Diagnosis
Chronic mesenteric ischemia
Episodic or constinuous intestinal hypoperfusion.
Also known as: Abdominal angina, Intestinal angina
Etiology
Cause [nyn]
Atherosclerotic disease
Arterial hyperplasia
Vasculitis
Pathophysiology
Obstructive atherosclerosis in 2 of 3 mesenteric arteries:
truncus celiacus
mesenterica superior (most commonly)
mesenterica inferior
Risk factors [nyn]
Age (>60)
Smoking
Atherosclerosis
Diabetes mellitus
Hypercholesterolemia
Heart disease, including coronary artery disease, heart failure, heart valve disease and artrial fibrillation
Low/high blood pressure
Intra-abdominal cancer
Thrombophilia.
Epidemiology
Incidence per 100.000 [5os]
Symptoms & findings
Symptoms
Arrhythmia, Diarrhea, Malnutrition, Nausea, Vomiting, Weight loss
Clinical findings
Anemia, Atrial fibrillation, Electrolyte abnormality
Anamneses
None listed.
Localized findings
Approach
Blood test: anemia, hypoalbuminemia, electrolyte abnormalities ( malnutrition)
CT/MR angiography
Duplex ultrasound
Catheter angiography
Treatment
Endovascular repair, includes angioplasty and/or stent placement [ti6]
Indication for open surgical repair: [nyn]
Peritonitis
Massive GI hemorrhage
Ongoing abdominal pain, fever, or sepsis
Symptoms > 14-21 days
Chronic malabsorption leading to protein-losing colopathy
Colonoscopic evidence of segmental colitis with frank ulceration
Ischemic stricture and abdominal symptoms
Non-operative medical treatment: co-morbid patients not available for intervention:
Anticoagulation
Nitrate therapy (symptomatic)
Differential diagnoses
Acute mesenteric ischemia, Acute pancreatitis, Biliary obstruction, Celiac disease, Cholangitis, Cholecystitis, Chronic pancreatitis, Colorectal cancer, Diverticulitis, Esophageal hiatal hernia, Gastric cancer, Gastritis, Pyelonephritis, Ulcer disease
References
[1] Patel R, Waheed A, Kimyaghalam A, et al. Chronic Mesenteric Ischemia. [Updated 2025 Jan 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430748/
[2] Terlouw LG, Verbeten M, van Noord D, Brusse-Keizer M, Beumer RR, Geelkerken RH, Bruno MJ, Kolkman JJ; Dutch Mesenteric Ischemia Study Group. The Incidence of Chronic Mesenteric Ischemia in the Well-Defined Region of a Dutch Mesenteric Ischemia Expert Center. Clin Transl Gastroenterol. 2020 Aug;11(8):e00200.
[3] Hohenwalter EJ. Chronic mesenteric ischemia: diagnosis and treatment. Semin Intervent Radiol. 2009 Dec;26(4):345-51.
[4] http://emedicine.medscape.com/article/183683 (2014-01-02); [Medscape]