Ischemic bowel disease

Ischemic disease of the intestine (abdominal ischemic disease) - acute or chronic insufficiency of blood supply in the basins of the celiac, upper or lower mesenteric (mesenteric) arteries, leading to insufficient blood flow in certain areas or in all parts of the intestine.

Causes and pathogenesis

The main causes of ischemic bowel disease are:

• Atherosclerosis, localized in the mouths of the corresponding arteries (the most common cause);
• systemic vasculitis (nonspecific aortoarteriog, obliterating thrombangiitis of Burger, nodular panarteritis, etc.);
• systemic connective tissue diseases;
• fibro-muscular dysplasia;

Causes and pathogenesis of ischemic bowel disease

Acute mesenteric ischemia

According to available statistical data, acute intestinal ischemia leads to a catastrophe in the abdominal cavity with high mortality, and at present only small progress is achieved compared with 30 years, when the lethality was 70-100%. In specialized institutions targeting this problem, mortality from ischemia can be reduced by 20-30% compared to the national average level due to early diagnosis using selective angiography and subsequent timely treatment with vasodilators, embollectomy, thrombectomy, reconstruction of the arteries and resection guts.

Acute mesenteric ischemia 

Embolism of the upper mesenteric (brachial) 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.

Embolism of the upper mesenteric (brachial) artery 

Thrombosis of the upper mesenteric artery

The most common cause is widespread atherosclerosis.

The clinical picture of thrombosis of the upper mesenteric artery is basically similar to the embolism clinic described above, however, thrombosis differs in that the abdominal pain is less intense, does not have a cramping character.

Thrombosis of the upper mesenteric artery 

Non-occlusive mesenteric ischemia

Its true frequency 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.

Non-occlusive mesenteric ischemia

Mesenteric vein thrombosis

Thrombosis of the mesenteric veins can lead to acute bowel ischemia. The clinical picture is characterized by the following manifestations:

• blurred and fuzzy localized abdominal pain;
• bloating;
• diarrhea;

Mesenteric vein thrombosis

Chronic mesenteric ischemia ("abdominal angina")

Slowly progressing for a long time, the obstruction of the visceral arteries can lead to the development of collateral circulation, not to be accompanied by pronounced disorders and not to be manifested by a clear symptomatology. This is confirmed by the data of pathologists.

Chronic mesenteric ischemia

Ischemic colitis

Ischemic colitis is a chronic inflammation of the large intestine caused by its ischemia.

The blood supply of the large intestine is provided by the upper and lower mesenteric arteries. The upper mesenteric artery blood supply to the entire thin, blind, ascending and partially transverse colon; the lower mesenteric artery is the left half of the large intestine.

Ischemic colitis 

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