Pathological Study of the Intestinal Infarction -especially Non -occlusive Intestinal Infarction
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概要
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Among intestinal infarctions, there is a relatively high incidence of non-occlusive intestinal infarctions, which have no evidence of apparent mesenteric vascular occlusion . In these cases, etiology and/or pathogenesis are not known, though some authors described congestive heart failure, digitalis intoxication, minute vessel occlusion , vasospasmus and so on as the trigger of the disorders. The purpose of this study is to examine the vascular factors which have not been reported systematically. Fifteen autopsy cases were used for this study including five cases of vascular occlusive intestinal infarction (two of arterial occlusions, two of venous occlusions and one of strangulation) and ten non-occlusive ones. Specimens for pathological study were obtained from both mesenteries and intestinal walls. As to the lesions of the intestinal walls, there were some differences between arterial and venous occlusions. Arterial occlusion showed mucosal necrosis and submucosal congestion while venous occlusion showed marked edema and hemorrhage of intestinal walls with less common necrosis of the mucosa. Ten cases of non-occlusive intestinal infarctions consisted of eight diffuse and two segmental cases. In the latter, in addition to marked stenotic atherosclerosis of the proximal superior mesenteric artery(SMA), the branch of the SMA toward the impaired parts of intestine was also narrowed by arteriosclerosis. Three of eight diffuse infarction cases also had stenotic proximal SMA and one of them had diffuse arteriosclerotic narrowing from proximal SMA to small mesenteric arteries (vasa recta). One of the other five cases presented microthrombi in the intestinal wall, suggesting Disseminated intravascular coagulation (DIC). The remaining four cases had no obvious vascular changes. In clinical aspects, six of ten non-occlusive intestinal infarction cases had cardiac diseases such as congestive heart failure, myocardial infarction and pericardial effusion . Hypertension was also found in five of ten cases. Hypotension (shock) before intestinal symptoms became manifest was not seen in any cases.
- 1983-10-25
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