Chronic Mesenteric Ischemia

Mesentery refers to the tissues that connect the blood vessels to the intestines. Ischemia refers to a restriction in blood supply. Mesenteric ischemia happens when an artery or vein that supports the intestine becomes blocked or narrow. Chronic mesenteric ischemia (CMI) develops gradually and is a long-term condition. This is sometimes referred to as "intestinal angina."

CAUSES

CMI occurs when fatty deposits are building up in an artery or vein, but have not yet restricted blood flow entirely. It can also be caused by a difference in some people's anatomy or by a large, rapid weight loss. When blood supply to the intestine is severely restricted, needed oxygen cannot reach the intestines for proper function.

Patients over age 50 with a history of coronary or vascular disease and people who smoke have the greatest risk for mesenteric ischemia.

SYMPTOMS

CMI usually feels like a severe stomachache. Some patients with CMI become fearful of eating due to pain. CMI typically causes:

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

  • Abdominal pain after eating that becomes worse over time.

  • Diarrhea.

  • Nausea.

  • Vomiting.

  • Bloating.

DIAGNOSIS

CMI is often diagnosed through the patient's history, physical exam, and X-ray tests such as CT scans or angiography. Angiography is an imaging test that uses a dye to obtain a picture of blood flow to the intestine.

TREATMENT

Treatment of CMI may include:

  • Medicines to reduce blood clotting and increase blood flow.

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

  • Surgery to remove the blockage, repair arteries or veins, and restore blood flow. In addition:

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

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

PREVENTION

Certain lifestyle factors can help to prevent CMI. These include:

  • Regular exercise.

  • Healthy weight.

  • Healthy diet.

  • Managing cholesterol levels.

  • Keeping blood pressure and heart rhythm problems under control.

  • Not smoking.

HOME CARE INSTRUCTIONS

  • Only take over-the-counter or prescription medicines as directed by your caregiver.

  • Keep all follow-up appointments as directed by your caregiver.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have severe abdominal pain.

  • You notice blood in your stool.

  • You develop 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.