Koch H
Fortschr Med. 1977 May 5;95(17):1155-9.
Blood flow disturbances in the gastrointestinal tract can lead to serious illness. They can be acute or chronic, their cause may be arterial or venous occlusion or hypotonia. Lesions of the gastrointestinal tract caused by ischemia depend on localisation, acuteness and degree of the blood flow disturbance. They may reach from focal and segmental ischemic lesions to extensive necroses of the entire intestinal tubes. The most serious ischemic disease is the embolic and thrombotic occlusion of the arteria mesenterica superior due to previous arterosclerotic damage. Infarction of a large part of the intestines and peritonitis can be the consequence. These patients' only chance of survival is early diagnosis--as a rule exclusively via angiography--and immediate surgery. Chronic occlusion of the arteria mesenterica superior leads to angina abdominalis which mainly occurs after food intake and can last for hours. The reason may also be a general arteriosclerosis. Men are affected more frequently and at a younger age than women. As a consequence of lowered intestinal blood flow these patients suffer from malabsorption and heavy weight loss. Conservative therapy is not effective. These patients, too, will have to be treated surgically after previous angiography. Vascular disease with decreased blood flow as its consequence can be found in a number of inflammatory diseases, in malign hypertensian, in collagen disease and in other more rare diseases as pseudoxanthoma elasticum or Ehlers-Danlos-syndrome. In the case of ischemic colitis arterial and more rarely venous occlusions cause decreased blood flow in the big bowel. A frequent consequence is colitis in the left colon which is characterized by acuteness, pain in the left side of the abdomen and by heavy rectal bleeding. Diagnosis is established by means of endoscopy, barium enema and angiography. Primarily therapy of ischemic colitis is of the conservative type. In severe cases with gangrene and peritonitis the colon has to be resected.
胃肠道血流紊乱可导致严重疾病。这些紊乱可以是急性的或慢性的，其病因可能是动脉或静脉阻塞或张力减退。缺血引起的胃肠道病变取决于血流紊乱的部位、急性程度和程度。病变范围可从局灶性和节段性缺血性病变到整个肠管的广泛性坏死。最严重的缺血性疾病是由于先前的动脉粥样硬化损伤导致的肠系膜上动脉栓塞和血栓形成性阻塞。其后果可能是大部分肠道梗死和腹膜炎。这些患者唯一的生存机会是早期诊断——通常只能通过血管造影——并立即进行手术。肠系膜上动脉慢性阻塞会导致腹绞痛，主要在进食后发作，可持续数小时。病因也可能是全身性动脉粥样硬化。男性比女性更易患病，且发病年龄更小。由于肠道血流减少，这些患者会出现吸收不良和体重严重减轻。保守治疗无效。这些患者同样需要在进行血管造影后接受手术治疗。在许多炎症性疾病、恶性高血压、胶原病以及其他更罕见的疾病如弹性假黄瘤或埃勒斯-当洛综合征中，均可发现以血流减少为后果的血管疾病。在缺血性结肠炎中，动脉阻塞，较少见的是静脉阻塞，会导致大肠血流减少。常见的后果是左半结肠结肠炎，其特点是起病急、左下腹疼痛和严重的直肠出血。通过内镜检查、钡剂灌肠和血管造影来确诊。缺血性结肠炎的主要治疗方法是保守治疗。在出现坏疽和腹膜炎的严重病例中，必须切除结肠。
