In mesenteric infarction, an intestinal vessel is blocked by embolism or thrombosis, which can affect both intestinal and intestinal veins.
The intestine in the supply area of the affected vessel is no longer sufficiently supplied with blood, so that - without timely countermeasures - the tissue dies (infarction and necrosis). In arterial mesenteric infarction, 85% of the cases involve the superior mesenteric artery, which supplies large parts of the small intestine, large intestine, and pancreas.
The remaining 15% are approximately equal parts of the celiac trunk ("peritoneal trunk"), in the supply area next to the stomach, liver, spleen and pancreas of the duodenum, and the inferior mesenteric artery ("lower intestinal artery"), the descending Colon and upper rectum. A mesenteric infarction of the inferior mesenteric artery has a better prognosis.
The cause of a mesenteric infarction is either an embolism or a thrombosis. Embolisms typically occur in middle-aged patients.
Cardiac pre-existing conditions such as cardiac arrhythmias or artificial heart valves favor the formation of an embolus in the heart, which is first carried into the aorta and finally into the intestinal vessels. Thrombosis in the mesenteric arteries is more likely to develop in older patients due to arteriosclerosis.
By fat deposits, connective tissue proliferations and inflammatory processes, the vessel wall thickened until no sufficient blood flow is possible. Rarely, mesenteric vein thrombosis is responsible for mesenteric infarction. It is usually preceded by a thrombosis-promoting underlying disease, z. As a local inflammation, sepsis or a clotting disorder.
Mesenteric infarction is an extremely life-threatening condition. In general, the disease runs in three phases. In Phase I, suddenly, severe abdominal pain occurs, focusing particularly on the area around the navel. But there are no immune defenses and pressure pains. In addition to colicky abdominal discomfort, bloody diarrhea and symptoms of circulatory shock are common.
Due to a circulatory disturbance of the intestine by an embolism or a thrombosis, the intestinal sections affected by the occlusion die off. Your necrosis begins about two hours after the vascular occlusion by the undersupply of the appropriate intestinal sections. In the investigation of the abdomen, however, initially nothing is noticeable.
However, an increasing deterioration of the patient is observed. About six to eight hours after the start of the initial phase, the pain suddenly disappears and the patient seems to be doing better. Sometimes this so-called "deceptive peace" is accompanied by meteorism and flatulence. This apparent improvement in the symptoms is due to the decrease in intestinal peristalsis, which is also caused by the lack of supply of the intestine.
Stage II, with the apparent relief of the symptoms, is then replaced by phase III with irreparable necrosis of large intestinal sections. This leads to a [(intestinal paralysis]], which prevents a transfer of the intestinal contents, resulting in paralytic intestinal obstruction, breakthrough of the intestine with the formation of peritonitis and severe intoxication of the body.The lethality is up to 90 percent.
Mesenteric infarction is classically involved in 3 stages. The leading symptom in the initial stage is an acute abdomen: a sudden onset, severe, colicky abdominal pain.
Defense voltage is often initially absent. Unfortunately, the acute abdomen is a relatively nonspecific sign that can have many causes. Therefore, the emergency diagnosis is often not made fast enough. In addition, the pain subsides after a few hours by the drying up of the intestinal peristalsis and thus begins an apparent improvement.
This second phase is called "lazy peace". A blood gas test provides important information (metabolic acidosis, lactic acidosis). Increased white blood cell counts indicate inflammatory processes. Apparently, the mesenteric infarction can be represented by an X-ray overview of the abdomen, by sonography and / or CT angiography.
If the mesenteric infarction is not diagnosed in time, the condition of the patient deteriorates after about 12 hours by advanced intestinal necrosis massively. The end stage begins: The patient gets into a septic shock with intestinal obstruction (ileus) and peritonitis (peritonitis). Left untreated, mesenteric infarction is a safe death sentence.
Mesenteric infarction causes the death of the patient in the worst case. However, this complication usually only occurs if the mesenteric infarction is not treated. The sufferers suffer from very severe pain in the stomach and intestine, which leads to significant limitations in the quality of life.
Likewise, it is not uncommon for diarrhea and a tense stomach. The resilience of the patient decreases and it often comes to a fatigue. Not infrequently, mesenteric infarction also leads to a reduced appetite and thus also to deficiency symptoms. Due to the permanent pain many patients also suffer from depression and mental complaints or moods.
In mesenteric infarction, a direct operation is necessary to avoid consequential damage and the death of the person affected. This usually has to occur several hours after the onset of mesenteric infarction. In most cases, there are no complications, but dead parts of the intestine must be removed.
After the procedure, there is usually a large scar on the abdomen. Whether the life expectancy is reduced by the mesenteric infarction, can not be predicted in the rule.
If the person suffering from complaints in the abdominal region, there is a health impairment. If there is persistent or increasing abdominal and abdominal pain, a doctor should be consulted. In case of sudden severe symptoms, a doctor's visit is required as soon as possible. If it comes to a colic, should be alarmed by the person or persons present a rescue service. Since a mesenteric infarction can lead to a fatal disease progression in the worst-case scenario, immediate consultation with an emergency physician is required. The instructions of the emergency physician must be obeyed imperatively, so that the survival of the person concerned is ensured.
A repeated or increasing in intensity diarrhea should be clarified by a doctor. Disorders or irregularities of the abdominal muscles indicate an alarming irregularity. A doctor's visit is advisable, so that a diagnosis can be made. If a closure of the intestine sets in, the usual level of performance gradually falls further or if the person experiences a general malaise, he needs medical help. An inner restlessness, changes in body temperature and a general malaise are signs of an existing condition that should be treated. A breakdown of powers or inability to perform everyday obligations are symptoms that need to be discussed with a doctor.
Mesenteric infarction is an internal emergency and requires swift action. Intestinal necrosis can occur just 2 hours after the onset of infarction.
The affected intestinal tissue can only be rescued if an early operation makes the vessels through again. The operation requires a large abdominal incision and is referred to as laparatomy with (attempted) embolectomy. If the tissue is already irreversibly damaged, the dead intestinal components must be removed. Often, about 12 hours after successful initial surgery, a so-called second-look operation is performed to resect any further necroses.
The postoperative care must counteract sepsis and peritonitis as well as other thromboses. Especially because of the short time window for a promising therapy, a mesenteric infarction has an unfavorable prognosis. On average, the lethality of mesenteric infarction is 90%. Operated patients have a chance of survival of 50%.
In a large number of patients, the prognosis is unfavorable in the case of mesenteric infarction. It is a life-threatening condition in which the risk of premature death of the patient is significantly increased. The disease runs in three stages. In most cases, it is very late to a diagnosis and adequate medical care. This has a negative impact on the further course of the disease and thus the prognosis.
In addition, a large number of patients suffer from other pre-existing conditions. These usually relate to the cardiovascular area and thus cause an increase in the existing symptoms. If the person concerned refuses medical treatment, it inevitably leads to a critical condition and ultimately to the death of the person affected. Even with the use of a medical treatment extreme caution is required. Within a few hours irreversible damage and death may occur.
Patients who have received timely and comprehensive care have better prospects. If there are no other primary diseases, there are certainly chances of recovery despite the critical condition. Nevertheless, it should be noted that most patients in a mesenteric infarction suffer from various cardiovascular diseases. As a result, nearly half of those affected die prematurely even after successful surgery.
The prevention of mesenteric infarction on the one hand are measures that generally prevent atherosclerosis: abstinence from cigarettes, healthy diets with healthy fats and adequate exercise. On the other hand thrombosis prophylaxis with anticoagulants is important in high-risk patients, especially in older people with heart disease. Beyond prevention, it is crucial to consider the possible diagnosis of mesenteric infarction, especially in these high-risk patients, in order not to let any saving time pass.
As a rule, mesenteric infarction can not be controlled by various self-help treatments. In any case, it is necessary to consult a doctor to avoid complications or, at worst, death.
Especially in acute emergencies, the hospital should be visited directly or an emergency doctor should be called. This is the case when the person suffering from a strong tension of the abdomen or an intestinal obstruction. These complaints are accompanied by severe pain. The treatment of mesenteric infarction always takes place in a hospital through surgery and usually leads to success if the procedure is carried out early. Often a second procedure is necessary to avoid further necrosis.
A mesenteric infarction can be avoided by a healthy lifestyle. These include a healthy diet and sports activities. Likewise, the renunciation of alcohol and cigarettes also has a positive effect on the disease. At-risk patients should take part in regular examinations in order to avoid a mesenteric infarction. A successful treatment usually does not result in a reduced life expectancy of the patient.