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Intestinal artery obstruction and abdominal angina

Intestinal artery obstruction(Mesenteric infarction): Life-threatening acute occlusion of one or more intestinal arteries (mesenteric vessels) with severe abdominal pain. The cause is thrombosis due to pronounced vascular calcifications or blood clots from the heart that loosen, enter the bloodstream and then occlude the intestinal arteries (embolism).

Abdominal angina(Angina intestinalis, abdominal claudication): Preliminary stage of the intestinal artery obstruction (similar to angina pectoris as a preliminary stage of myocardial infarction) with recurring abdominal pain after eating.

Elderly people in particular are affected by circulatory disorders in the intestinal arteries. If they are not recognized and operated on in time, the intestinal loops die and the contents of the intestine break through into the abdominal cavity with peritonitis (peritonitis). The prognosis is poor; 60–80% of patients with intestinal artery obstruction die as a result.

Symptoms and key complaints

Abdominal angina

  • Again and again stomach pain after eating
  • Weight loss.

Intestinal artery obstruction

  • Suddenly severe abdominal pain, usually after eating, which is difficult to localize
  • Strong feeling of illness
  • In the late stages, hardened abdominal wall with strong immune system, palpitations and fever.

When to the doctor

See a doctor or hospital immediately, if

  • the described symptoms of intestinal artery obstruction occur.

In the next few days at

  • recurring abdominal pain after eating
  • unwanted weight loss.

The illness

The intestine receives blood from the mesenteric arteries. If the arteries are narrowed due to arteriosclerosis (vascular calcification) or blocked by a thrombus or an alluvial blood clot (embolism), not enough blood can reach the intestinal walls. This reduced blood flow is particularly noticeable when the intestine has to work and needs more oxygen for it. The consequences range from pain after eating to death of intestinal tissue.

clinic

Abdominal angina. With this circulatory disorder of the intestine, abdominal pain occurs repeatedly about 15-30 minutes after eating. Because the feeding artery is narrowed, it does not supply the intestine, which is working at full speed, with sufficient blood. The intestine lacks oxygen and pain develops. Sometimes the symptoms improve when the patient eats smaller portions. Such measures do not stop the actual disease process, however: the arteries continue to calcify until there is a risk of a complete intestinal artery obstruction.

Intestinal artery obstruction. The sudden complete interruption of the blood supply (acute ischemia) in an intestinal artery manifests itself in sudden, severe, cramp-like abdominal pain that can lead to shock. Often there is also nausea and vomiting. This first phase lasts up to 6 hours.

This is followed by a phase lasting around 6-12 hours, which the doctor also calls the silent interval (lazy peace). During this time, bowel movements and pain decrease, but the death of the bowel wall continues.

In the third phase after the silent interval, severe pain occurs again. This is due to the fact that bacteria now migrate into the abdominal cavity through the dead tissue of the intestinal wall. There they cause peritonitis up to blood poisoning and shock. In this phase, a hard stomach and a "dead silence" in the intestine are typical, since no intestinal noises can be heard anymore due to the intestinal paralysis.

Very similar symptoms also show up when there is one Mesenteric vein thrombosis (Blockage of a vein in the intestines with a blood clot).

Diagnostic assurance

Abdominal angina. In angina abdominalis, the typical symptoms after eating lead the suspicion of a circulatory disorder in the intestine. The doctor then uses color duplex sonography and angiography to detect the narrowed artery.

Acute intestinal obstruction. The acute obstruction of the intestinal arteries is an emergency and shows clear symptoms: Severe abdominal pain, nausea, vomiting and a mostly seriously ill patient. In the early stages the abdomen is soft, in the late stages board-hard. Color duplex sonography, angiography and computed tomography (CT angiography), with which the doctor can easily recognize the occlusion of an intestinal artery, are also evidence here. Important signs of an intestinal obstruction are also a sharp increase in white blood cells and lactate in the blood. The ECG often shows atrial fibrillation as the cause of the embolism.

Differential diagnoses. Severe abdominal pain cause z. B. also acute pancreatitis, stomach ulcers, a gastric perforation or appendicitis.

treatment

Abdominal angina. If angina abdominalis is detected early, there are several options for doctors to ensure blood flow to the bowel:

  • Percutaneous transluminal angioplasty, PTA: Doctors push a catheter over the groin into the narrowed artery and expand the constriction with a balloon (balloon dilatation). In addition, they sometimes also place a stent in the constriction of the artery, which keeps the vessel open from the inside.
  • Thrombic endarterectomy. During this operation, doctors remove the thrombus or embolism by opening and peeling the affected artery. This makes the previously narrowed vessel open again.
  • Bypass. Doctors use a bypass to bridge long bottlenecks in particular. The bypass consists either of a vein of the patient himself (usually a superficial leg vein) or of plastic and is sewn onto the vessel in front of and behind the constriction.

Intestinal artery obstruction. Only if the doctor makes the diagnosis in good time so that treatment can begin after less than 6 hours is there any hope that the intestine can still be saved. The aim of treatment is to eliminate the embolism (thrombosis), either via a catheter or open abdominal surgery.

Procedure via the catheter

  • Thrombic endarterectomy
  • Percutaneous transluminal angioplasty, balloon dilatation with and without insertion of a stent (see above)
  • Thrombolysis, in which the doctors inject medication (so-called fibrinolytics) directly into the thrombus through a catheter that is pushed up to the narrow point in order to dissolve it.

If these measures fail, doctors must switch to open abdominal surgery. In this operation, vascular surgeons and abdominal surgeons usually work as a team. The vascular surgeons open the affected artery and remove the blood clot, while the abdominal surgeons remove the dead parts of the intestine that are no longer supplied with blood. The mortality from such an emergency operation is over 50%.

forecast

The prognosis for complete intestinal artery obstruction is poor: 60-80% of patients die from it.

Your pharmacist recommends

Prevention

Because acute intestinal obstruction develops in most cases on the basis of constricted and calcified vessels, the same basic preventive measures as for arteriosclerosis are recommended:

  • Stop smoking. Smoking is one of the most important risk factors for developing arteriosclerosis. If you stop doing this, you will relieve your blood vessels. Nicotine replacement therapy or medication can help you quit smoking. You can find tips on smoking cessation in the article Nicotine addiction.

Treat high blood pressure. Long-term high blood pressure also damages the blood vessels. You should therefore take your antihypertensive drugs consistently and have your blood pressure values ​​checked regularly.

Maintain a healthy weight. Obesity is not healthy in any way, and being overweight is also a risk factor for arteriosclerosis. You can find helpful tips and information about losing weight in the article Overweight and obesity in adults.

To keep moving. Moderate endurance sport, especially jogging, Nordic walking, swimming and cycling, trains muscles, lungs and the entire cardiovascular system. Side effect: the more you move, the easier it is for you to achieve or maintain a healthy weight.

Drink less alcohol. If you want to protect your vessels, you don't have to do without alcohol completely. There is nothing wrong with moderate alcohol consumption - but it is less than most would assume. Men should not consume more than about 20 g of alcohol per day (this corresponds to about 0.5 l of beer or 0.2 l of wine), women not more than about 10 g (i.e. about 0.25 l of beer or 0.1 l wine).

Eat healthy. A healthy diet is essential for healthy blood vessels. Sugar and animal fats are important factors. Those who do without this will improve their blood lipid levels and at the same time prevent diseases such as type 2 diabetes mellitus. You can also find helpful nutrition tips in the article Coronary Heart Disease.

Reduce stress. Constant time pressure and stress damage not only the psyche, but also the blood vessels. Try to bring your life into a healthy balance and take small breaks every now and then. Helpful are e.g. B. Mind-body therapies such as autogenic training or tai chi.