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Non-occlusive mesenteric ischemia
Last reviewed: 23.04.2024
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The true frequency of non-occlusive mesenteric ischemia is not defined, since the process is reversible. Nevertheless, it is known that it is responsible for 50% of cases of intestinal infarction. One of the main causes of the development of non-occlusive mesenteric ischemia is cardiac insufficiency of various etiologies. According to observations of S. Rentom, 77% of patients with acute intestinal ischemia suffered from severe heart diseases. Almost half of them observed different types of arrhythmias. The role of arrhythmias in reducing cardiac output and the development of intestinal injuries is supported by other researchers who have experimentally proved that atrial fibrillation leads to a sharp decrease in mesenteric blood flow. Attention is also paid to digitalis preparations that have a selective vasoconstrictive effect on the mesenteric circulation. Another factor that plays a causal role in the occurrence of non-occlusive ischemia in some patients is called hemoconcentration, which develops after the introduction of fast acting diuretics.
Clinic. Clinical manifestations of non-occlusive failure of mesenteric circulation are similar to those observed in embolism or thrombosis of the upper brachial artery. However, it should be noted that the clinical symptoms are less severe with non-inclusive ischemia. Pain in the abdomen can be neostroy even in patients in critical condition. Therefore, the symptoms of increasing hypovolemia and unexplained metabolic acidosis should be considered as additional key signs of the development of non-occlusive ischemia.
Angiography with non-occlusive ischemia does not reveal pathology most often: mesenteric vessels of normal structure and patency are found.
Treatment is medicated if there are no peritoneal symptoms. Conduct infusions of dilators, which can give good results. The appearance of signs of irritation of the peritoneum suggests the development of intestinal infarction and requires surgical treatment. The prognosis for non-occlusive ischemia remains unfavorable because of the frequent combination of this lesion with severe cardiovascular disease.
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