Thrombosis of the upper mesenteric artery
Last reviewed: 22.11.2021
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The most common cause of thrombosis of the upper mesenteric artery is widespread atherosclerosis.
Symptoms of thrombosis of the upper mesenteric artery are basically similar to the embolism clinic, but thrombosis differs in that the abdominal pain is less intense, does not have a cramping character. Mesenteric thrombosis can be latent for a certain time. However, in the future, as the intestinal ischemia increases, clinical symptoms also increase, bowel infarction and peritonitis clinic develop, intestinal noises disappear.
Unlike the clinical picture of embolic occlusion of the upper brachial artery, early manifestations of thrombotic occlusion are minor: the pain syndrome is moderately expressed and has an intermittent character. With the development of a bowel infarction, the symptomatology becomes similar to that observed in embolism of the upper brachial artery. It is noteworthy that in the history of patients with thrombosis there are almost always indications of cardiovascular diseases with circulatory insufficiency.
Diagnosis of mesenteric thrombosis is complicated by the fact that it is latent for a long time. Therefore, anamnestic data indicating intermittent claudication, abdominal pain after eating, and symptoms of cerebrovascular insufficiency should be given great importance. The indicated anamnestic information in combination with the results of physical examination (palpation of the pulse on the peripheral arteries) allow us to reveal the signs of widespread atherosclerosis and suggest the possible occlusion of the upper brigeire artery. It should be especially emphasized the significance of the revealed combination of symptoms of widespread atherosclerosis with abdominal pain, which, according to JE Dunphy, may be a harbinger of a fatal vascular occlusion.
Angiography is performed with both a diagnostic purpose and a choice of surgical access.
In specialized institutions, sometimes treatment is started with thrombolytic therapy and dilatation with a balloon catheter. However, these methods are permissible only in the initial period of the disease and, in addition, are fraught with complications (bleeding, distal embolization). The only effective method is reconstructive surgery on vessels for the purpose of revascularization and (if necessary) gut resection.