79 - Treatment of chronic mesenteric ischemia

Summary

Owing to the rich blood supply to the intestines, symptoms of chronic mesenteric ischemia are rare. The major vessels supplying the intestines are the celiac artery for the foregut, the superior mesenteric artery for the midgut, and the inferior mesenteric artery for the hindgut. Additionally, the inferior mesenteric artery receives a rich collateral flow from branches of both internal iliac arteries. In the event of chronic occlusion of one or more of the main arteries supplying the bowel, an extensive network of interconnecting branches ensures adequate collateral flow to the intestines. Hence, for symptoms of chronic mesenteric ischemia, stenosis or occlusion in two or more of the three major vessels is often necessary.

The diagnosis of chronic mesenteric ischemia can usually be suspected on clinical grounds alone. Postprandial pain is the most prevalent complaint, which may be accompanied by symptoms of bloating, weight loss, “food fear,” nausea, vomiting, diarrhea, and/or constipation. The pain is typically dull and crampy, poorly localized to the midepigastric region or midabdomen, and usually occurs within the first hour after eating. The symptoms are often severe enough to cause the patient to restrict food intake (“food fear”). The weight loss may be so acute as to result in cachexia and prompt a work-up for an underlying neoplasm. In the only available natural history study of chronic mesenteric ischemia, 86% of the patients developed symptoms significant enough to attempt revascularization or they died due to bowel ischemia.