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Mesenteric Ischemia

The mesenteric arteries supply blood to your small and large intestines. Ischemia occurs when your blood cannot flow through your arteries and your intestines do not receive the necessary oxygen for digestion. Mesenteric ischemia usually involves the small intestine.

Causes of Mesenteric ischemia

Mesenteric ischemia usually occurs when one or more of those arteries narrows or becomes blocked. When this blockage occurs, you can experience severe abdominal pain. The blockage may worsen and cause tissues in your intestine to die because they lack enough blood flow.

Mesenteric ischemia can be either chronic or acute. Chronic means that you have had the condition and symptoms 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.

Symptoms of Mesenteric Ischemia

Chronic mesenteric ischemia usually presents as follows:

  • Severe pains in your abdomen 15 to 60 minutes after you eat.  (Chronic Intestinal Angina)
  • 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

Risk Factors

Risk factors for Mesenteric Ischemia usually include:

  • Age.  This 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 you go to your physician or the emergency room if you experience any of the symptoms.

What to Expect at Your Medical Exam

Your vascular surgeon will try to determine if you are suffering from mesenteric ischemia as well as the best method of treatment.

  1. Your vascular surgeon will ask you questions about your:
    1. general health
    2. medical history
    3. symptoms
  2. Your vascular surgeon will conduct a physical examination. You will be asked about family and medical history.  Your vascular surgeon will ask you to describe your symptoms; how often they occur, how often and their location.
  3. Your vascular surgeon will listen for sounds of blood flow in your carotid arteries. Your blood pressure will be taken.
  4. After the history and exam, if your vascular surgeon suspects you have mesenteric ischemia, he or she will recommend further diagnostic testing to evaluate your bowel and circulation.

Diagnostic Testing 

Diagnostic testing for mesenteric ischemia usually includes:

  • Angiogram
  • Doppler ultrasound
  • Blood test. When you have mesenteric ischemia, especially the acute variety, your white blood cells may be high. Blood tests may also show if acid in your blood is at high levels, a condition called acidosis. These findings may indicate the threat of serious bowel injury.
  • Computed tomography (CT) scan

Treatment for Mesenteric Ischemia

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

Treatment for Chronic Mesenteric Ischemia

  • Angioplasty and stenting
  • Bypass surgery. In this surgical procedure, the surgeon creates a detour around a narrowed or blocked section of the artery.
  • Trans-aortic endarterectomy.  This surgical procedure is performed rarely.  The goal is to remove plaque that blocks your mesenteric artery.

Treatment for Acute Mesenteric Ischemia

Because acute mesenteric ischemia is treated on an emergency basis, the 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, your vascular surgeon will advise you as to what procedure is the best for your particular situation. 

Physicians who treat this condition

 

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