A mesenteric infarction describes the acute occlusion of an intestinal vessel which, if left untreated, leads to the death of sections of the intestine. It is a life-threatening disease that is often recognized too late and has a high mortality rate. Patients with previous cardiovascular diseases are mostly affected.
What is a mesenteric infarction?
In a mesenteric infarction, an intestinal vessel is blocked by an embolism or thrombosis, whereby both intestinal arteries and intestinal veins can be affected.
The intestine in the supply area of the affected vessel is no longer sufficiently supplied with blood, so that – without timely countermeasures – the tissue dies (infarction and necrosis). In arterial mesenteric infarction, the superior mesenteric artery (“upper visceral artery”), which supplies large parts of the small intestine, large intestine and pancreas, is affected in 85 percent of cases. See AbbreviationFinder for abbreviations related to Mesenteric Infarction.
The remaining 15 percent are divided equally between the celiac trunk (“stem of the abdominal cavity”), in whose supply area the stomach, liver, spleen and pancreas are located, as well as the duodenum, and the inferior mesenteric artery (“lower visceral artery”), which supplies the descending nourishes the colon and upper rectum. A mesenteric infarction of the inferior mesenteric artery has a better prognosis.
The cause of a mesenteric infarction is either an embolism or a thrombosis. Embolism typically occurs in middle-aged patients.
Cardiac pre-existing conditions such as cardiac arrhythmias or artificial heart valves favor the development of an embolus in the heart, which is first carried into the aorta and finally into the viscera. Thrombosis in the mesenteric arteries is more likely to occur in elderly patients due to arteriosclerosis.
The vascular wall thickens due to fat deposits, connective tissue proliferation and inflammatory processes until adequate blood flow is no longer possible. More rarely, a mesenteric vein thrombosis is responsible for the mesenteric infarction. It is usually preceded by an underlying disease that promotes thrombosis, e.g. B. a local inflammation, sepsis or a coagulation disorder.
Symptoms, Ailments & Signs
A mesenteric infarction is an extremely life-threatening condition. In general, the disease progresses in three phases. In phase I, severe abdominal pain suddenly occurs, which is particularly concentrated in the area around the navel. But there are no defensive tensions or pressure pains. In addition to colicky abdominal pain, bloody diarrhea and symptoms of circulatory shock often occur.
Due to a circulatory disorder in the intestine caused by an embolism or thrombosis, the sections of intestine affected by the blockage die off. Their necrosis begins about two hours after the vascular occlusion due to the undersupply of the corresponding sections of the intestine. When examining the abdomen, however, nothing is initially noticeable.
However, an increasing deterioration of the patient is observed. About six to eight hours after the onset of the initial phase, the pain suddenly disappears and the patient appears to be better. Sometimes this so-called “false peace” is accompanied by meteorism and flatulence. This apparent improvement in the symptoms is based on the reduction in intestinal peristalsis, which is also caused by the reduced supply to the intestine.
Phase II, with the apparent calming of the symptoms, is then replaced by phase III with irreparable necrosis of large sections of the intestine. This initially leads to [(intestinal paralysis]], which prevents the intestinal contents from being passed on. The consequences are paralytic intestinal obstruction, perforation of the intestine with the development of peritonitis and severe intoxication of the body. The lethality rate is up to 90 percent.
Diagnosis & History
A mesenteric infarction typically occurs in 3 stages. The key symptom in the early stages is an acute abdomen: a sudden onset of severe, colicky abdominal pain.
Defense tension is often not initially present. Unfortunately, acute abdomen is a relatively unspecific sign that can have many causes. Therefore, the emergency diagnosis is often not made quickly enough. In addition, the pain subsides after a few hours due to the drying up of intestinal peristalsis and an apparent improvement begins.
This second phase is called “lazy peace”. A blood gas test provides important information (metabolic acidosis, lactic acidosis). Elevated leukocyte levels indicate inflammatory processes. The mesenteric infarction can be visualized using an X-ray overview of the abdomen, sonography and/or CT angiography.
If the mesenteric infarction is not diagnosed in time, the patient’s condition deteriorates massively after about 12 hours due to advanced intestinal necrosis. The final stage begins: the patient goes into septic shock with intestinal obstruction (ileus) and peritonitis (peritonitis). Left untreated, mesenteric infarction is a certain death sentence.
In the worst case, the mesenteric infarction can lead to the death of the patient. However, this complication usually only occurs if the mesenteric infarction is not treated. Those affected suffer from very severe pain in the area of the stomach and intestines, which leads to considerable restrictions in the quality of life.
It is also not uncommon for diarrhea and a tense stomach to occur. The patient’s resilience decreases and fatigue often occurs. Not infrequently, the mesenteric infarction also leads to a reduced appetite and thus to deficiency symptoms. Due to the permanent pain, many patients also suffer from depression and psychological complaints or upsets.
In the case of a mesenteric infarction, a direct operation is necessary in order to avoid consequential damage and the death of the affected person. This usually has to occur a few hours after the appearance of the mesenteric infarction. In most cases there are no complications, but dead parts of the intestine must be removed.
After the procedure, in most cases there is a large scar on the abdomen. Whether the life expectancy will be reduced by the mesenteric infarction cannot usually be predicted.
When should you go to the doctor?
If the person concerned suffers from complaints in the abdominal region, there is a health impairment. If you experience persistent or increasing abdominal or abdominal pain, you should consult a doctor. If severe symptoms occur suddenly, you need to see a doctor as soon as possible. If colic occurs, an emergency service should be alerted by the person affected or bystanders. Since a mesenteric infarction can lead to a fatal course of the disease in the worst case, immediate consultation with an emergency doctor is required. The instructions of the emergency doctor must be followed to ensure the survival of the person concerned.
Repeated or increasing diarrhea should be checked out by a doctor. Disorders or irregularities in the abdominal muscles indicate a worrisome irregularity. A doctor’s visit is advisable so that a diagnosis can be made. If the intestines become blocked, the usual level of performance gradually decreases, or if the person concerned experiences a general feeling of illness, he needs medical help. Anxiety, changes in body temperature, and a general feeling of being unwell are signs of an existing condition that should be treated. A breakdown in strength or the inability to carry out daily activities are symptoms that need to be discussed with a doctor.
Treatment & Therapy
The mesenteric infarction is an internal emergency and requires quick action. Intestinal necrosis can occur as early as 2 hours after the onset of the infarction.
The affected intestinal tissue can only be saved if an early operation makes the vessels passable again. The surgery requires a large abdominal incision and is called a laparatomy with (attempted) embolectomy. If the tissue is already irreversibly damaged, the dead parts of the intestine must be removed. A so-called second-look operation is often carried out about 12 hours after the successful first operation in order to resect any further necroses.
Postoperative care must counteract sepsis and peritonitis as well as further thrombosis. A mesenteric infarction has an unfavorable prognosis, particularly because of the short time window for a promising therapy. On average, the lethality of mesenteric infarction is 90%. Operated patients have a 50% chance of survival.
Outlook & Forecast
The prognosis for a large number of patients with a mesenteric infarction is unfavorable. It is a life-threatening condition that significantly increases the risk of the patient dying prematurely. The disease progresses in three stages. In most cases, a diagnosis and adequate medical care only come very late. This has a negative impact on the further course of the disease and thus the prognosis.
In addition, many of the patients suffer from other pre-existing conditions. These usually relate to the cardiovascular area and thus cause an increase in the existing symptoms. If the person concerned refuses medical care, a critical condition and ultimately death of the person concerned will inevitably result. Extreme caution is also required when seeking medical treatment. Irreversible damage and death can occur within a few hours.
Patients who receive timely and comprehensive care have improved prospects. If there are no other primary diseases, there are chances of recovery despite the critical condition. Nevertheless, it must be taken into account that most patients with a mesenteric infarction suffer from various previous cardiovascular diseases. As a result, almost half of all those affected die prematurely even after a successful operation.
Mesenteric infarction is prevented by measures that generally prevent arteriosclerosis: no cigarettes, a healthy diet with healthy fats and sufficient exercise. On the other hand, thrombosis prophylaxis with anticoagulants is important in high-risk patients, especially in older heart patients. Beyond prevention, it is crucial to think about the possible diagnosis of a mesenteric infarction, especially in the case of these high-risk patients, in order not to let any saving time pass.
The follow-up care of a mesenteric infarction depends primarily on the cause. This should be decided individually by the patient with his treating doctor. Every patient should also discuss with their family doctor whether certain dietary changes should be considered. In addition, symptoms such as frequent heartburn, stabbing stomach pains or vomiting blood must be linked to the previous history and clarified in the future. Sufferers should adopt a healthy lifestyle that reduces the likelihood of recurrence. A balanced diet and sufficient exercise are essential.
You can do that yourself
As a rule, a mesenteric infarction cannot be combated by various self-help treatments. With this disease, it is necessary to consult a doctor in order to avoid complications or, in the worst case, death of the person concerned.
In acute emergencies in particular, you should go straight to the hospital or call an ambulance. This is the case when the person concerned suffers from severe abdominal tension or an intestinal obstruction. These symptoms are accompanied by severe pain. Mesenteric infarction is always treated in a hospital by means of a surgical procedure and is usually successful if the procedure is carried out early. A second intervention is often necessary to avoid further necrosis.
A mesenteric infarction can be avoided by a healthy lifestyle. This includes a healthy diet and physical activity. Avoiding alcohol and cigarettes also has a positive effect on the disease. Patients at risk should take part in regular examinations in order to avoid a mesenteric infarction. If the treatment is successful, the patient’s life expectancy is usually not reduced.