Mesenteric Ischemia: Causes, Symptoms, Daignosis, Prevention and Treatment

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Mesenteric Ischemia
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Mesenteric Ischemia

• Mesenteric ischemia is an uncommon condition
  that is characterized by obstruction of one of
  the arteries to the intestines.Blockage happens
  when a blood clot forms at a site which is
  already narrowed by atherosclerosis, when plaques
  gradually build up in the arterial walls, or when
  an embolus lodges in an artery.Less often,
  mesenteric ischemia results from obstruction of a
  vein leading away from the intestine. Total
  obstruction of a mesenteric artery due to severe
  atherosclerosis may be preceded by a period of
  "abdominal angina"abdominal pain that begins 20
  to 30 minutes after eating and lasts for several
  hours. Blockage resulting from an embolus happens
  without warning.Total blockage of a mesenteric
  artery causes death of the affected part of the
  intestine. Treatment involves extracting any
  permanently ruptured portion of the intestine
  and, if possible, extraction of the embolus or
  bypassing the portion of the artery which is
  obstructed by the clot.

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What causes mesenteric ischemia?

• Mesenteric thrombosis happens in people with
  far-advanced atherosclerosis (buildup of plaque
  and fatty matter on the blood vessel walls)
• Aneurysms (an abnormal enlargement or bulging) or
  blood clots in the vessels
• An embolus in the mesenteric arteries is most
  common in patients with atrial fibrillation,
  artificial heart valves, and valvular heart
  disease
• Oral contraceptives can increase the risk for
  occlusion of mesenteric veins

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Diagnosis of mesenteric ischemia

• Patient history and physical examination
• Abdominal x-ray
• For abdominal angina, a barium-swallow test or
  a CT scan may be followed by angiography.
• Magnetic Resonance Angiogram (MRA) scan can be
  done to produce the detailed three-dimensional
  images of your blood vessels from cross-sectional
  images of your body that are compiled.
• If complete blockage of a mesenteric artery is
  suspected, immediate angiography is done to
  locate the blockage, followed by emergency
  surgery if diagnosis is confirmed. When the
  diagnosis is strongly advised, surgery can be
  initiated without angiography.

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Symptoms of mesenteric ischemia

• Change in eating habits due to post-meal pain or
  fear of eating
• Flatulence
• Constipation
• Weight loss
• Abdominal swelling
• Nausea and vomiting
• Fever
• Diarrhea or constipation
• Rectal bleeding or bloody stools
• Rapid heartbeat

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Treatment of mesenteric ischemia

• When blockage of the mesenteric blood supply is
  only partial, surgical options include arterial
  bypass graft and percutaneous transluminal
  angioplasty.
• Complete occlusion requires immediate surgery.
  The ruptured part of the intestine is extracted
  and the left over ends are sewn together.
• A second operation is often needed 24 to 36 hours
  later to remove dead bowel tissue that was not
  apparent at the time of the first procedure.
• Heparin, an anticoagulant, may be administered
  after surgery to reduce the risk of subsequent
  clots.

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