How should ischemic bowel disease be examined?

Ischemic bowel disease is a disease that is prone to infarction. It is caused by ischemia and hypoxia of the intestinal wall. Ischemic bowel disease is more common in some middle-aged and elderly patients with arteriosclerosis and heart failure. The main examinations and diagnosis for ischemic bowel disease include colonoscopy, barium examination, etc. Traditional Chinese medicine or intravenous rehydration is usually used to treat ischemic bowel disease.

Ischemic bowel disease is a disease caused by ischemia and hypoxia of the intestinal wall, which eventually leads to infarction. This disease is more common in elderly patients suffering from arteriosclerosis and heart failure. The lesions often occur segmentally with the splenic flexure of the colon as the center. The direct cause of colon ischemia is mostly due to vascular occlusion and stenosis of the mesenteric arteries and veins, especially the superior mesenteric artery, caused by atherosclerosis or thrombosis. Heart failure and shock can cause low blood pressure, and insufficient blood supply to the local intestine can also be causes of the disease.

Radiological examination

In 19 cases of abdominal plain films, localized spasm was observed in 16 cases in the early stage, followed by intestinal gas accumulation, segmental dilatation, and disappearance of the colon bag in the affected intestinal segment, but it was non-specific; transverse ridges similar to Kerckring's folds of the small intestine were observed in 7 cases, which is one of the characteristic X-ray signs of this disease, and free gas was found in 1 case, which was considered to be severe ischemic intestinal perforation.

Barium enema, especially double contrast colonography, is of great significance in the diagnosis of this disease. In the acute phase, characteristic multiple polypoid filling defects, called "finger pressure sign" or "pseudotumor sign", were seen in all 17 cases. Intestinal spasm and splenic flexure sharp angle sign were also common in the early stage. The presence of barium development in the intestinal wall in one case was specific, indicating that the necrosis reached deep into the muscle layer. Perforation was not performed in 1 case.

CT scans were performed in 13 of the 19 cases in the middle and late stages of the disease, which could clearly show changes such as annular thickening, stenosis, dilatation and gas accumulation of the intestinal wall, gas in the portal vein and free gas in the abdominal cavity, and mesenteric artery embolism, which are of great significance for diagnosis.

Treatment Cases

The treatment of intestinal dysfunction caused by ischemic bowel disease should focus on treating the primary disease. For example, actively correct shock, fast, provide intravenous hypernutrition, allow the intestine to fully rest, and give broad-spectrum antibiotics. When cardiac function is normal, drugs that cause mesenteric vasoconstriction, such as digitalis and vasopressin, should be withdrawn as much as possible. Severe intestinal dysfunction is not only not conducive to the recovery of ischemic lesions, but also can aggravate ischemia and even cause complications such as water and electrolyte disorders, protein-deficient colopathy, and colon perforation. Therefore, active symptomatic treatment should be given, such as giving intestinal venting and nasogastric tube decompression to those with colon distension; giving antiemetics and gastrointestinal motility drugs to those with nausea and vomiting; and giving intestinal mucosal protective agents such as smectite and bismuth subcarbonate to those with diarrhea.

Antispasmodics such as atropine, scopolamine, etc. and opium preparations such as phenoxylate and loperamide can reduce intestinal motility and increase the reabsorption of salt and water due to increased contact time with the intestine, thereby reducing the frequency of bowel movements and relieving abdominal pain. However, since these drugs may induce intestinal paralysis and intestinal perforation, they should be selected with caution in actual work. Glucocorticoids are not helpful for the recovery of ischemic lesions and may induce intestinal perforation, so their use is not recommended. Most non-gangrenous patients can improve within 1 week after the above treatment. If diarrhea, bleeding or obvious obstructive symptoms continue, surgical operation is generally required.