of vital micro and macroelements - potassium, calcium, magnesium, chlorine - at a physiological level. We must also not forget about maintaining the pH at a certain level;
Timely correction of the functions of the cardiovascular system will be very important. The patient is monitored by a special monitor (a machine that constantly shows oxygen levels, heart rate, breathing rate and pulse).

However, in this case, prevention of the occurrence of a necrotic process is no less important. This is especially important for those who have various types of disorders of the blood coagulation system (this is shown as test data - coagulograms). Clinical evidence of this feature of the body is thrombosis, thrombophlebitis and varicose veins. Prevention is carried out with the help of drugs that thin the blood - antiplatelet agents (flamogrel), anticoagulants (cardiomagnyl) and thrombolytics (streptokinase).

If a person does not have the desire to carry out prevention properly, he should look at photos of patients with gangrene. These photos can convince anyone of the need for systematic prevention.

conclusions

Gangrene is a dangerous disease, the etiological factor of which in the vast majority of cases is a violation of the blood supply to the intestine (occlusion of mesenteric vessels), but sometimes this pathology can be caused by trauma to the intestinal wall with subsequent infection.

If you have abdominal syndrome, it will be very important to seek medical help in time and not to take painkillers, which will only complicate the diagnosis of this disease.

The only treatment that will be acceptable in this case is urgent surgery, which will be combined with massive infusion and antibacterial therapy. Prevention will also be very important due to the fact that some people are predisposed to developing blood clots that obstruct the lumen of the blood vessels.

Intestinal infarction is a necrotic process caused by blockage of the arterial or venous trunks supplying the organ. Acute disruption of blood flow causes gangrene and rapid development of peritonitis, and lethality reaches 100%.

Thrombosis of mesenteric vessels (which is the main cause of intestinal infarctions) is a very dangerous phenomenon, the frequency of this pathology is inexorably growing. More than half of the patients are women, the average age of patients is about 70 years. Age plays a significant aggravating role, because radical operations in older people can be risky due to severe concomitant diseases.

An intestinal infarction develops similarly to a heart or brain infarction. Unlike the latter, one hears much less often about acute disruption of blood flow in the vessels of the mesentery. Meanwhile, despite the availability of modern diagnostic methods and the development of new treatment methods, Mortality from intestinal vascular thrombosis continues to remain high even with urgent surgery.

blood supply to the intestine – small (left) and large (right)

The severity of the pathology, the rapidity of development of irreversible changes, and the high probability of death require specialists to pay close attention to people at risk, and these are elderly patients with atherosclerosis, hypertension, and heart failure, who make up the majority among the population of many countries.

Causes and stages of intestinal infarction

Among the causes of intestinal infarction, the most important are:

with pathology of blood coagulation, tumors of the blood system (erythremia), heart failure, inflammation of the pancreas, tumors of internal organs and the intestine itself, injuries, abuse of hormonal drugs, atherosclerosis of the mouths of mesenteric vessels;
mesenteric arteries by blood clots that have entered it from other organs and vessels - in cardiac pathology (myocardial infarction, arrhythmias, rheumatic defects), aortic aneurysm, blood clotting pathology;
Non-occlusive Causes: heart rhythm disturbances, abdominal vasospasm, decreased blood flow due to blood loss, shock, and dehydration.

mechanism of typical mesothrombosis

Considering that intestinal necrosis more often affects the elderly population, most patients have a combination of several causes. Of no small importance for blood flow disturbances are those that cause damage to the arterial bed with a high risk.

In the development of intestinal infarction, several stages are distinguished, successively replacing one another:

Stage of acute intestinal ischemia, when occurring the changes are reversible, the clinic is nonspecific.
The stage of necrosis is destruction of the intestinal wall, irreversible, continues even after normalization of blood circulation, the main symptom is abdominal pain.
Peritonitis due to intestinal destruction, enzyme activation, and bacterial infection. It usually has a diffuse nature, general intoxication is pronounced.

Intestinal ischemia characterizes partial blockage of the lumens of blood vessels, their spasm, or the very initial stage of complete occlusion, when blood flow is not completely stopped. Dystrophic changes begin in the wall of the organ, swelling appears, and formed elements leave the vessels. Typically, ischemia is the initial stage of necrosis (infarction), that is, irreversible cell death in the area of cessation of blood flow.

Term "intestinal infarction" indicates a vascular factor as the root cause of necrosis, it can also be called intestinal gangrene, which means the death of cells in an organ that comes into contact with the external environment, and the intestines, although indirectly, are in contact with it. There are no other differences between these definitions; they mean the same disease. Surgeons use the term “mesenteric thrombosis” or “mesothrombosis,” which is also synonymous with infarction.

When the lumen of a vessel involved in the blood supply to the intestine is closed, the death of the organ elements with early infection progresses very quickly, because the intestine itself is populated by bacteria, and food coming from outside carries them within itself. The area of the intestine becomes swollen and red; with vein thrombosis, the phenomena of venous stagnation are clearly expressed. With gangrene, the wall of the organ is thinned, and the lumen is swollen and brown or dark brown in color. In the abdominal cavity with peritonitis, inflammatory fluid appears, the peritoneal vessels are full of blood.

Manifestations of intestinal necrosis

The disease usually begins suddenly, and the nonspecificity of clinical signs does not allow all patients to make an accurate diagnosis at the initial stage. If the blood flow in the intestinal arteries has already been disrupted for some time against the background of atherosclerosis and periodic spasms, then discomfort in the abdomen is a familiar sensation for the patient. If pain appears against this background, the patient will not always immediately seek help, even if the pain is quite intense.

Symptoms of intestinal ischemia begin with abdominal pain– intense, in the form of contractions, which by the end of the first period of the disease becomes constant and strong. If the small intestine is affected, the pain is localized mainly near the navel; with ischemia of the colon (ascending, transverse, descending) - on the right or left in the abdomen. Complaints of nausea, stool instability, and vomiting are possible. The examination data does not correspond to the clinic, and with severe pain, the abdomen remains relaxed and soft, palpation does not cause increased pain.

Symptoms of intestinal infarction appear after the first period, after about six hours from the moment blood circulation in the arteries or veins ceases. At the same time, the pain intensifies, and symptoms of intoxication appear. In acute thrombosis or embolism, signs of necrosis develop rapidly, starting with intense pain in the abdomen.

The progression of intestinal gangrene and the addition of inflammation of the peritoneum (peritonitis) leads to a sharp deterioration in the patient’s condition:

The skin is pale and dry, the tongue is covered with a white coating, dry;
Severe anxiety appears, possibly psychomotor agitation, which is then replaced by apathy and the patient’s indifference to what is happening (areactive peritonitis);
The pain weakens and may disappear completely, which is associated with total necrosis and death of nerve endings, and therefore this is considered an extremely unfavorable sign;
The abdomen is initially soft, then gradually swells as intestinal atony worsens and peristalsis ceases.

The Kadyan-Mondor symptom will be specific for intestinal gangrene: palpation of the abdomen reveals a cylindrical formation of dense consistency, painful, and difficult to displace. This is a fragment of the intestine with the mesentery, which has undergone edema.

A few hours after the onset of ischemia, fluid may appear in the abdomen (ascites); when inflammation occurs, they speak of ascites-peritonitis.

In case of a small intestinal infarction due to blockage of the superior mesenteric artery, vomiting mixed with blood and bile is among the symptoms. As it progresses, the contents of the stomach become fecal in nature.

Damage to the inferior mesenteric artery and gangrene of the thick section can manifest as blood in the stool, which is sometimes excreted copiously unchanged.

In the terminal stage of intestinal infarction, the patient's condition becomes critical. The pain weakens or stops completely, feces and gases do not pass away, intestinal obstruction develops, and severe intoxication is expressed, the patient is apathetic and indifferent, weak, does not show complaints not because of their absence, but due to the severity of the condition. Convulsions and coma are possible. Peritonitis begins 12-14 hours after the vessel is closed, death - within the first two days.

Even if you start treatment at the last stage of intestinal infarction, the effect is hardly possible. Irreversible changes in the abdominal cavity doom the patient to death.

Chronic intestinal ischemia may precede acute forms of damage. Its most common cause is atherosclerosis of the aorta, celiac trunk or mesenteric arteries, which provokes a lack of blood flow to the intestines.

Chronic intestinal ischemia is manifested by periodic cramping pain in the abdomen, which appears or intensifies after eating, which is why over time the patient begins to limit himself in nutrition and loses weight.

Impaired passage of contents through the intestines is accompanied by malabsorption, vitamin deficiency, and metabolic disorders. Patients complain of prolonged constipation, which is followed by diarrhea. Lack of blood flow causes a decrease in intestinal motor activity, stool stagnates - constipation occurs. Fermentation of feces provokes periodic diarrhea and bloating.

Low awareness of doctors in the field of identifying mesenteric thrombosis at the prehospital stage significantly affects the results of treatment, which is delayed due to the lack of a correct diagnosis. Another reason for late diagnosis may be the lack of technical capabilities in the hospital itself, because not everywhere there are conditions for urgent angiography, and not every hospital can even boast of having a working CT machine.

It is possible to suspect a bowel infarction by the presence of a compacted painful conglomerate in the abdomen, the presence of increased noises of peristalsis, and the detection by percussion of areas of swollen intestines by a characteristic sonorous sound. To confirm the diagnosis, ultrasound, X-ray, angiography, laparoscopy can be used.

Treatment

Treatment of intestinal infarction is only surgical; the chances of saving the patient's life depend on how quickly it is done. Its purpose is not only to remove the affected segment of the intestine, but also to eliminate the main pathogenetic link, that is, blockage of the vessel.

Necrosis of the intestinal wall develops rapidly, and the clinic does not allow an accurate diagnosis at the prehospital stage, and therefore the treatment is delayed. The first hours of the development of the disease, the patient needs fibrinolysis, which can help dissolve the blood clot that clogged the vessel, but during this period, most doctors try to establish an accurate diagnosis, and the patient is left without pathogenetic treatment.

Another obstacle to early surgical intervention is the long period of diagnosis already in the hospital, because sophisticated research methods, in particular, angiography, are needed to confirm thrombosis. When it becomes clear that a bowel infarction has occurred due to thrombosis, the patient will need an emergency operation, the outcome of which, due to a long delay, may become unfavorable.

Conservative therapy for intestinal necrosis should be started within the first 2-3 hours after thrombosis or embolism. It includes:

Infusion of colloid and crystalloid solutions in order to improve blood circulation in the intestine, compensate for the volume of circulating blood, detoxification;
Administration of antispasmodics for non-occlusive forms of pathology;
Application, administration every six hours under the control of coagulogram parameters.

Conservative treatment cannot be an independent method, it is indicated only in the absence of signs of peritonitis. The shorter the period of drug treatment and preparation for the upcoming operation, the higher the likelihood of a positive outcome of intestinal infarction.

Surgical treatment is considered the main way to save a patient’s life. Ideally, removal of the affected area of the intestine should be accompanied by surgery on the vessel (), otherwise the effect of non-radical treatment will not be positive. Without removing the obstruction to blood flow, it is impossible to ensure adequate intestinal perfusion, so isolated resections will not lead to stabilization of the patient's condition.

Surgery for intestinal infarction should consist of the stage of restoring vessel patency and removing necrotic intestinal loops. According to indications, the abdominal cavity is sanitized; in case of peritonitis, it is washed with physiological solutions and antiseptics. At the end of the operation, drains are installed to drain discharge from the abdomen.

restoration of patency of a thrombosed vessel, preceding removal of necrotic intestinal tissue

Depending on the volume of the lesion, either individual loops of the intestine or large sections of it can be removed, up to complete excision of the small intestine, the right or left halves of the large intestine. Such radical operations are difficult, lead to permanent disability, and the mortality rate reaches 50-100%.

It is advisable that surgical care be provided on the first day of the disease. After 24 hours, irreversible necrotic processes develop in the intestinal wall, peritonitis increases, which makes any treatment ineffective. Almost all patients who underwent surgery after the first day die despite intensive therapy.

If surgeons manage to save the life of a patient with intestinal infarction, then in the postoperative period significant difficulties arise associated with the consequences of the disease. Among the most likely complications are peritonitis, bleeding, which may occur before or immediately after surgery; in case of successful treatment, digestive difficulties, insufficient absorption of nutrients, weight loss with exhaustion.

To eliminate intoxication after the intervention, infusion therapy is continued, painkillers and antibiotics are administered to prevent infectious complications.

Nutrition of patients who have undergone radical treatment of intestinal gangrene is a difficult task. Most of them will never be able to eat regular food again; at best, it will be a diet excluding solid food; at worst, they will have to be prescribed parenteral (tube) nutrition for life. With an appropriate diet, parenteral nutrition is prescribed in parallel with the main one to compensate for the lack of nutrients.

The prognosis for intestinal necrosis is disappointing: more than half of patients die even with surgical treatment. If there is a delay in the operation, every patient dies.

Since diagnostic difficulties in the case of intestinal infarction are very difficult to overcome, and treatment is almost always ineffective, prevention of this most dangerous condition is necessary. It consists of following the principles of a healthy lifestyle, combating atherosclerosis, timely treatment of pathologies of internal organs, and constant monitoring of persons with cardiovascular pathologies that provoke thrombus formation and embolism.