The Modern View on the Diagnosis of Acute Intestinal Vascular Insufficiency at an Early Hospital Stage

M.V. Maksimenko

Abstract


Background. Violation of mesenteric circulation is one of the severest diseases, which occurs in urgent abdominal gastroenterology. Peculiarities of acute ischemia on a background of various comorbidities complicate diagnosis, and its decompensation often leads to an operation as a method of desperation when there irreversible pathological process develops. Materials and methods. The work is based on the results of clinical and sonographic dynamic examination of 51 patients with the clinical acute vascular insufficiency of intestine at the City clinical hospital of emergency medicine. The age characteristics of the disease in patients of different age groups were evaluated and taken into account. The severity of intestine hemodynamic impairments was verified by clinical and sonographic diagnosis included triplex scanning for quantity estimation of intestine hemodynamics and sonographic monitoring at every stage of diagnostics and treatment. Results. The usage of the standard technique of ultrasonographic diagnostics was found to determine large impairments of regional hemodynamics of great vessels only. Spectral Doppler sonography diagnosis of intestinal hemodynamics revealed objective signs and differences in intestinal state depending on vessel impairment that allowed verify a total lesion, while segmental pathological process required dynamic sonographic monitoring to verify intestinal acute vascular insufficiency against continued intensive therapy that allowed optimize further treatment (surgical) strategy. On total intestinal damage in 23 patients, especially the pool of superior mesenteric artery showed lack of both systolic and diastolic blood moving through the main mesenteric vessels. In addition, the severity of the destructive process in the abdomen indicated indirect sonographic features such as a large number of peritoneal content in the abdomen, lack of peristalsis, no signs of damaged isolation loops of small intestine, enterodilatation generalized with thickening and swelling of the intestinal wall. It revealed the lack of central hemodynamics. In 28 patients with segmental mesenteric thrombosis clinical picture (based on surgery resection length of 50 to 100 cm) the characteristics of changes in regional hemodynamics were determined, which manifested in the preservation of maximum systolic velocity 172.6 ± 4.2 cm/s in the main vessels, the minimum diastolic velocity of 46.90 ± 2.11 cm/s and tissue resistance index 0.67 ± 0.05 cm/s, while the intestine intramural vessels had mosaic inhibited blood flow. Furthermore, in these patients, we observed some indirect sonographic signs. It should be noted that the patients with evident or latent occlusion of vessels in the small intestine needed a dynamic diagnostic examination, it is not always possible to verify pathology by the primary signs on admission. The use of dynamic scanning triplex on the background of infusion therapy revealed negative trends in regional intestine hemodynamics, which manifested on the background of the preserved maximum systolic and minimum diastolic velocity in the main vessels. The results of hemodynamic assessment according to spectral Doppler examination found no effect of conservative of intravenous therapy in patients with segmental thrombosis. Conclusions. Thus, the diagnostic algorithm in the patients with a clinical picture of intestinal acute vascular insufficiency and severe disorders of other organs and systems, with a possible complication in a selective vascular intestine should include one-time sonographic examination. In the absence of clear signs of a possible characteristic of pathological process should be carried out by the dynamic sonographic monitoring triplex scan that will accelerate the verification of the diagnosis, and prevent thrombosis generalization, the application will facilitate reasonable and adequate surgical treatment and will improve the outcomes.


Keywords


acute intestinal vascular insufficiency; early hospital stage; thrombosis; sonographyacute intestinal vascular insufficiency; early hospital stage; thrombosis; sonography

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DOI: https://doi.org/10.22141/2224-0586.8.79.2016.90372

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