Embolism of the superior mesenteric (mesenteric) artery

The superior mesenteric artery supplies the entire small intestine, the cecum, ascending colon, and part of the transverse colon.

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

The main clinical signs of superior mesenteric artery embolism are:

• sudden sharp pain in the navel area or right upper quadrant of the abdomen;
• cold sticky sweat;
• vomit;
• diarrhea (does not appear immediately, sometimes after several hours);
• intestinal bleeding (discharge of blood or blood-stained mucus from the anus) is a sign of infarction of the intestinal mucosa; appears after several hours;
• pronounced abdominal distension, slight pain in the abdominal wall upon palpation;
• the appearance of symptoms of peritoneal irritation during the progression of the pathological process (pronounced tension of the abdominal wall), which indicates necrosis of all layers of the intestinal wall and the development of peritonitis; during this period, intestinal noises disappear;
• presence of vascular noise in the epigastrium;
• drop in blood pressure, tachycardia;
• increase in body temperature;
• pronounced leukocytosis;
• increased pneumatization of intestinal loops on plain radiograph of the abdominal cavity;
• occlusion of the superior mesenteric artery, detected by percutaneous transfemoral retrograde angiography. There is no consensus on the need for its implementation, however, many surgeons consider this diagnostic procedure necessary.

Laboratory studies reveal leukocytosis, usually over 20x10 ⁹ /l; in case of intestinal necrosis, metabolic acidosis.

When examining abdominal organs with X-rays, it is sometimes possible to detect air-filled intestinal loops with thinned walls, which allows one to suspect ischemia. However, according to most researchers, a plain abdominal X-ray has no diagnostic value. To confirm mesenteric ischemia in patients with suspected cases, it is recommended to perform percutaneous transfemoral retrograde arteriography. This study is considered to be the first stage of diagnostics. It can be performed safely for the patient in cases where there are no signs of peritonitis, hemodynamic parameters are stable, normal renal function is preserved, and the patient is not allergic to iodine-containing contrast agents. There are also opponents of angiography. Their objections are as follows. Firstly, in their opinion, people over 45 years of age may have occlusion of visceral arteries of varying degrees of severity, which does not cause them any noticeable disorders. Therefore, angiographic signs of mesenteric artery occlusion detected in patients will not help in determining when this occlusion arose and whether it is the cause of the symptoms indicated. Secondly, the absence of angiographic data on vascular occlusion is not of decisive diagnostic importance for the surgeon and, in the presence of peritonitis symptoms, cannot and should not deter him from laparotomy. As for the majority of experienced surgeons, they, according to A. Marston (1989), agree that angiographic findings are far from always specific and, if in doubt, it is safer to operate on the patient. Nevertheless, they prefer to have angiographic data when starting an operation for suspected occlusion of the superior mesenteric artery.

Treatment of embolism of the superior mesenteric artery is surgical. An emergency operation is performed - embolectomy and resection of the necrotic section of the intestine. Rapid diagnosis and timely treatment contribute to improved results, but in general, the high rate of fatal outcomes remains. Repeated embolization is observed in 10-15% of cases.

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