Embolism of the superior mesenteric (mesenteric) artery

The upper mesenteric artery supplies the entire small intestine, the blind, ascending and partially transverse colon.

The sources of embolization of the upper brachial artery are different. In 90-95% - these are thrombi in the left atrium, as well as thrombi on prosthetic or pathologically affected mitral or aortic valves, particles of migrating atheromatous plaques.

The main clinical signs of embolism of the upper mesenteric artery:

• sudden acute pain in the navel or right upper quadrant of the abdomen;
• cold sticky sweat;
• vomiting;
• diarrhea (appears unintentionally, sometimes in a few hours);
• intestinal bleeding (discharge from the anus of blood or mucus stained with blood) - is a sign of a mucosal infarction of the intestine; appears after a few hours;
• pronounced bloating, slight soreness of the abdominal wall during palpation;
• the appearance of symptoms of irritation of the peritoneum with the progression of the pathological process (pronounced abdominal wall tension), which indicates the necrosis of all layers of the intestinal wall and the development of peritonitis; during this period, intestinal noises disappear;
• the presence of vascular noise in the epigastrium;
• drop in blood pressure, tachycardia;
• increased body temperature;
• pronounced leukocytosis;
• increased pneumatization of intestinal loops on a survey radiograph of the abdominal cavity;
• occlusion of the upper mesenteric artery, revealed by percutaneous ileal retrograde angiography. There is no consensus on the need for its implementation, however, many surgeons consider this diagnostic procedure necessary.

Laboratory tests reveal leukocytosis, usually more than 20x10 ⁹ / l, with necrosis of the intestine - metabolic acidosis.

With the radiographic examination of the abdominal cavity organs, it is sometimes possible to detect air-filled loops of intestines with thinned walls, which makes it possible to suspect ischemia. However, according to most researchers, the survey radiograph of the abdominal cavity does not have diagnostic significance. To confirm mesenteric ischemia in patients with suspected it is recommended to carry out percutaneous hip retrograde arteriography. This study is regarded as the first stage of diagnosis. It can be performed without danger to the patient in those cases when there are no signs of peritonitis, hemodynamic parameters are stable, normal kidney function is preserved, and the patient does not have an allergy to iodine-containing contrast agents. There are also opponents of angiography. Their objections are as follows. First, in their opinion, people over 45 years of age may experience occlusion of visceral arteries of varying severity, which does not cause them any noticeable disorders. Therefore, angiographic signs of mesenteric obstruction, found in patients, will not help in finding out when this occlusion occurred and whether it is the cause of this symptomatology. Secondly, the absence of hagiographic data on the obstruction of the vessels for the surgeon is not of decisive diagnostic significance and, in the presence of symptoms, peritonitis can not and should not keep him from laparotomy. As for the majority of experienced surgeons, according to A.Marston (1989), they agree that angiographic findings are far from always specific and, in case of doubt, it is safer to operate the patient. Nevertheless, they prefer to have angiographic data, starting surgery for suspected occlusion of the superior mesenteric artery.

Treatment of embolism of the upper brachial artery is surgical. An emergency operation is performed - embobectomy and resection of the necrotic bowel site. Rapid diagnosis and timely treatment contribute to better results, but overall, the high incidence of deaths persists. Repeated embolization is observed in 10-15% of cases.

[1], [2], [3], [4], [5], [6]