Diffuse umbilical pain

Introduction The cause of acute obstruction of the superior mesenteric artery is mostly cardiac emboli occlusion obstruction of the artery, or arteriosclerosis secondary to thrombus obstruction of the lumen, eventually leading to the corresponding tissue infarction, the severity depends on the arterial basis The severity of the lesion, infarction, degree, and collateral circulation. Abdominal pain is the most common symptom, often a sudden diffuse umbilical pain, the patient's expression can be extremely painful, and painkillers are often ineffective.

Cause

Lesions of the blood vessels themselves and hypoperfusion are the two major factors that cause most acute superior mesenteric infarction, followed by bacterial infections. On the basis of the original extensive arteriosclerosis, it can also occur in the case of dissection aneurysm, systemic lupus erythematosus, long-term oral contraceptives or hypercoagulable state, resulting in acute superior mesenteric ischemia, thrombosis or embolism.

1. Vascular diseases are mainly atherosclerosis, arterial embolism or thrombosis. In addition, multiple nodular arteritis, rheumatoid arthritis, diabetes and other diseases are also complicated by arteritis of small blood vessels. The lesion often involves the trunk and branches of the superior mesenteric artery, sometimes in the small arteries, and the superior mesenteric artery is most likely to occur within 2 cm of the opening of the abdominal aorta. The superior mesenteric artery is obliquely separated from the abdominal aorta, and the embolus in the systemic circulation easily enters the artery to form an embolism.

2, blood flow insufficiency atherosclerosis in patients with vascular stenosis, although the blood supply can maintain the normal activities of the intestinal tract. However, the reserve capacity has been reduced, and blood pressure drop for any reason may lead to insufficient blood supply and infarction, especially when the patient is accompanied by a dissection aneurysm or systemic lupus erythematosus.

3, bacteria and bacterial toxins under normal circumstances, the intestinal flora maintains a dynamic balance, intestinal ischemia, intestinal wall defense ability is reduced, bacteria that invade the intestinal wall, can cause pseudomembranous colitis, postoperative enteritis, acute necrotic enteritis Acute hemorrhagic enteritis. Animal experiments have shown that after intestinal ischemia, if antibiotics are added, the rate of shock occurs.

an examination

Related inspection

Abdominal vascular ultrasonography MRI gynecological examination of liver, gallbladder, pancreas and spleen

Laboratory examination: leukocytes in the superior mesenteric artery embolization often exceed 20 × 109 / L, serum amylase increased, CPK increased with the progress of the disease, 72 h gradually recovered. Serum lactate dehydrogenase (LDH) and its isoenzyme LD ratio, serum inorganic phosphorus increased. Aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and CPK have reference value for the diagnosis of superior mesenteric artery thrombosis.

Other auxiliary inspections:

1. Abdominal X-ray examination: Intestinal plain film can be seen in the small intestine in the early stage; when the disease develops to intestinal paralysis, the small intestine and colon are flatulent, the intestinal wall is edematous and thickened; when the intestinal necrosis occurs, the intestinal gas leaks into the intestinal wall and accumulates in the pulp. Under the film, the flat sheet can be seen as a light-transmitting belt or a light-transmitting ring, and sometimes a gas shadow is also visible in the portal vein.

2, angiography: suspected acute mesenteric ischemia, plain film excludes other acute abdomen, regardless of abdominal signs, should be an early angiography, so can not only identify large blood vessel occlusion is caused by thrombosis or embolization Caused by, can also diagnose non-occlusive ischemia, the extent and extent of vascular stenosis. The embolus tends to embolize in the distal or branch of the beginning of the superior mesenteric artery trunk. The contrast agent is filled on the proximal side of the embolization and the distal blood vessel is not developed. Thrombosis usually occurs within 3 cm of the initial part of the artery, with a sudden interruption of the blood vessel, accompanied by reactive vasoconstriction, and a generally smaller diameter. Because of the formation of collateral circulation, the distal end of the obstruction can have different degrees of filling; non-occlusive mesenteric ischemia and superior mesenteric artery and its branches have different manifestations: diffuse stenosis, the beginning of most branch of superior mesenteric artery Stenosis, stenosis and dilatation of the superior mesenteric artery branch, arterial arch, insufficient filling of blood vessels in the wall.

3, CT examination can directly display the blood clots in the intestinal wall and blood vessels, better than X-ray film and tincture examination.

4. Doppler ultrasound can measure the blood flow of portal vein and superior mesenteric vein, and has certain diagnostic value for judging intravascular thrombosis.

5, radionuclide examination with radionuclide indium or sputum labeled platelet monoclonal antibody, injected into the human body after gamma photography, can show acute mesenteric occlusion of the ischemic area.

Differential diagnosis

The disease mainly needs to be differentiated from ulcerative colitis, Crohn's disease, strangulated intestinal obstruction.

Diagnosis: The diagnosis of this disease is mesenteric angiography. However, in the following emergency situations, in order to avoid extensive necrosis of the intestine and life-threatening, laparotomy should be performed to restore the perfusion of the superior mesenteric artery in time.

1, 50 years of age or older have valvular heart disease, atrial fibrillation, recent myocardial infarction or embolism in other parts of the body, or a history of post-prandial colic (about 50% of patients with symptoms of chronic intestinal ischemia before onset) .

2, acute diffuse severe abdominal pain and mild abdominal signs.

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