What are the causes of mesenteric ischemia?

The mesenteric arteries supply blood to the small and large intestines. Ischemia occurs when blood cannot flow through arteries and the intestines do not receive the necessary oxygen for digestion. Mesenteric ischemia usually involves the small intestine. Mesenteric ischemia usually occurs when one or more of those arteries narrows or becomes blocked. When this blockage occurs, severe abdominal pain is experienced. The blockage may worsen and cause intestinal tissues die because they lack enough blood flow. Mesenteric ischemia can be either chronic or acute. Chronic means that the condition and symptoms are experienced over a relatively long period of time, often with weight loss. Acute means that the symptoms start abruptly and can become very serious in a short period of time. Chronic mesenteric ischemia can progress without warning to acute mesenteric ischemia.

What are the symptoms of mesenteric ischemia?

Chronic mesenteric ischemia usually presents as follows:

• Severe abdominal pains 15 to 60 minutes after eating

• The pain may last for as long as 60 to 90 minutes and then disappear

• Diarrhea

• Nausea

• Vomiting

• Flatulence

• Constipation

Acute mesenteric ischemia usually presents as follows:

• Sudden, severe stomach pain.

• Nausea

• Vomiting

What are the risk factors for mesenteric ischemia?

Risk factors for mesenteric ischemia usually include:

• Age – the condition usually occurs in people older than age 60

• History of smoking

• High cholesterol level

Other conditions that may lead to mesenteric ischemia include:

• Celiac Compression Syndrome

• Low blood pressure

• Congestive heart failure

• Aortic dissection, which is a tear in the aorta's inner layer

• Occlusion or blockage of the veins in the bowel

• Coagulation disorders

• Unusual disorders of the blood vessels such as fibromuscular dysplasia and arteritits

Mesenteric ischemia is a serious condition that may come on and worsen quickly. It is extremely important that medical assistance is sought if symptoms develop.

What can be expected at the initial medical exam?

A vascular surgeon will try to determine if the condition presented is mesenteric ischemia and will develop a best method of treatment. Be prepared for the following:

• Medical history evaluation
  
  
  • General health
  
  
  • Symptoms
  
  
  • Family medical history


• Physical examination
  
  
  • Blood pressure evaluation

If mesenteric ischemia is suspected, further diagnostic testing to evaluate bowel and circulation systems will be necessary:

• Angiogram

• Doppler ultrasound

• Blood test

• Computed tomography (CT) scan

How is mesenteric ischemia treated?

The goal of treatment for mesenteric ischemia (both chronic and acute) is to re-open the artery to allow adequate blood flow to reach the intestine to allow it to work properly. Because this must be accomplished before permanent damage is done to the bowel, depending on the situation, treatment may be performed as an emergency or as a scheduled procedure.

Chronic Mesenteric Ischemia

Treatment for chronic mesenteric ischemia may include:

• Angioplasty and stenting

• Bypass surgery

• Trans-aortic endarterectomy

Acute Mesenteric Ischemia

Because acute mesenteric ischemia is treated on an emergency basis, a vascular surgeon will try to remove the clot with catheters or by surgery. Since the effectiveness, risk, and durability of each tool available for the treatment of mesenteric ischemia depends upon many issues, a vascular surgeon will advise the best procedure for each patient.