hemorrhagic infarction of small intestine ICD-10: K55.0
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Frau, 60 J. Dünndarmteilresektat wegen sehr schmerzhaften akuten
Abdomens und beginnenden Schockzustandes
- Architektur der Darmwand noch erkennbar
- Darmwand verdickt wegen des starken Ödems
- Ausgedehnte Nekrose
- Gesamte Darmwand hämorrhagisch durchsetzt
- Mesenterium ebenfalls teilweise hämorrhagisch infarziert
Pathogenese:
- Embolus in der Arteria mesenterica superior oder einem ihrer Seitenäste.
Häufiger Ausgangspunkt: Endokarditis der Mitral- oder Aortenklappe
Thrombose der Vena portae
60-year-old female patient presented with acute abdomen and signs of shock. A partial
resection of the small intestine was performed.
- A section through the intestinal wall and the attached mesentery is shown.
- The architecture of the intestinal wall is maintained. However, the wall is swollen due to marked edema
(Ödems).
- The blood vessels show prominent congestion. Extensive interstitial hemorrhage permeates the wall and part of the mesentery.
- The mucosa shows extensive necrosis (Nekrose), submucosa and muscularis propria show beginning necrosis.
Pathogenesis:
Small intestinal infarction may be due to mesenteric arterial or venous occlusion. In both instances the net result will be hemorrhagic
infarction due to blood reflow into the damaged area. Infarction is more frequently caused by arterial occlusion. The latter may be due
to arterial thrombosis (e.g. severe atherosclerosis, systemic vasculitis) or arterial embolism (e.g. cardiac vegetations in endocarditis
of the mitral or aortic valve). Venous thrombosis is observed in patients with hypercoagulable states, intraperitoneal sepsis, cirrhosis
or invasive carcinoma, especially hepatocellular carcinoma.