Chronic Mesenteric Ischemia

Mesenteric ischemia is a deficiency of blood in an area of the intestine supplied by an artery that supports the intestine. Chronic mesenteric ischemia, also called intestinal angina, is a long-term condition. It happens when an artery or vein that supports the intestine gradually becomes blocked or narrow, restricting the blood supply to the intestine. When the blood supply to the intestine is severely restricted, the intestines cannot function properly because needed oxygen cannot reach them.

CAUSES

  • Fatty deposits that build up in an artery or vein but have not yet restricted blood flow entirely.

  • Differences in some people's anatomy.

  • Rapid weight loss.

  • Weakened areas in blood vessel walls (aneurysms).

  • Swelling and inflammation of blood vessels (such as from fibromuscular dysplasia and arteritis).

  • Disorders of blood clotting.

  • Scarring and fibrosis of blood vessels after radiation therapy.

  • Blood vessel problems after drug use, such as use of cocaine.

RISK FACTORS

  • Being female.

  • Being over age 50 with a history of coronary or vascular disease.

  • Smoking.

  • Congestive heart failure.

  • Diabetes.

  • High cholesterol.

  • High blood pressure (hypertension).

SIGNS AND SYMPTOMS

  • Severe stomachache. Some people become fearful of eating because of pain.  

  • Abdominal pain or cramps that develop about 30 minutes after a meal.  

  • Abdominal pain after eating that becomes worse over time.  

  • Diarrhea.  

  • Nausea.  

  • Vomiting.  

  • Bloating.  

  • Weight loss.

DIAGNOSIS

Chronic mesenteric ischemia is often diagnosed after the person's history is taken, a physical exam is done, and tests are taken. Tests may include:

  • Ultrasounds.

  • CT scans.

  • Angiography. This is an imaging test that uses a dye to obtain a picture of blood flow to the intestine.

  • Endoscopy. This involves putting a scope through the mouth, down the throat, and into the stomach and intestine to view the intestinal wall and take small tissue samples (biopsies).

  • Tonometry. In this test a tiny probe is passed through the mouth and into the stomach or intestine and left in place for 24 hours or more. It measures the output of carbon dioxide by the affected tissues.

TREATMENT

Treatment may include:

  • Medicines to reduce blood clotting and increase blood flow.  

  • Surgery to remove the blockage, repair arteries or veins, and restore blood flow. This may involve:  

  • Angioplasty. This is surgery to widen the affected artery, reduce the blockage, and sometimes insert a small, mesh tube (stent).  

  • Bypass surgery. This may be performed to bypass the blockage and reconnect healthy arteries or veins.  

  • A stent in the affected area to help keep blocked arteries open.

HOME CARE INSTRUCTIONS

  • Only take over-the-counter or prescription medicines as directed by your health care provider.  

  • Keep all follow-up appointments as directed by your health care provider.  

  • Prevent the condition from occurring by:

  • Doing regular exercise.

  • Keeping a healthy weight.

  • Keeping a healthy diet.

  • Managing cholesterol levels.

  • Keeping blood pressure and heart rhythm problems under control.

  • Not smoking.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have severe abdominal pain.  

  • You notice blood in your stool.  

  • You have nausea, vomiting, or diarrhea.  

  • You have a fever.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.