Mesenteric artery ischemic disease is a clinical manifestation of hemorrhagic intestinal obstruction due to acute blood circulation disorders in the mesenteric arteries, resulting in ischemic necrosis of the intestinal canal. Its causes include superior mesenteric artery embolism and superior mesenteric artery thrombosis, among which superior mesenteric artery embolism is more common, with rapid clinical onset, rapid disease development, high misdiagnosis rate and mortality.
1.Timely and accurate diagnosis is the key to improve the efficacy Arterial embolism is the most common in mesenteric artery ischemic diseases. Emboli mainly come from the heart, such as atrial fibrillation, rheumatic heart valve disease, mural embolism after myocardial infarction, ventricular wall aneurysm, etc. With the increase of intracavitary treatment, medical embolism is also reported. In addition, some patients have mesenteric artery thrombosis, mostly formed on the basis of pre-existing atherosclerosis, often preceded by manifestations of chronic superior mesenteric artery ischemia, such as abdominal pain and diarrhea, but it is often difficult to distinguish from arterial embolism at acute onset. The clinical manifestations of this disease are highlighted by the disproportion between severe symptoms and mild signs. Abdominal pain is often very severe, but there are no obvious signs of peritonitis on examination, which can be differentiated from other abdominal diseases, but patients with already extensive intestinal necrosis may also have obvious signs of peritonitis.
Diagnostic methods include ultrasound, MRI, CT, mesenteric arteriography, etc. Ultrasound examination is convenient and quick, and is an important tool for diagnosing this disease, which can clarify the situation of the root and proximal end of the superior mesenteric artery. Mesenteric arteriography can make a definite diagnosis, but due to its invasive nature it is not widely used at present. CT arteriography and nuclear magnetic arteriography are also important diagnostic tools, but they often require a certain delay, therefore, if there are positive findings on ultrasonography, direct surgical exploration is advisable to avoid the aggravation of intestinal ischemic necrosis or necrosis. In addition, attention should be paid to the differentiation from mesenteric vein thrombosis, which is divided into two categories: primary and secondary, with secondary factors being more common, including various causes that can cause a hypercoagulable state of blood, such as tumors, oral contraceptives, portal hypertension, and cirrhosis, etc. These aspects should be noted when taking a medical history. Most of the mesenteric vein thrombosis has a slow onset and longer gastrointestinal symptoms, but when the acute vascular complete obstruction can appear severe abdominal pain and peritoneal irritation signs, at this time, ultrasound or CTA can help the differential diagnosis.
2. Those who are diagnosed or highly suspected should be operated in time to determine the appropriate surgical method. Once the diagnosis of mesenteric artery ischemic disease, especially superior mesenteric artery embolism is confirmed, emergency surgery should be performed, and those who cannot determine the diagnosis but are highly suspected clinically or have signs of peritonitis should be operated in time to avoid delaying the treatment, and timely restoration of mesenteric blood supply and resection of necrotic intestine is the key to improve the survival rate. The key lies in early diagnosis and timely surgery, allowing a certain rate of negative exploration, but it is important to avoid delaying the timing of surgery by pursuing too much the accuracy of diagnosis. Surgical methods include superior mesenteric artery embolization and intestinal resection, etc. Recently, endoluminal treatment, hybridization and laparoscopic surgery have also been reported. Laparoscopic exploration is less traumatic and can be the preferred means of exploration if available, and can be transferred to open surgery if necessary, which has also been reported in China. If possible, embolization of the superior mesenteric artery should be performed as early as possible to restore blood flow to the intestine, but sometimes the results of exploration will be negative, that is, the embolism or thrombus cannot be detected in the main trunk of the superior mesenteric artery, but the blood flow to the intestine is already impaired, then it may be branch embolism. If the results are negative or if residual stenosis is suspected after removal of the embolus, intraoperative angiography is feasible.
Intraoperative judgment of intestinal activity is crucial to ensure that all necrotic intestinal tubes are removed and the embolized mesentery is removed at the same time.
3, the treatment of short bowel syndrome should be gradual, gradually transition to a normal diet Short bowel syndrome is a complication of extensive intestinal necrosis after intestinal resection, can occur severe diarrhea, water-electrolyte imbalance and malnutrition, such as improper treatment, the patient is difficult to survive, but with reasonable dietary management, the extension of time, the residual small intestine absorption function can gradually occur compensatory enhancement.