[Stenosis of the small intestine of ischemic origin in the adult (segmental and transmural lesions)]. / Sténoses de l'intestin grêle d'origine ischémique de l'adulte (lésions segmentaires et transmurales)

Focal ischemia of the small intestine does not always lead to necrosis and perforation, but may induce fibrous stenosis which is evidenced clinically by acute or chronic intestinal occlusion. Among 8 intestinal stenoses 5 were revealed by the presence of an intestinal occlusion whereas the others were manifested by intestinal occlusions complicated by subsequent perforation of the intestinal wall. Annulo-tubular stenoses of ischemic origin are frequently accompanied by inflammatory mesenteric adenopathies due to mucosal ulcerations in the septic environment of the intestinal lumen. Their aspect is reminiscent of Crohn's disease or annular carcinoma. Histological examination of the resected loop frequently reveals the primary oschemic origin of the stenotic lesion, characterized by the presence of macrophages loaded with hemosiderin in the thickened inflamed mucosa. The tissue alterations observed resemble those found in myocardial infarction, but the inflammatory response is more pronounced due to the septic medium. Although such stenoses are relatively rare, they should be distinguished from other lesions provoking a narrowing of the intestinal lumen, since their treatment calls for certain therapeutic precautions. In some cases, angioplastic intervention is required in order to improve perfusion of the vascular bed irrigated by the superior mesenteric artery following resection of the stenotic loop and termino-terminal anastomosis. Furthermore, during any operation requiring revascularization of the mesenteric vessels for intestinal angina, it is important to carry out a very careful examination of the state of the small intestine.