Mesenteric Ischemia (Intestinal Angina)

The mesenteric arteries are the arteries that supply blood to the large and small intestines. Mesenteric ischemia usually occurs when one or more of the mesenteric arteries narrows or becomes blocked. When this blockage occurs, you can experience severe abdominal pain. Mesenteric ischemia usually occurs in people older than age 60. Mesenteric ischemia is more common in smokers.

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. Acute means that the symptoms start abruptly and become very serious in a short period of time. Mesenteric ischemia is a serious condition that may come on and worsen quickly. Chronic mesenteric ischemia can progress without warning to acute mesenteric ischemia, sometimes very quickly.

Symptoms

In chronic mesenteric ischemia, you may experience severe pain in the abdomen 15 to 60 minutes after a meal. This pain can occur in any part of the abdomen, but most commonly it occurs in the middle to upper part. The pain may last for as long as 60 to 90 minutes and then disappear. Unfortunately, it tends to return the next time you eat. Many people with chronic mesenteric ischemia begin losing weight because, although they may feel hungry, they do not want to eat because they experience the pain (food fear).

In addition to abdominal pain and weight loss, other symptoms include:

  • Diarrhea
  • Nausea
  • Vomiting
  • Flatulence
  • Constipation


With acute mesenteric ischemia, you may have sudden, severe abdominal pain. Narcotic pain medications may not adequately alleviate the pain that is associated with mesenteric ischemia. Nausea and vomiting may also be associated with acute mesenteric ischemia.

Causes

Atherosclerosis with blockage of the mesenteric vessels
Blood clot may result in acute ischemia symptoms
Other conditions that may lead to mesenteric ischemia include:

  • Low blood pressure
  • Congestive heart failure
  • Aortic dissection
  • Occlusion or blockage of the veins in the bowel
  • Coagulation disorders
  • Unusual disorders of the blood vessels such as fibromuscular dysplasia and arteritits

Diagnosis

  • Ultrasound
  • CT Scan
  • Angiogram

Treatment

With acute mesenteric ischemia, you may have sudden, severe abdominal pain. Narcotic pain medications may not adequately alleviate the pain that is associated with mesenteric ischemia. Nausea and vomiting may also be associated with acute mesenteric ischemia.

Open Surgery

Open mesenteric artery bypass may be needed to establish blood flow to the intestines. This is performed through an incision in the abdomen. Treatment for acute mesenteric ischemia is usually an emergency procedure, since severe intestinal damage can occur rapidly in this setting. In some situations, the physician may use medications, called thrombolytic agents, to dissolve a clot, if one is found. However, the vascular surgeon may need to remove the clot surgically, especially if there is evidence of intestinal damage or too little time is available for the thrombolytic agent to work.

In cases of acute mesenteric ischemia, portions of the intestine can be damaged beyond repair. In addition to restoring the blood flow to your intestinal arteries, some patients require surgery to remove the damaged portions of the intestine. This is a decision your vascular surgeon will make, often in conjunction with other surgical specialists.

To restore blood flow surgically to the intestines, a bypass operation may be required in some cases. The operation is performed through an incision in the abdomen and bypasses are performed to the intestinal blood vessels from the aorta or in some cases the pelvic arteries.

Endovascular Options

In some cases of intestinal ischemia, stents can be placed in the intestinal blood vessels with restoration of blood flow. Stents can be placed through the groin arteries or in some cases through the arm arteries. Most patients are able to go home the same day or within 24 hours. After stents serial ultrasounds are performed in the office at regular intervals of six months to a year to assure long term patency.

Risks of Operation

Complications

With an open operation there are risks of bleeding and infection. In addition there are risks of bowel ischemia and perforation. There are chances of prolonged hospitalization and malnutrition. There are chances of short gut syndrome if a large amount of the intestine requires resection. There are chances of myocardial infarction, multi organ system failure and possibly a very small risk of death.

With the endovascular approach, there are chances of bleeding, infection, renal failure and a chance of conversion to open operation.