Digestive infarction: what are the symptoms?

L’digestive (or intestinal) infarction corresponds to the suffering of the intestine due to an obstruction of one of its vessels. Same case as myocardial infarction or stroke, yet digestive infarction is much less known and often much more serious. Insufficiently irrigated, the digestive tract becomes necrotic and eventually dies. Update with Prof. Olivier Corcos, gastroenterologist, responsible at Beaujon de Clichy hospital (APHP), of the Structure of Intestinal Vascular Emergencies (SURVI), the only service dedicated to the management of digestive infarctions, which are still difficult to diagnose and treat.

What is a digestive infarction?

The digestive infarction is a bowel stroke. It would affect 10,000 people each year in France according to the French national society of gastroenterology. “The artery (or a vein in 20% of cases) is blocked, the digestive tract is then deprived of a sufficient blood supply. It suffocates, blackens and rots if the patient is not quickly taken care of. “, explains Prof. Oliver Corcos. Most often, it is the superior mesenteric artery that is partially or totally blocked.

This is an absolute emergency. “From the moment the artery is blocked, we are faced with a countdown of a few hours. During this time, the intestine necrosis and the bacteria present in the digestive tract invade the body and cause the death”, specifies the gastroenterologist.

Olivier Corcos distinguishes two forms of digestive infarction:

Gastrointestinal infarction occurring after chronic mesenteric ischemia: “also called mesenteric angina, it is the complete or partial occlusion of several arteries in the digestive tract. The arteries gradually become clogged. After a while, if the angina is not diagnosed, the patient is then the victim of a digestive infarction “, explains Olivier Corcos.
In the acute form, one of the arteries supplying the digestive system becomes blocked without any warning signs. “The subject is fine, suddenly a pain occurs then the intestine suffocates, blackens and ends up rotting”, describes the specialist.

What are the causes of digestive infarction?

The most common causes are :

embologenic heart disease: “The arrhythmia, the history of infarction, the diseases of the valves … these are pathologies which favor the occurrence of clots which will migrate from the heart into one of the arteries originating from the aorta, such as digestive arteries and which cause embolism “.
Atheromatous diseases: “Atheroma is this plaque of cholesterol which clogs the arteries to such an extent that blood no longer passes or an acute thrombosis appears on one of these plaques. Several diseases are the cause of atheroma; diabetes, l ‘hyper-cholesterolemia, blood pressure, family history, tobacco … ”

The rare causes :

Tearing of a digestive artery by dissection
Traumatic stroke
An invasive tumor that eventually clogs an artery or mesenteric vein

“In patients in intensive care, often in a state of shock, the arterial flow is not powerful enough to sufficiently vascularize the intestine. Without a sufficiently high blood pressure, the intestine risks suffering and necrosis”, explains Olivier Corcos.

What are the symptoms ?

In the case of chronic mesenteric ischemia, the patient has more and more stomach ache after meals. He can too vomiting or having diarrhea. “Almost always, we observe a change in eating habits. People eat in small quantities or skip a meal or split meals. food fear and weight loss“, emphasizes Olivier Corcos.

In acute forms, the patient feels a very severe abdominal pain. “They come to the emergency room or are taken there because the pain is unbearable and requires morphine to relieve it.”

How is the diagnosis made?

Currently only one abdominal scanner injected arterial (injection of a contrast product to see the arteries) makes it possible to make the diagnosis. “If during the scan, we do not look at the vessels or if we only look at the veins and not the arteries, then we will not be able to save the patient”, declares Prof. Corcos, who regrets that this still happens too often in hospitals.

He adds : “In the acute form of a digestive infarction, the patient should be taken care of within six hours. For patients suffering from chronic mesenteric ischemia, we have time, but we still have to make the right diagnosis. This again consists of observing the arteries during an abdominal CT angiography “.

What support ?

Upstream of the digestive infarction, for chronic mesenteric ischemias, the treatment consists of unclogging the artery by angioplasty, with stenting, or bypass.

For acute mesenteric ischemia, without appropriate management, the mortality rate rises to 100% after a digestive infarction. “If the correct diagnosis has been made, at the right time, before the necrosis of the intestine, the management consists of revascularizing the digestive system, by unblocking the artery mechanically or medically, or even removing a small part intestine “, explains our expert.

Besides the life of the patient, it is also a question of saving his intestine. “Removing a large part of the bowel – the extensive bowel resection – will save his life but living with a short bowel will put the patient at risk later on”, notes Prof. Olivier Corcos. It is therefore necessary to intervene sufficiently early to be able to treat the blocked artery. and not its consequence, the necrotic intestine.

Olivier Corcos is responsible for the SURVI device (Structure of Intestinal Vascular Urgences) at Beaujon Hospital in Clichy, which has developed a unique protocol in France for the management of these patients. It consists of rapid and coordinated action by several specialists: emergency physicians, radiologists, resuscitators, gastroenterologists, vascular and digestive surgeons.

For Olivier Corcos, it would be necessary that such a protocol – an intervention before the necrosis of almost the entire intestine and an optimal revascularization – could spread elsewhere in France. “This is one of the first abdominal emergencies, it is important to improve its management”, concludes our expert.

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