Intestinal infarction: symptoms and therapy

The intestinal infarction is the death of a section of the intestine (necrosis) and is caused by a drop in blood supply

This disorder occurs when the intestine no longer receives an adequate amount of blood.

Ischemia can affect the small intestine, the large intestine, or both.

It is a very serious condition that can cause:

1. Severe pain,
2. Loss of bowel function.

The massive intestinal infarction is very severe and leads to death within a few days (on average within 24 hours).

The intestinal infarction can be of the following nature:

1. Embolic, if caused by an embolus, probably in patients with heart disease such as arrhythmias,
2. Thrombotic (is the most common form), if it is caused by a thrombus that closes a blood vessel,
3. Non-obstructive: during hemorrhagic shock, there may be a different distribution of the amount of circulating blood. In order to bring blood to the brain and heart, the splanchnic vessels are sacrificed and thus the cells do not receive enough oxygen and nutrients. If ischemia is not occlusive, some ischemic and other healthy sections alternately form in the intestine.

Older people (over 50 years of age) have a greater risk of developing these symptoms than others.

As a rule, this disease is very rare in the population.

Children

Intestinal infarction mainly affects the elderly, but newborns can suffer from necrotizing enterocolitis, usually premature babies.

Pathological anatomy

There are basically three blood vessels that can transport blood to the abdominal region and cause an arterial intestinal infarction:

1. Coeliac artery,
2. superior mesenteric artery,
3. Inferior mesenteric artery.

In the superior mesenteric artery is the equestrian segment from which the arteries originate:

1. Colica,
2. Ileocoelica,
3. Colica media.

A closure of the rider segment can trigger an infarction of the entire intestine.

Venous ischemia

A blood coagel can develop in a vein that carries blood out of the intestine.

If the vein is blocked, the blood returns to the intestine, causing swelling and bleeding.

This disorder is characterized by:

1. blood stasis,
2. Hypoxia
3. changes in intestinal microcirculation,
4. Dilated and blood-filled intestinal loops.

In general, one speaks of an infarction in the blockage of an artery. But in this case, this also applies to a venous narrowing, because in both cases it comes to:

1. Hypoxia
2. Damage to the endothelium (inner wall) of blood vessels.

Causes can be:

1. pressure from tumors or lymph nodes,
2. Pancreatitis
3. abdominal infection,
4. Intestinal disorders such as Crohn’s disease, ulcerative colitis and diverticulitis.
5. diseases that lead to increased coagulability of the blood,
6. Trauma
7. High amounts of estrogen.

The symptoms are the same as with an infarction or ischemia emanating from an artery.

Causes of intestinal infarction

The occlusion of an artery can be caused by:

1. Atherosclerosis
2. blood clotus (which can form in the heart in the case of atrial fibrillation),
3. Aneurysms in the blood vessels.

The occlusion of the vein can cause this disorder in:

1. Portal hypertension (the portal vein transports blood from the stomach and intestines to the liver). The vein arises from the union of the superior mesenteric vein and the splenic vein (into which the inferior mesenteric vein flows).
2. Deep vein thrombosis. This is more likely in case of increased coagulability of the blood or in case of inflammation.
3. Sepsis
4. Trauma
5. Surgical intervention.

Causes of non-occlusive intestinal ischemia:

1. Hypotension (low blood pressure), a prolonged low blood pressure caused by heart surgery, can lead to ischemia of the intestine and, in certain cases, intestinal infarction.
2. spasm (contraction) of the arteries leading to the intestine,
3. colon tumor, which narrows the blood vessels and can cause a circulatory disorder,
4. Heart failure
5. shock and bleeding – they lead to a reduction in circulating blood volume and arterial blood pressure,
6. Side effect of medications (vasoconstrictors, vasodilators and contraceptives) and some drugs.

Risk factors include:

1. Smoke
2. Overweight
3. Severely low blood pressure.

Signs and symptoms of intestinal infarction

The symptoms are of two types:

1. Acute symptoms of infarction that occur suddenly,
2. Chronic ischemia symptoms that develop over time.

Acute symptoms

1. Sudden severe abdominal pain, especially in a certain area of the abdomen. The pain can be triggered by a chemical stimulus (ischemia and changes in pH) or mechanical (intestinal expansion upstream of the artery or vein occlusion).
2. Nausea
3. Vomit
4. blood in the stool,
5. bloated abdomen,
6. Urgent bowel movements,
7. Fever.

With thrombosis or embolism, symptoms develop as follows:

1. Initially, the person has severe pain, similar to colitis. The pain is not localized, it is felt everywhere in the abdomen.
2. After a few hours, the pain concentrates in the navel area or on one side. This phase lasts 4 to 6 hours. The intensity of pain decreases, but other symptoms worsen: accelerated heart rate, decreased blood pressure, rapid breathing.
3. At the end of the second stage, intestinal necrosis occurs with peritonitis and shock.

Chronic symptoms

1. abdominal pain after eating,
2. nausea and vomiting,
3. diarrhea or constipation,
4. weight loss, as the person in question does not eat anything to avoid the pain,
5. Bloated abdomen.

Complications of intestinal infarction

The consequences or complications of intestinal infarction are:

1. Death of intestinal tissue
2. If blood circulation is completely and suddenly interrupted, the intestinal tissue may die (gangrene).
3. Perforation
4. A tear may occur in the intestinal wall. The consequence is that intestinal contents leak into the abdominal cavity and cause a serious infection (peritonitis).
5. Fibrosis or colon narrowing
6. During the healing process of ischemia, fibrous scar tissue is formed, which narrows and blocks the intestine.
7. Death

Diagnosis and examination of intestinal infarction

Depending on the signs and symptoms, the doctor may order the following examinations:

1. Angiography with CT or magnetic resonance imaging to create detailed images of blood flow to the small intestine and to look for arterial occlusions.
2. Sometimes the doctor can treat blocked arteries during angiography, in case of insufficiency of the coeliaca or mesenteric artery, the doctor may insert a stent through the catheters before an intestinal infarction occurs.
3. In this way, blood circulation can be restored, for example in the case of a disease affecting the coeliac artery.
4. Arteriography consists of a X-ray of blood vessels.
5. The echo Doppler shows whether the occlusion is venous or arterial.
6. 4) If the patient does not experience any improvement from the medications, the doctor recommends a laparoscopic examination to identify and remove the damaged tissue.
7. Exploratory surgery enables diagnosis and therapy.

The blood tests in the laboratory show:

1. leukocytosis (elevated white blood cells) with neutrophils above 15,000/mm³;
2. Increased lactate dehydrogenase (LDH);
3. High amylase;
4. High alkaline phosphatase;
5. Increased lactate.

Therapy and medication for intestinal infarction

Treatment of intestinal ischemia consists in restoring sufficient blood circulation in the digestive tract.

The possibilities vary depending on the type and severity of the disease.

Medication

Thrombolytic drugs can be administered to dissolve the thrombi or to prevent the development of the coagels.

In addition, vasodilators are used to dilate the blood vessels in acute ischemia of the intestinal artery.

With chronic mesenteric ischemia, the doctor may prescribe anticoagulants.

Venous mesenteric thrombosis

If the intestine has not been damaged, taking an anticoagulant medication for about three to six months is likely required.

Anticoagulants prevent thrombus formation.

If the examination indicates a blood clotting disorder, lifelong use of anticoagulants may be necessary.

If sections of the colon are damaged, surgery may be required to remove them.

Ischemia of the colon

Colon mixemia can heal on its own, but the doctor should prescribe antibiotics to prevent infection.

The doctor may advise the treatment of other related conditions, for example:

1. Compensated heart failure,
2. Irregular heartbeat (arrhythmia).

Taking all medications that lead to vasoconstriction must be stopped. This concerns, for example, remedies against:

1. Migraine
2. hormone treatments,
3. Heart disease.

If the colon has been damaged, surgery may be required to remove the dead tissue or bypass an arterial intestinal blockage.

Acute mesenteric ischemia (infarction)

As a rule, surgery is required:

1. To remove a blood clot,
2. To bypass an arterial blockage or
3. To restore or remove a damaged part of the intestine.

With early diagnosis and if the disease affects only a small part of the intestine, the surgeon can remove a segment of the intestine and make an anastomosis..

Treatment includes drugs that:

1. prevent thrombus formation,
2. dissolve clots,
3. Dilate blood vessels.

If angiography is used to diagnose the problem, the simultaneous treatment of the disease by means of angioplasty is possible.

In angioplasty, a balloon is inserted into an artery that inflates to:

• compress fat reserves,
• To widen the artery.

The result is an artery with a larger diameter, which allows the blood to flow undisturbed.

The doctor may insert a cylindrical metal structure (stent) into the artery to keep it open.

With complete occlusion of the mesenteric artery, a massive intestinal infarction develops. In this case, the surgeon can not remove the entire intestine (part of the small intestine), as this would not be compatible with life.

Therefore, heparin is administered to the patient through the vein in the hope that the blood coagel will dissolve or shrink.

Chronische Mesenterialischämie

Gewöhnlich ist eine Operation erforderlich zur:

1. Wiederherstellung der Durchblutung,
2. Verhinderung eines Fortschreitens einer akuten Mesenterialischämie.

Der Chirurg kann die verschlossene Arterie umgehen oder verengte Arterien erweitern mittels:

• Einer angioplastischen Operation,
• Einsetzen eines Stents.

Außer Angioplastik und Bypass gibt es noch ein anderes Verfahren bei chronischer Mesenterialischämie, das sich transaortale Endoarteriektomie nennt.

Bei dieser Operation wird der Plaque, der die Mesenterialarterie verschließt, entfernt.

Rekonvaleszenz nach der Operation

The postoperative course depends on the patient’s condition and the extent of intestinal necrosis.

The prognosis is in most cases infaust, with a venous occlusion recovery is more likely.

Prevention, diet and nutrition in case of intestinal infarction

You can reduce the risk of intestinal ischemia by changing your lifestyle to prevent atherosclerosis:

To do this, you should choose a diet with plenty of fruits, vegetables, nuts and seeds.

The amount of added sugars should be reduced, as well as finished products, cereal products and dairy products.

Smoking. People who smoke should talk to their doctor about the possibility of quitting smoking.

Advice, medication and nicotine replacement products are one way to do this.

Regular physical exercise

The goal is at least 30 minutes a day.

Keep your body weight according to your height.

Treat other health problems.

Prevent or treat the following diseases:

1. Hypertension
2. High cholesterol,
3. Diabetes or other conditions that increase the risk of atherosclerosis.

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