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Mesothrombosis, or thrombosis of the mesenteric vessels, is the process of blockage of the vessels of the mesentery (mesenterium). As a result of the formation of a thrombus, blood circulation in the vessels of the mesenteric film that covers the abdominal organs worsens. Due to impaired blood supply in the affected areas, irreversible changes and necrosis of these sections of the mesentery occur. With thrombosis of the mesenteric vessels, immediate removal of the blood clot is required.
Most often, mesenteric thrombosis is localized in the superior mesenteric artery, less often in the mesenteric veins and in the inferior mesenteric artery. The defeat of the arteries of the mesentery occurs more often than the defeat of the veins. A mixed form of mesenteric thrombosis occurs in advanced cases.
Code IKB-10: K55.0, included in the interval “acute vascular bowel disease”. Most often it occurs in elderly patients, in women a little more often than in men. In rare cases, mesenteric thrombosis is diagnosed in newborns with congenital intestinal pathologies and in persons younger than 40 years of age.
The mesentery fixes the intestinal loops in a “suspended” state. Veins, inferior and superior mesenteric arteries pass between its leaves.
The distribution of blood supply between the vessels of the mesentery:
Superior mesenteric artery (90% provides blood supply to the gastrointestinal tract) – feeds the small intestine, blind, ascending, 70% of the transverse colon;
Inferior mesenteric artery – feeds 30% of the transverse colon, rectum, sigmoid, descending colon;
Collateral vessels (anastomoses) – pump blood from the superior mesenteric to the inferior mesenteric artery; with thrombosis of the superior artery, intestinal collaterals are unable to provide blood supply to the mesenterium.
Venous outflow of blood from the intestine occurs through the portal vein. As a result of blockage of the vessel by a thrombus, an acute violation of the blood supply to the intestine, ischemia of its walls develops. Further development of the process leads to irreversible tissue destruction, hemorrhagic necrosis of the intestinal walls. Pathology is distinguished by a severe course, a high probability of death.
Pathways for blood clots to enter the mesentery
Movement of a blood clot through the arterial system:
From the heart – when separated from the wall of the aortic aneurysm resulting from a heart attack;
From the thoracic or abdominal aorta – with vessel dissection;
Detachment of an atherosclerotic plaque;
Directly from the mesenteric artery – as a result of its damage as a result of trauma (for example, when hit in the stomach).
Formation of a blood clot in the venous system:
Inflammatory bowel pathologies affecting the veins (thrombophlebitis);
Decrease in blood pressure against the background of deterioration in the activity of the heart muscle;
Portal hypertension as a complication of hepatitis;
Blood stasis in portal vein thrombosis;
Diseases and conditions that increase blood viscosity – the consequences of splenectomy, long-term use of hormonal oral contraceptives, pathologies of the hematopoietic organs.
With a heart disease characterized by communication of its chambers, a thrombus can enter the mesenteric arteries from the vessels of the leg through the vena cava, right atrium, left ventricle, and abdominal aorta.
Classification of mesenteric thrombosis
Depending on the localization and prevalence of the lesion, the following forms of mesenteric thrombosis are distinguished:
Compensation – the functionality of the intestine is fully restored;
subcompensation – as a result of incompletely restored blood flow, such intestinal pathologies as colitis, enteritis, abdominal toad develop;
Decompensation – leads to the development of purulent peritonitis and abdominal sepsis.
Symptoms of thrombosis of mesenteric vessels
Before the onset of acute symptoms of thrombosis, precursors such as abdominal toads or chronic occlusion of the mesenteric vessels may appear. Her symptoms are diarrhea, abdominal pain after eating, marked weight loss.
The very first symptoms (up to 12 hours)
Symptoms of acute thrombosis in the first 6-12 hours:
Sudden debut, acute cramping pains in the abdomen;
The general anxiety of the patient, he is in a forced position with his legs pressed to his stomach;
Nausea, vomiting with blood, with bile, with the smell of feces;
Frequent loose stools with blood;
skin cyanosis;
Pancake symptom – increase in blood pressure by 60-80 mm Hg. St;
Slow heart rate.
At the beginning of the pathology, there are no symptoms of peritoneal irritation, the abdomen remains soft and almost painless.
Symptoms in the stage of infarction (after 12 hours)
Symptoms of thrombosis in the stage of infarction (after 6-12 hours):
Deterioration of the general condition;
Reducing the intensity of the pain syndrome;
Increased pain on palpation of the affected area;
Mondor’s symptom – the appearance of swelling of a test-like consistency between the pubis and the navel;
Rapid pulse;
Preservation of the excretory function of the intestine.
Symptoms in the stage of peritonitis (after 18-36 hours)
Symptoms of thrombosis of the mesentery in the stage of peritonitis (after 18-36 hours):
Pronounced deterioration;
Signs of intoxication;
Symptoms of peritonitis;
Severe pain on movement
Intestinal paralysis, obstruction.
It is important to distinguish mesenteric thrombosis from acute pancreatitis, perforated duodenal ulcer, intestinal obstruction, acute appendicitis. The main difference between thrombosis is that there is no pain during palpation of the abdomen in the projection of the pancreas, there is loose stool, and vomiting has a shade of coffee grounds.
Diagnostics
When diagnosing a pathology, the doctor examines the patient’s history, the presence of heart and vascular diseases, analyzes the clinical symptoms, the presence of an acute pain symptom.
Laboratory and instrumental diagnostic methods:
Blood test for coagulogram;
Blood test for cholesterol;
Determining the number of platelets;
X-ray of the abdominal cavity;
Selective mesentricography, which determines the presence or absence of blood flow in the arteries of the mesentery;
Magnetic resonance imaging of the vessels of the mesentery;
Diagnostic laparoscopy to detect signs of intestinal infarction, changes in the abdominal cavity.
Treatment of thrombosis of mesenteric vessels
The only possible method of eliminating mesenteric thrombosis is emergency surgery.
Purpose of surgery:
Assessment of intestinal viability;
Restoration of blood flow;
Removal of areas of intestinal necrosis;
Revision of mesenteric vessels;
Prevention of sepsis and peritonitis.
There are several methods of surgical elimination of mesenteric thrombosis. The surgeon reconstructs the main vessels, restoring their blood supply. In the area of intestinal stenosis, conditions are created for shunting. In case of necrosis, resection of the gangrenous area is performed, then blood supply is restored, measures are taken to prevent intestinal paresis. After 1-2 days, a second laparotomy is performed for a second revision of the abdominal cavity.
Postoperative measures:
The introduction of antithrombotic drugs to prevent the recurrence of a blood clot;
Restoration of general blood circulation;
Treatment of the consequences of intoxication;
Stabilization of the functioning of the heart muscle;
Stimulation of tissue metabolism;
Sanitation of the abdominal cavity;
Antibacterial therapy for the prevention of sepsis and peritonitis.
Development Forecast
If the patient is helped in the first 4-6 hours after the violation of blood flow in the vessels of the mesentery, it is possible to fully restore the functioning of the intestine and prevent its infarction. When assistance is provided at later stages, the number of irreversible changes increases, mortality increases to 90%. The presence in the anamnesis of the underlying disease, the advanced age of the patient worsens the prognosis.
To prevent the development of thrombosis of the mesenteric vessels, it is necessary to promptly treat the underlying disease that becomes the source of blood clots – aneurysms, rheumatic heart disease, atherosclerosis.