Mesenteric infarction
| Classification according to ICD-10 | |
|---|---|
| K55.0 | Acute vascular diseases of the intestine |
| ICD-10 online (WHO version 2019) | |
A mesenteric infarction is usually an acute blockage of an intestinal vessel , which leads to infarction and necrotization of the corresponding section of the intestine. Both the embolization of an artery and the thrombosis of a vein can be responsible. A mesenteric vascular occlusion usually affects older people with cardiovascular stress.
In about 85% of the cases, the affected arteries are the superior mesenteric arteries , the remainder are divided equally between the celiac trunk and the inferior mesenteric artery . Occlusions of the inferior mesenteric artery are clinically milder and have a better prognosis because it has a much smaller coverage area.
Stages
Mesenteric infarction can be life-threatening and typically has three phases:
Initial stage: violent cramp-like abdominal pain , possibly hemorrhagic (bloody) diarrhea and shock symptoms, often without defensive tension and with no pressure pain. This stage is also marked by increasing patient decline. The pain occurs mainly in the area of the belly button . The necrosis of the affected section of the intestine begins as early as two hours after the closure, which is why urgent action is always required!
Latency stage: Deceptive relief of pain over several hours, decreasing intestinal peristalsis ("lazy peace")
Stage of irreparable intestinal necrosis: paralytic ileus , peritonitis and severe general intoxication up to death.
diagnosis
- acute abdomen as the patient deteriorates
- Leukocytosis> 20000 / µl
- metabolic acidosis, lactic acidosis (sensitive parameter)
- color-coded duplex sonography
- Abdominal survey x-ray may be indicated
In non-occlusive mesenteric ischemia (NOMI), the importance of which is increasingly recognized, a conservative, i.e. H. medication should be considered.
In occlusive mesenteric ischemia (OMI) , i.e. the occlusion of a vessel, vascular surgical intervention is indicated as an emergency in order to revascularize the intestine at risk of infarction by restoring the blood flow path. H. restore the supply of blood. Necrotic parts of the intestine must be resected .
The prognosis is poor with a mortality rate of 90%. This is mainly due to the fact that the diagnosis is usually made too late (difficult differential diagnosis ).
See also
literature
- Ernst Klar, Parwis B. Rahmanian, Arno Bücker, Karlheinz Hauenstein, Karl-Walter Jauch, Bernd Luther: Acute mesenteric ischemia - a vascular emergency . In: Deutsches Ärzteblatt . tape 109 , no. 14 , April 6, 2012, p. 249–256 , doi : 10.3238 / arztebl.2012.0249 .
