I.V. BARKHATOV¹, N.A. BARKHATOVA²

¹Regional Clinical Hospital No. 3, 287 Pobedy Ave., Chelyabinsk, Russian Federation, 454021

²South Ural State Medical University of the Ministry of Health of the Russian Federation, 64 Vorovskogo Str., Chelyabinsk, Russian Federation, 454092

  Contact details:

Barkhatov I.V. — Cand. Med. Sc., Head of the Endoscopy Department of the polyclinic, e-mail: [email protected]

Barkhatova N.A. — D. Med. Sc., Associate Professor, Professor of the Department of General Surgery, e-mail: [email protected]

Received: January 29, 2018, accepted for printing: April 9, 2018.

 The results of a comparative study of 113 patients with atherosclerosis of the aorta and chronic mesenteric insufficiency in the stage of compensation and decompensation of the visceral blood supply are presented in the article. In the presence of atherosclerosis of the aorta, stenoses of visceral arteries were diagnosed in 51 % of cases, and in 49 % of cases, dysfunction of these arteries was noted. The features of the clinic and endoscopic picture of the angiogenic pathology of the digestive organs are described. Modern methods and ultrasonic criteria for the diagnosis of stenosis and functional disorders of the visceral arteries are presented. The revealed high frequency of combination of atherosclerosis of the aorta with the pathology of its branches made it possible to determine the main directions of diagnostics and tactics of managing patients with chronic mesenteric insufficiency aimed at compensating visceral blood supply and correcting the pathology of the digestive organs. Among 113 patients, decompensation of chronic mesenteric insufficiency developed in 33.6 % of cases, and mortality in this complication was 15 %. Analysis of the features of the clinic and treatment tactics showed that in the acute stage of the disease there was a slow increase in the clinic, a more favorable course of the disease with frequent development of non-occlusive options of mesenteric thrombosis, with the development of decompensation more often noted in women older than 70 years. In this group of patients, operative activity was 61 %, but only 8 % of cases were performed by resection of necrotic areas of the intestine, and in 53 % of cases, operations were diagnostic. Nevertheless, the intensive therapy with anticoagulants, disaggregants, antispasmodics and vasopressors allowed reducing the symptoms of abdominal ischemia in 55.3 % of patients, which is higher than 5-15 % of the survival rate for mesenteric thrombosis. Early complex clinical, ultrasound and endoscopic diagnostics of organic and functional pathology of the aorta and its unpaired branches, conducting supportive angiotropic therapy is intended to improve the course of the disease, reduce the risk of decompensation of the visceral blood supply, accelerate its early diagnosis and ensure timely selection of optimal therapeutic approach.

Key words: chronic mesenteric insufficiency, abdominal ischemia, mesenteric thrombosis.

(For citation: Barkhatov I.V., Barkhatova N.A. Chronic mesenteric insufficiency in emergency surgical practice. Practical medicine. 2018, No. 2 (113))

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