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Intestinal blockages and gangrene


Acute Mesenteric Ischemia is one of the leading causesof gangreneof intestines. The predominant cause is attributed to inadequate or interrupted blood flow through the intestines and mesenteric vessels. It is a rare condition and a life-threatening one leading to eventual gangrenous bowel wall. Embolic and thrombotic arterial occlusions occur due to insufficient blood perfusion of the colon and small bowel. Obstruction of the intestine is a major mechanical impairment. Obstruction is either partial or complete with mechanical obstruction being divided into large bowel obstruction and small bowel obstruction. Due to inadequate blood supply, the tissues of the body start dying a condition called gangrene.

Classifications of arterial ischemia

Arterial AMI: Arterial AMI is divided into NOMI or nonocclusive mesenteric ischemia and OMAI or occlusive mesenteric arterial ischemia

Venous AMI: Venous AMI is further divided into mesenteric venous thrombosis or MVT

Mechanical obstruction:

  • Food and fluid ingestions, gas and other digestive secretions gather above the blockage
  • Collapse of the distal segment
  • Distended proximal bowel
  • Depressed absorptive functions of the mucosa

Strangulating obstruction:

  • Associated with volvulus, intussusceptions, hernia
  • Progress to infarction and gangrene
  • Rapid ischemia of the bowel wall

Causes and risk factors of gangrene

  • Inadequate blood flow is the predominant cause
  • Diabetes
  • Atherosclerosis
  • Smoking
  • Peripheral arterial disease
  • Trauma
  • Raynaud s phenomenon

Causes of ischemic bowel

  • Strangulated hernia
  • Blood clots
  • Twisted part of the intestine
  • Cardiovascular disease
  • Tumours

Signs and symptoms of gangrenous bowel

  • Cramps and pain in the abdomen
  • Fever
  • Vomiting
  • Symptoms of ischemic bowel
  • Continuous and persistent abdominal pain
  • Bloody stools
  • Nausea and vomiting
  • Frequent urge for bowel movements and diarrhoea (if the colon is affected)

Diagnosis

  • Blood tests and lab studies: PTT; aPTT; CBC; INR; chemistry studies
  • X-ray: abdominal films
  • Angiography: preoperative planning of AMI
  • Contrast CT: for the assessment of ischemia
  • Duplex ultrasonography: for the presence of dilated bowel loops

Treatment

The gangrenous bowel is an emergency and requires surgical intervention. Resection of gangrenous tissue is performed. Antibiotics may be prescribed after the surgery.

I usually advise immediate attention and admission in case of intestinal blockages and gangrene.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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