Mesenteric Arterial Occlusive Disease
What is Mesenteric Arterial Occlusive Disease?
Mesenteric ischemia is poor circulation in the vessels supplying blood flow to the mesenteric organs: stomach, liver, colon, and intestine.
Three major vessels serve the abdominal contents:
- Celiac trunk: Supplies the esophagus, stomach, proximal duodenum, liver, gallbladder, pancreas, and spleen
- Superior mesenteric artery (SMA): Supplies the distal duodenum, jejunum, ileum, and colon to the splenic flexure
- Inferior mesenteric artery (IMA): Supplies the descending colon, sigmoid colon, and rectum
ACUTE Mesenteric Ischemia
This is commonly caused by a blood clot, which travels to one of the mesenteric arteries and suddenly blocks blood flow. These clots often originate in the heart and are more common among patients with an irregular heartbeat or heart disease.
CHRONIC Mesenteric Ischemia
This is frequently due to atherosclerosis (hardening of the arteries), which slows the amount of blood flowing through the arteries. The plaque can cause the artery to narrow and stiffen which can reduce the blood flow or completely block the arteries.
Symptoms:
- Acute mesenteric ischemia- sudden, severe stomach pain, sometimes with nausea and vomiting.
- Chronic mesenteric ischemia- severe stomach pain 15-60 minutes after eating (postprandial abdominal pain). Pain can last for as long as 2 hours and tends to recur with every meal. Can also have nausea, vomiting, diarrhea, and flatulence.
- More common in females than men, more common in the fifth or sixth decades of life.
- Weight loss can happen with chronic mesenteric ischemia as there is the tendency to eat less due to the pain.
Diagnosis:
- History- crampy or colicky pain located in the epigastric area that begins 15–30 minutes following eating, lasts for 2–3 hours, and gradually subsides.
- Physical exam
- Mesenteric angiography or CT angiography
- Doppler ultrasound- mesenteric duplex – can sometimes identify arterial occlusion but the sensitivity is low
Treatment
Acute Cases:
- If the symptoms are related to a blood clot blocking the artery thrombolysis is usually done. Thrombolysis involves injecting clot-dissolving medication into a blood vessel and is often given at the same time as a diagnostic angiogram.
- Sometimes surgery may be required to remove the clot and restore blood flow to your intestinal arteries (Embolectomy, revascularization, with or without bowel resection).
- Treatment is usually an emergency as it can cause rapid severe intestinal damage.
Chronic cases:
- Angiogram with balloon angioplasty and stenting.
- Bypass surgery if angioplasty is not an option or if it was unsuccessful.