Original title: I had stomachache on time at two or three o'clock every afternoon, and I lost more than 10 kilograms in more than a month. I even went to many hospitals to find out the cause! Who is the real murderer behind the bizarre abdominal pain?
Grandma Wang is 85 years old this year. In addition to hypertension and , her physical condition has always been OK and she lives a leisurely life. Who knew that starting half a year ago, a "strange disease" came to her, causing her torture - she had a stomachache as soon as she ate.
Regular abdominal pain began to occur half a year ago
Attack on time every two or three o'clock in the afternoon
The symptoms began to appear in February this year. The morning is fine, but after lunch, it will cause stomachache at two or three o'clock in the afternoon. At first she didn't care too much because the pain was not serious and it would be relieved in a while.
vague pain, obvious pain, and severe pain; half an hour, one hour, two hours... Time passed day by day, Grandma Wang's abdominal pain continued to worsen, and the duration increased exponentially. She also showed symptoms of vomiting, and she often vomited what she had eaten.
Grandma Wang ran to of community hospital for treatment. The doctor asked her to have an abdominal ultrasound. The result showed that there was no problem, so she could only take the painkiller and take it home first. The reason cannot be found, after all, taking painkillers can cure the symptoms but not the root cause.
As expected, the painkiller did not make Grandma Wang feel comfortable for long before it stopped working. However, the symptoms became more and more serious, and they developed even if they vomited when drinking water.
has a strong fear of eating
is less than 1.6 meters tall and only 65 kilograms left
"My mother was really in pain during that period. She had to feel pain and vomit as soon as she ate. She had a very strong fear of eating." Grandma Wang's son Lao Wang recalled that her mother did not dare to eat nor could she eat, and she couldn't bear it and then took a few sips of rice porridge.
"In July and August, she was tortured by hunger and pain at the same time. She almost lie on the bed with her body shrank down all day long. In more than a month, she lost more than ten kilograms, and was less than 1.6 meters tall, only 65 kilograms left." Lao Wang said that during that time, friends would be scared by her appearance when they came to visit her mother at home. Avoid Grandma Wang, and his friend lowered his voice and asked Lao Wang what was so bad and why was this happening.
"How could this happen? We also want to know why this happens, but we can't find the reason." Lao Wang smiled bitterly.
Recurrence and metastasis of gastric, intestinal, and tumors?
went to three hospitals, but the reason was still not found.
"eating" and "stomach pain". These two keywords are combined, and most people will think that there is something wrong with their stomach or intestines.
The family took Grandma Wang to the hospital and went to the Department of Gastroenterology and underwent B ultrasound and gastroenteroscopy. The results were the same as before, and no obvious problems were found. The treatment measures are still symptomatic treatment, and I really can't stand it and take some painkillers first.
"My mother had colon cancer surgery in 2013. She discovered it very early at that time. She didn't even need chemotherapy after the operation. Almost 10 years have passed, and even the doctor said that the probability of recurrence is very low. To be on the safe side, we took her to another hospital for examination."
is another round of new examination, and this time there is an additional CT. After getting the results, the possibility of tumor recurrence and metastasis was ruled out, and Grandma Wang's family was in a complicated mood. What I am happy about is that the tumor has not recurred or metastasized, but what I am worried about is that the cause of the problem has not been found.
Continue to change hospitals, but the reason may not be found forever. Grandma Wang's family even thought of going to the pain department for treatment, but after much trouble, there was no progress.
CT showed severe vascular calcification
Further examination found that the starting point of the superior mesenteric artery was severely stenosis
In early September, the family took Grandma Wang to the Affiliated Hospital of Hangzhou Normal University for treatment, which was the fourth hospital they went to.
At that time, because Grandma Wang was in severe pain and could not even straighten her waist, the doctor who received the doctor decided to admit her to the hospital first. At the strong request of the family, do all the tests again. At the same time, the hospital also arranged for multiple departments to consult Grandma Wang’s situation. pancreatitis , cholecystitis, gastric ulcer , tumor recurrence... one by one may be ruled out one by one, and the induce investigation is almost at a deadlock again.
On the seventh day after Grandma Wang was admitted to the hospital, Chief Physician Zhou Bing, director of the Department of Interventional Vascularity of the hospital, noticed a detail - CT showed that Grandma Wang's vascular calcification was severe.Combined with the symptoms of regular abdominal pain after meals, Director Zhou had a preliminary idea in his mind.
At the suggestion of Director Zhou, Grandma Wang underwent a CTA examination of the mesenteric artery (CTA: a non-invasive angiography). The examination results showed that Grandma Wang's superior mesenteric artery had severe calcification, resulting in multiple stenosis of the artery. The narrowest part of the blood vessel lumen was less than 1 mm, and the normal blood vessel diameter should be 8-9 mm, and almost all blood vessels were blocked. This result further confirmed Director Zhou's vision, and he immediately found Grandma Wang's family to communicate.
"In the elderly, atherosclerosis is very common due to problems such as aging blood vessels and hypertension. Therefore, although we have mastered the problem of arteriosclerosis from the beginning, it is difficult to think of further exploration. I think the old lady's condition may be that atherosclerosis causes intestinal artery stenosis, which leads to chronic paroxysmal or persistent intestinal blood perfusion, which seriously affects the blood supply of the small intestine, resulting in intestinal ischemia and intestinal dysfunction. Therefore, the symptoms of regular abdominal pain after eating and short-term weight loss occur. If further development continues, it may lead to intestinal necrosis and even life-threatening."
Conservative treatment is poor
All aspects of weighing minimally invasive surgery
Director Zhou told Grandma Wang's family that if you want to clearly diagnose superior mesenteric artery stenosis , CTA alone is not enough, and you also need to combine angiography . Although he has already gained most of the confidence in Grandma Wang's cause, it is impossible to say that abdominal pain after eating must be caused by stenosis of the superior mesenteric artery.
For patients with a clear diagnosis of superior mesenteric artery stenosis, the first treatment method is interventional minimally invasive treatment. The problem can be solved by simply sending the catheter into the stenotic blood vessel through the root of the thigh or the arm, and then dilating the blood vessel or implanting a stent. The entire operation is less trauma and quick recovery. Generally speaking, the condition will improve significantly 3 days after the operation. If the symptoms still exist one week after the operation, consider whether there are other reasons that have not been noticed.
Considering that Grandma Wang is 85 years old and has severe vascular calcification, there may be a risk of plaques falling off or blood vessel rupture during the operation, which will lead to serious consequences. Considering Grandma Wang's own situation, Director Zhou suggested that conservative treatment can be performed first through drugs, but drug treatment requires long-term persistence and may also occur repeatedly.
"Just like the highway from Hangzhou to Shanghai is blocked, the most direct way is to clear the expressway, but when direct clearing is not feasible, you can only change to the national highway, and the time spent on the road will be longer, and there is no guarantee that the national highway will not be traffic jams."
For more than a week of treatment for drug treatment, Grandma Wang's symptoms have been alleviated, but it has only been relieved, which is still relatively painful. After discussing with his family, Grandma Wang decided to make a decision. If she had been so painful, her quality of life would be too poor. After full communication between
, Zhou Bing's team immediately arranged a minimally invasive interventional surgery for Grandma Wang. Through puncture of brachial artery , the vascular sheath was inserted into the vascular sheath. The angiography in the operation identified the root cause of Grandma Wang's "strange disease", which is the stenosis of the superior mesenteric artery!
There was no time delay. Director Zhou used the balloon to carefully expand the narrow mesenteric artery and successfully placed a 5mm stent at the starting point of the narrowest. "The old lady's blood vessel wall is too calcified, its elasticity is weakened, and the blood vessel wall is bumpy. Choose a 5mm stent instead of directly dilating the blood vessel to 8-9mm, which is also to avoid 'excessive force' to avoid the blood vessel being broken. In order to make the operation smooth, we have discussed it repeatedly before the operation and thought of many ways. We also operate cautiously during the operation and do our best to ensure safety." After the stent was successfully placed, the stent of
was successfully placed, and the imaging showed that the blood flow of the mesenteric artery finally returned to patency, and the operation was very successful.
After the operation in the morning, Grandma Wang's abdominal pain had been significantly relieved that afternoon, and it almost didn't hurt the next day. After eating normally, there were no symptoms of abdominal pain or vomiting. The "strange disease" that tortured Grandma Wang for half a year was finally resolved!
Before being discharged from the hospital, Grandma Wang and her family were very happy and thanked the medical team of the interventional vascular department again and again.
"After the operation, my mother was able to eat and drink normally. She weighed almost 10 kilograms. It's not an exaggeration. We just weighed it." I contacted Lao Wang a month after the operation, and he was very happy on the other end of the phone. "She can eat a shallow bowl of rice for lunch and dinner, and eat meat and vegetables normally. In the past, she only ate light white porridge and side dishes for breakfast. Now she eats meat buns, vegetable buns, and flower rolls."
Superior mesenteric artery stenosis is often caused by the elderly
Repeated abdominal pain after eating for unknown reasons. It is recommended to check this item
Director Zhou introduced that superior mesenteric artery stenosis is often caused by the elderly, and most of them are caused by atherosclerosis, which causes insufficient blood supply in the intestinal tract, resulting in ischemic enteropathy . This disease is actually uncommon, but few are diagnosed.
"In clinical practice, there may be a considerable number of chronic abdominal pain caused by stenosis of the superior mesenteric artery, but it is rare to be as serious as Mrs. Wang. Among patients who have treated mesenteric artery stenosis, she is the most serious. Moreover, even if the superior mesenteric artery stenosis does not necessarily show symptoms, and it may even be asymptomatic, because one blood vessel blocks other blood vessels and causes compensation, it can still maintain the relatively normal supply of intestinal blood. There are no symptoms or the symptoms are not obvious, the patient will be himself. However, if you don’t come to the hospital, or if you happen to have other diseases, the stenosis of the superior mesenteric artery is ignored. After all, the cause of repeated abdominal pain lies in a blood vessel, which is still difficult to consider. "
Director Zhou reminds that the typical clinical manifestation of stenosis of the superior mesenteric artery is repeated abdominal pain after eating, which gradually worsens, which may be accompanied by nausea, belching, , abdominal distension, diarrhea, etc. If there is repeated abdominal pain after eating and the cause cannot be found, you can pay attention to checking the problem of the mesenteric artery.
Orange Persimmon Interaction·Urban Express Reporter Zhang Huili
Correspondent Zhu Yunxi
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