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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 diarrhea (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.

Dr. Deepak Varma advises immediate attention and admission in case of intestinal blockages and gangrene.