Intestinal vascular diseases

What are intestinal vascular diseases?

The small intestine and the large intestine receive blood from three arterial trunks arising from the abdominal aorta:

In addition to these main irrigations, there is a collateral circulation formed by arteries that connect the superior and inferior mesenteric, in such a way that they form the so-called arcade of Riolano. If in any of these arteries or in the corresponding veins one or moreblocked blood supply, the intestines will not be able to receive the oxygen supply necessary to carry out their function, with which there will be disturbances in digestive function. The set of these deficits in the intestinal blood supply are the so-called intestinal vascular diseases.

Types of vascular diseases

1. Acute occlusive mesenteric ischemia

In which there is an acute intestinal ischemia of one of the arteries mesenteric. It is more often caused by a embolism that not by a thrombosis, especially in patients with cardiac thrombosis or lesions of the heart valves. They rarely occur due to taking oral contraceptives, hematological diseases or aortic dissection. Persistent lack of irrigation causes cells begin to die shortly after.

2. Acute non-occlusive mesenteric ischemia

In which there is a sudden deficit of the irrigation of the mesenteric arteries, but not due to their occlusion, but due to a lack of arrival of blood, generally due to hypotension or a decrease in the volume of blood circulating in the body. It usually occurs in elderly patients with acute myocardial infarction, heart, liver or kidney failure, as well as if there is dehydration, in large burns, after major interventions or in cases of sepsis. Lack of irrigation leads to the death of cells in the intestine.

3. Acute venous thrombosis

In which a thrombus at the level of the intestinal venous system. It usually occurs in patients with portal hypertension, sepsis, cancer, diabetes mellitus, trauma, or increased coagulation. If the collateral venous system is not sufficient, the intestine becomes congested and hemorrhage occurs from the intestinal wall.

4. Acute ischemic colitis

The most common vascular disease, especially of arteriosclerotic origin, occurs in the colon or large intestine, mainly in the splenic flexure and the descending colon.

5. Chronic intestinal ischemia

Produced in 90% of cases by arteriosclerosis progression of the arteries supplying the intestines. Because of the connections between the arteries, two of the three main arteries must be occluded for it to occur.

Common symptoms

The acute intestinal ischemia (obstructive or not) gives symptoms of sudden onset:

• A penetrating abdominal pain appears, especially around the navel, which becomes more and more intense.
• It is often accompanied by nausea and vomiting that can sometimes be bloody.
• There is an abdominal distention with a rigid wall that is painful to the touch.

In the case of intestinal venous thrombosis the onset of symptoms is usually more gradual:

• The intensity of the pain is variable.
• nausea and vomiting also occur.
• Also, alterations in the intestinal habit, either constipation or diarrhea.
• Digestive bleeding may occur, either hematemesis or hematochezia.
• It is usually accompanied by fever and in the long term produce peritoneal irritation.

The ischemic colitis It usually occurs in people over 60 years of age and produces:

• Abdominal distension
• Intense pain
• Tenesmus
• bloody diarrhea
• Fever.
• In severe cases, a stenosis of some segment of the colon may occur, with the consequent risk of intestinal obstruction.

Symptoms of chronic intestinal ischemia They are more overlapping, since the occlusion occurs slowly and does not appear until two of the three large intestinal vessels are occluded:

• It gives a characteristic pain 15-30 minutes after eating, which increases and subsides after 2-3 hours. The pain is usually in the upper half of the abdomen, radiates to the back, and improves with leaning forward. pain after ingestion causes patients to eat little for fear of suffering from it and to become malnourished.
• It is accompanied by nausea, vomiting.
• Diarrhea and bloating.

Diagnosis

Acute intestinal ischemia, whether arterial or venous, should be suspected in all patients with clinical analysis of symptoms such as sudden, severe onset abdominal pain, accompanied by nausea, vomiting and diarrhea, with upper or lower gastrointestinal bleeding and vascular risk factors (hypertension, diabetes, hypercholesterolemia, history of ischemic episodes in other territories).

In the blood test Nonspecific inflammatory signs will be seen, as well as an elevation of white blood cells, lactate dehydrogenase (LDH), hematocrit and hemoglobin (the latter two due to blood concentration due to fluid loss).

In the abdominal x-ray Loops of the small or large intestine can be seen distended and with air-fluid levels, as air accumulates in the elevated areas of the intestines after stopping intestinal transit.

The mesenteric arteriography it is the test that will allow the evaluation of arterial occlusion with certainty, as well as in the case of venous thrombosis. It should be said, however, that in the case of venous thrombosis, computerized axial tomography (CT) is the test of choice, since it allows the thrombus to be seen at the level of the mesenteric vein.

In the case of ischemic colitis the fibrocolonoscopy It is the test of choice, since it allows to appreciate characteristic violaceous nodules in the intestinal mucosa. In this case, arteriography does not provide much information, which suggests that this pathology is due to involvement of smaller vessels and not of the main arteries.

Treatment

Treatment in all cases, regardless of the cause, will involve ensuring the contribution of liquids to the body and the correct cardiovascular function as well as to cover with antibiotics the more than probable infectious complications. Likewise, treatment will begin anticoagulant with heparin. During mesenteric arteriography and in case of arterial involvement vasodilators can be given to correct the blood supply and break the embolus or thrombus if possible.

In case of severe intestinal involvement and long evolution, a surgical intervention explorer to assess the affected areas, resect those parts of the intestine that are severely damaged and perform an arterial bypass bypassing the affected area. With regard to chronic intestinal ischemia, the only definitive treatment is bypass of the affected logs by means of a bypass.

Precautionary measures

All measures aimed at reducing the risk of vascular thrombosis will reduce the risk of suffering from intestinal vascular disease:

• Perform physical exercise on a regular basis
• Maintain a balanced and healthy diet
• Reduce the consumption of salt and animal fats
• Give up tobacco