Gangrene of the intestine is the necrosis of the tissues of an organ, which occurs due to impaired blood supply. Due to ischemia and lack of oxygen, the cells undergo necrotic changes. This is an extremely dangerous condition that requires emergency surgery. It is no longer possible to restore bowel function and the dead part of the organ has to be removed. Without treatment, patients die within the first two days. But even with timely surgical intervention, the prognosis of the disease remains unfavorable.
Causes of pathology
The cause of intestinal gangrene is coronary disease of this organ. Due to the narrowing or blockage of blood vessels, blood stops flowing into the intestinal tissues. Hypoxia occurs, and then tissue necrosis.
Ischemia can be acute or chronic. In the first case, the blood supply stops instantly due to a sudden blockage of blood vessels. Suchthe form of the disease is rare and very quickly leads to gangrene. Acute ischemia requires emergency medical attention.
More often, ischemia develops gradually and proceeds chronically. Such a violation of the blood supply is observed in elderly patients, it is associated with atherosclerosis. In this case, at the initial stage, it is still possible to restore the patency of the vessels by conservative methods. However, if tissue necrosis has already begun, then the only way out is surgery.
Ischemia most often occurs as a result of cardiovascular disorders. After all, the blood supply to the intestines directly depends on the work of the heart and the condition of the vessels. Also, the causes of this condition can be injuries and pathologies of the digestive tract.
Forms of ischemia
What causes circulatory disorders in the intestines? Doctors distinguish two forms of ischemia: occlusive and non-occlusive.
Occlusive ischemia occurs due to blockage of the mesenteric veins and arteries. The following pathologies can provoke a violation of blood supply:
- atrial fibrillation;
- heart defects;
- intestinal tumors;
- diseases of the digestive tract;
- cirrhosis of the liver.
Also, the occlusive form of the disease is noted in some patients who underwent prosthetic heart valves.
Non-occlusive ischemia occurs in about half of cases. Signs of pathology develop slowly. At present, the exact reasons for this violation have not been established. It is assumed that non-occlusive ischemia can be provoked bythe following diseases and conditions:
- heart failure;
- chronic hypotension;
- dehydration;
- taking blood-clotting drugs.
It is important to remember that any form of ischemia can lead to intestinal gangrene. Even if the violation of blood supply develops gradually, then without treatment sooner or later necrotic changes in the tissues occur.
Stages of ischemia
The necrosis of intestinal tissues develops in several stages. Doctors distinguish several stages of ischemia:
- Impaired blood supply. Due to the lack of nutrients in the intestinal tissues, the metabolism worsens. Dystrophic changes occur in the epithelium. Because of this, the production of enzymes decreases and the digestion of food is disturbed, and peristalsis also changes. At this stage, oxygen deficiency is compensated by the flow of blood through bypass routes.
- Intestinal infarction. This stage of ischemia is considered decompensated. Blood stops flowing even through the bypass branches of the vessels. Tissue necrosis occurs. At this stage, gangrene of the intestine occurs. Photos of necrotic areas of the epithelium can be seen below.
It should be noted that with decompensated ischemia, the color of the intestinal wall changes. First, due to a lack of blood supply, anemia occurs and the epithelium of the organ turns pale. Then the blood begins to seep through the vessels. The intestinal wall becomes red. Blood appears in the feces. In this case, doctorsthey talk about hemorrhagic gangrene of the intestine, since tissue necrosis is accompanied by bleeding. As necrosis progresses, the affected area turns black.
Without surgery, necrosis quickly leads to peritonitis. Tissue death is exacerbated by inflammation. The wall of the organ becomes thin and breaks. The contents of the intestine come out, and inflammation of the peritoneum occurs. This is often fatal.
Ischemia symptoms
Symptoms of circulatory disorders depend on the type of pathology. If ischemia develops suddenly and proceeds in an acute form, then the following manifestations are characteristic of it:
- There is severe pain in the abdomen. It is localized in the navel or right upper abdomen.
- Nausea and vomiting occurs due to impaired digestion of food.
- Intestinal motility increases sharply, there are frequent urges to defecate and diarrhea mixed with blood.
- Fever sets in.
Acute ischemia threatens the life of the patient and requires immediate medical attention. Approximately 6 hours after the first manifestations, irreversible changes occur and intestinal gangrene begins.
In chronic ischemia, symptoms develop over time and are less pronounced:
- The patient is concerned about paroxysmal pain in the abdomen, which do not have a clear localization. They come on after eating. At the beginning of the disease, pain is stopped by taking antispasmodics, but in advanced cases, the medication is no longerhelp.
- In patients, the abdomen is swollen, due to increased gas formation, rumbling in the abdominal cavity is heard.
- The patient often experiences nausea and vomiting.
- The process of defecation is disturbed, diarrhea alternates with constipation.
- Because of bouts of pain, a person cannot fully eat. This leads to a sharp weight loss, up to exhaustion.
Such symptoms should be a reason for immediate medical attention. Even the slow course of the disease is extremely dangerous. Chronic circulatory failure can lead to an attack of acute ischemia and the rapid development of gangrene.
Signs of necrosis
Symptoms of intestinal gangrene develop approximately 6 hours after an acute ischemia attack. The patient's condition is extremely serious. The following pathological manifestations are noted:
- sudden sharp weakness;
- skin blanching;
- unbearable abdominal pain;
- flatulence;
- vomit;
- diarrhea or delayed bowel movements;
- rapid heartbeat;
- weak pulse;
- dramatic drop in blood pressure;
- loss of consciousness.
Signs of pathology also depend on the localization of the site of necrosis. Gangrene of the small intestine is characterized by vomiting with bile and blood. As necrosis develops, fecal impurities appear in the vomit. When the colon is affected, diarrhea with blood occurs.
After 12-14 hours after the cessation of blood supply, peritonitis begins. The patient's pain disappearsas the nerve endings become necrotic. Gases and fecal masses do not depart. The patient is lethargic and lethargic. In severe cases, convulsions appear, and the patient falls into a coma. This condition can be fatal within 48 hours.
Diagnosis
With gangrene, the patient needs immediate surgery and there is very little time for diagnosis. When probing the abdomen, a swollen section of the intestine with a mesentery is determined. This is a specific manifestation of necrosis.
After admission to the hospital, the patient is given an x-ray of the intestine. The contrast agent is not injected. If the picture shows signs of tissue destruction or peritonitis, then they urgently proceed to surgical intervention.
Treatment
Surgery is the only treatment for intestinal tissue necrosis. Dead parts of the body have to be removed. First, the surgeon restores the blood supply, and then resects the affected area. After that, the sanitation of the abdominal cavity is done.
After the operation, the patient is prescribed a course of antibiotics and anticoagulants. Special solutions are administered to dissolve blood clots. Do novocaine blockade to prevent intestinal spasms. It is also necessary to administer drugs to maintain the work of the heart.
Drug therapy is only an additional method of treatment and is used after surgery. It is impossible to get rid of such a disease only by conservative methods.
Disability
Mostpronounced consequences are noted in patients after surgery for gangrene of the small intestine. Is there a disability group or not? This question is often of interest to patients.
During the operation, part of the intestine is removed. As a result, the length of the organ changes and its function changes. Patients have recurrent abdominal pain, flatulence, diarrhea, and weight loss. The condition after surgery is called short bowel syndrome (SBS). The purpose of the disability group depends on the degree of its severity:
- 3 group. It is prescribed in the event that the manifestations of SBS are moderate or moderate, and body weight is below the norm by no more than 5-10 kg.
- 2 group. It is established if the patient has a severe form of SBS. At the same time, in addition to diarrhea, there are signs of beriberi and metabolic disorders, and a person loses more than 10 kg of weight.
- 1 group. It is prescribed for the most severe patients in whom SCC occurs with complications, there are intestinal fistulas. This disability group is also established for those patients who have had 4/5 of the small intestine removed.
Forecast
The outcome of the disease largely depends on how timely medical care was provided for intestinal gangrene. The prognosis of this pathology is always very serious.
Even with a timely operation, death occurs in more than 50% of patients. Without surgery, mortality is 100%. Patients die from sepsis or peritonitis.
The sooner the patient is hospitalized and operated on, themore chance of survival. If assistance was provided on the first day of illness, then the prognosis is more favorable.
Prevention
How to prevent intestinal gangrene? To avoid such a dangerous disease, you need to be careful about your he alth. It is necessary to treat pathologies of the heart, blood vessels and organs of the gastrointestinal tract in time. If a person is often worried about abdominal pain, nausea, diarrhea and unreasonable weight loss, then you should immediately visit a doctor. At the initial stage of ischemia, it is still possible to normalize blood circulation and avoid a major operation.
