Der akute Mesenterialarterienverschluss // Acute mesenteric artery occlusion
Journal für Gastroenterologische und Hepatologische Erkrankungen 2016; 14 (4): 11-17
Volltext (PDF) Summary
Keywords: Diagnose, Mesenterialarterienembolie, Mesenterialarterienthrombose, nonokklusive intestinale Ischämie, Therapie, diagnosis, mesenteric artery embolism, mesenteric artery thrombosis, non-occlusive mesenteric ischemia, therapy
Acute mesenteric artery occlusion is the most common form of acute arterial visceral vessel occlusion. It can be caused by embolism, thrombosis but also by non-occlusion. Acute severe abdominal pain is the cardinal symptom. The disease process is characterized by a triphasic progression and if untreated, ends in endotoxin shock. Due to initially substantially unremarkable abdominal medical reports, acute mesenteric ischemia is frequently diagnosed too late.
CT-angiogram constitutes today’s diagnostic technique of choice. A possible course of treatment in early stages is clot dissolution by means of local lysis therapy or transfemoral aspiration embolectomy. If this procedure does not result in success within a period of approximately four hours, surgical procedure is indicated.
Occlusions in the peripheral part of superior mesenteric artery are treated by means of resection of the affected parts of the intestine. In case of occlusion of the central part of superior mesenteric artery embolectomy in combination with resection of the affected intestine is indicated. In the majority of cases, a second-look operation is performed after approximately 24 hours. In case of a nonocclusive blockage of the superior mesenteric artery, an intraaterial infusion of vasoactive substances will be administered during the early stage. In case of therapy failure or advanced stages, surgical procedure is indicated as well.
The disease pattern overall displays a negative outcome and a high lethality rate which is caused by the disease not being detected and medical diagnoses continuing for too long in conjunction with surgery being performed too late respectively. One approach to improving the results of treatment which even today are bad is to sensitize the medical faculty to this pattern of disease as a situation of serious emergency which requires immediate diagnosis and immediate therapeutic intervention.
Kurzfassung: Der akute Mesenterialarterienverschluss stellt die häufigste Form des akuten Viszeralarterienverschlusses dar. Dieser kann embolisch, thrombotisch, aber auch nichtokklusiv bedingt
sein. Leitsymptom sind akut einsetzende, starke abdominelle Schmerzen. Das Krankheitsgeschehen ist durch einen triphasischen Verlauf gekennzeichnet und endet unbehandelt im Endotoxinschock. Aufgrund des initial meist weitgehend
unauffälligen abdominellen Untersuchungsbefundes wird das akute mesenterielle Geschehen häufig zu spät diagnostiziert.