The intestines are cramping

Many people often feel intermittent cramping in their intestines, but they dare not go to the hospital for a check-up, for fear of finding out what disease they are suffering from. You must be careful with this kind of stomach and intestinal pain, as you may have intestinal spasm, intestinal colic, or gastrointestinal ulcers or gallbladder inflammation. The cause of stomach and intestinal pain must be identified, because early detection and early treatment will lead to faster recovery.

The main nutrient arteries of the gastrointestinal tract are the celiac artery, the superior mesenteric artery and the inferior mesenteric artery. When chronic occlusion occurs, three possible consequences may occur: establishment of adequate collateral circulation; intestinal infarction; intestinal ischemia without infarction.

The latter is because the collateral circulation is sufficient to maintain intestinal vitality, but not enough to maintain the physiological function needs during eating, so postprandial intestinal pain occurs. It is named intestinal colic because its clinical condition is similar to angina pectoris and intermittent claudication.

Disease diagnosis

1. It needs to be differentiated from peptic ulcer, cholecystitis, pancreatitis and abdominal masses.

2. It needs to be differentiated from mesenteric artery embolism and thrombosis.

Inspection method

Laboratory tests:

Decreased hematocrit, hypoproteinemia, hypocholesterolemia and low immunity, etc. In some cases, jejunal or colonic puncture biopsy can reveal manifestations of chronic ischemia, including atrophy of intestinal mucosal villous, flattening of epithelial cells, and chronic swelling.

Other auxiliary examinations:

1. Selective visceral artery angiography

(1) Anteroposterior abdominal artery angiography: The catheter is inserted through femoral artery puncture to the upper part of the origin of the abdominal artery. After a small test dose is given to confirm that the catheter is properly positioned, 30-40 ml of 50% sodium gluconate diatrizoate is injected. Then, multiple rapid and continuous films are taken to show whether one or both of the abdominal artery and superior mesenteric artery are stenotic or occluded.

(2) Inferior mesenteric artery angiography: After celiac artery angiography, the catheter is inserted above the origin of the superior mesenteric artery and angiography is performed. If the inferior mesenteric artery is significantly dilated and elongated and the superior mesenteric artery is filled by collateral circulation, it indicates superior mesenteric artery occlusion.

(3) Lateral arterial angiography: For medial arcuate ligament syndrome, lateral arterial angiography can show compression of the superior edge of the celiac artery and caudal displacement of the artery, while the superior and inferior mesenteric arteries usually appear normal.

2. Doppler ultrasound examination: The proximal part of the obstruction may show high-speed jet blood flow or blood flow disorder spectrum. If there is blood reflux in the hepatic artery, it indicates obstruction or severe stenosis of the celiac artery. In addition, the mesenteric vascular flow can also be measured. The typical intestinal large blood vessel flow is 500-1200 ml/min, which is 10%-20% of the cardiac output.

3. Magnetic resonance imaging: There is a significant difference in the blood flow of the superior mesenteric artery between normal people and patients within 30 minutes after a meal. Simultaneous measurement of the blood flow of the superior mesenteric artery and superior mesenteric vein showed that the more severe the superior mesenteric artery occlusion, the less obvious the increase in the blood flow ratio between the superior mesenteric artery and the superior mesenteric vein after a meal.