Mesenteric Ischemia

What is mesenteric ischemia?

Mesenteric ischemia is decreased or blocked blood flow to your intestine.

  • Ischemia means poor blood supply.
  • The main arteries that carry blood and oxygen to your intestines are called the mesenteric arteries.

When your intestines do not get enough blood and oxygen, you may have severe abdominal pain. If blood flow decreases too much, your intestines can stop working and start to die. This is a medical emergency.

What causes mesenteric ischemia?

There are 2 types of mesenteric ischemia:

  • Chronic mesenteric ischemia occurs when plaque builds up inside the walls of your mesenteric arteries. This is called atherosclerosis, or hardening of the arteries. As plaque builds, it starts to block blood flow through your artery. This type of ischemia may come and go for a while, and then become constant.
  • Acute mesenteric ischemia is a constant and severe decrease in blood flow. A blood clot that forms in the heart and then breaks free and blocks the mesenteric arteries often causes this condition.

Who is at risk for mesenteric ischemia?

Risk factors for mesenteric ischemia include:

  • Older age
  • Low blood pressure
  • High blood pressure
  • Heart disease, including coronary artery disease, heart failure, heart valve disease, atrial fibrillation
  • High cholesterol and triglycerides in the blood
  • Cigarette smoke
  • Blood that easily clots
  • Inflammatory conditions such as pancreatitis and diverticulitis
  • Rheumatologic conditions called vasculitis
  • Injury
  • Kidney failure
  • Decompression sickness, a deep water diving injury
  • Recent heart attack
  • Recent catheter studies of the blood vessels
  • Use of cocaine

What are the symptoms of mesenteric ischemia?

The main symptom of this condition is severe abdominal pain. The pain is usually in the middle or upper part of the abdomen at first, and then generalizes. If chronic, the pain usually starts within an hour after eating. It may last for an hour or more. People who have this type of pain may not eat and start to lose weight. Pain in acute mesenteric ischemia starts suddenly and continues, and is usually extremely severe.

Other symptoms include:

  • Diarrhea
  • Nausea
  • Vomiting
  • Gas
  • Constipation
  • Rectal bleeding
Later symptoms include:
  • Low blood pressure
  • Severe infection
  • Shock
  • Death

How is mesenteric ischemia diagnosed?

Diagnosing this condition starts with a history and physical exam. Your healthcare provider will check your abdomen and ask you about your pain. He or she will also ask about and any history of smoking, heart disease, or high cholesterol. Tests that may be done to diagnose the disease include:

  • Angiography. For this test, a long, thin tube called a catheter is inserted into an artery in the groin. It’s then threaded into the mesenteric arteries. Dye that shows up on X-rays is injected and images are taken. Once the blockage is found, treatment may be done through the catheter.
  • CT angiography. This test is similar to angiography but uses 3-Dimages guided by a computer.
  • MR angiography. This test is similar to other types of angiography, but the 3-Dimages are created using a computer and radio waves.
  • Doppler ultrasound. This test uses sound waves to create images of blood vessels to see whether blood is flowing through them.
  • Blood tests. Tests that measure the number of white blood cells and the level of acidity in the blood may help in the diagnosis.

How is mesenteric ischemia treated?

Acute mesenteric ischemia is an emergency. You must get treatment quickly to prevent permanent damage to your intestines or death. The exact treatment will depend on how severe the blockage is. Options include:

  • Angioplasty. A doctor does this procedure during an angiogram. A small balloon at the end of the catheter inflates to open up your artery and restore blood flow. Your doctor may leave in place a tiny support structure, called a stent. This helps keep your artery open.
  • Transaortic endarterectomy. During this procedure, a surgeon makes an incision into your abdomen and removes the plaque, or clot, from your artery.
  • Bypass surgery. In this abdominal operation, a surgeon uses a small vein or a man-made blood vessel to make a detour around your blocked artery.
  • Resection. If part of your small or large intestine has started to die and can't be saved, it may need to be removed.
  • Medicines. Your treatment may include medicines that restore fluid, dissolve clots, and open blood vessels.

Can mesenteric ischemia be prevented?

The best way to prevent this condition is to make healthy lifestyle choices:

  • Don’t smoke.
  • Don't do drugs.
  • Eat a healthy diet.
  • Exercise regularly.
  • Work with your healthcare provider to manage problems like diabetes, heart disease, high blood pressure, and high cholesterol.

If you have stomach pain after eating, tell your healthcare provider. If you have severe abdominal pain, along with other symptoms of mesenteric ischemia, seek medical care right away. If you have had mesenteric ischemia in the past, your healthcare provider may suggest you take long-term anticoagulation or antiplatelet therapy to prevent future attacks. 

When should I call my healthcare provider?

If you have pain after eating, diarrhea, nausea, or vomiting, or rectal bleeding, contact your healthcare provider. Severe abdominal pain may be an emergency and you should get treatment right away.

Key points

  • Mesenteric ischemia is decreased or blocked blood flow to your large or small intestine.
  • It can be chronic, due to plaque buildup over time, or acute, due to a blood clot. It can also happen from certain drugs and cocaine.
  • Acute mesenteric ischemia is an emergency.
  • Chronic mesenteric ischemia develops over time and causes pain about one hour after eating.
  • Acute mesenteric ischemia occurs suddenly and causes acute abdominal pain.
  • Urgent medical care is needed to prevent permanent damage to your intestines.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

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