Mesenteric Ischemia
POSTED BY Dr. Sumit Kapadia | Jul 09, 2024

Understanding Mesenteric Ischemia: Causes, Symptoms, and Treatments

Have you ever wondered what happens when the blood supply to your intestines is suddenly cut off? This condition, known as mesenteric ischemia or abdominal angina, and can be life-threatening if not treated promptly. 

In this blog, we will explore the different types of mesenteric ischemia, their causes, symptoms, and available treatment options. Let’s dive into the details.

What is Mesenteric Ischemia?

Mesenteric ischemia is a condition in which blood flow to the intestines is reduced, which can lead to tissue damage or death if not treated quickly. The mesentery is a fold of tissue that attaches the intestines to the abdominal wall and contains the blood vessels that supply them. When these blood vessels are blocked or narrowed, the blood flow to the intestines is reduced, leading to mesenteric ischemia.

What are the Different Types of Mesenteric Ischemia?

Mesenteric ischemia can be classified into two main types: acute mesenteric ischemia and chronic mesenteric ischemia.

Acute Mesenteric Ischemia

Acute mesenteric ischemia is a sudden reduction in blood flow to the intestines. It is an emergency situation that requires immediate medical attention. If not treated promptly, it can rapidly progress to intestinal tissue death (necrosis or gangrene). 

Acute mesenteric ischemia accounts for about 0.1% of all hospital admissions and has a high mortality rate if not treated quickly. Delayed diagnosis can often end up with extensive bowel gangrene, septicemia and death! 

Chronic Mesenteric Ischemia

Chronic mesenteric ischemia, on the other hand, develops slowly over time due to a gradual reduction in blood flow. This type is less urgent but still requires medical treatment to prevent complications. 

Patients with chronic mesenteric ischemia often experience symptoms for months or even years before being diagnosed. The condition is often underdiagnosed because its symptoms can be similar to other gastrointestinal disorders.

Who Does It Affect?

Mesenteric ischemia can affect anyone, but it is most commonly seen in older adults, particularly those over the age of 60. Other risk factors include a history of cardiovascular disease, smoking, high cholesterol, and diabetes. 

People with conditions that increase blood clotting, such as atrial fibrillation or thrombophilia, are also at a higher risk. Additionally, individuals with a history of peripheral artery disease or abdominal aortic aneurysm are more susceptible to developing mesenteric ischemia.

What Causes This Condition?

Causes of Acute Mesenteric Ischemia

  • Blood Clots: The most common cause of acute mesenteric ischemia is a blood clot (embolus) that blocks one of the major arteries supplying blood to the intestines. These clots often originate from the heart, especially in patients with atrial fibrillation.
  • Narrowing of Arteries: Severe narrowing of the mesenteric arteries due to atherosclerosis can also cause acute ischemia. When atherosclerotic plaques rupture, they can lead to the sudden blockage of blood flow.
  • Low Blood Pressure: Extremely low blood pressure, often due to shock or heart failure, can reduce blood flow to the intestines, leading to ischemia.
  • Vasospasm: Spasms of the intestinal arteries can also lead to acute mesenteric ischemia. This can occur in response to certain medications or conditions that cause the blood vessels to constrict.

Causes of Chronic Mesenteric Ischemia

  • Atherosclerosis: The most common cause of chronic mesenteric ischemia is atherosclerosis, where fatty deposits build up in the arteries, reducing blood flow. This process occurs gradually over many years.
  • Other Conditions: Chronic mesenteric ischemia can also be caused by other conditions that affect blood flow, such as vasculitis (inflammation of the blood vessels) or fibromuscular dysplasia (abnormal growth of the artery wall).

What are the Symptoms?

Symptoms of Acute Mesenteric Ischemia

  • Severe Abdominal Pain: The hallmark symptom of acute mesenteric ischemia is sudden, severe abdominal pain that is out of proportion to physical findings. Patients often describe it as the worst pain they have ever experienced.
  • Nausea and Vomiting: These symptoms often accompany the abdominal pain and can be severe.
  • Diarrhea: Some patients may experience diarrhea, which can be bloody in advanced cases.
  • Blood in Stool: In advanced cases, there may be blood in the stool, indicating significant intestinal damage.

Symptoms of Chronic Mesenteric Ischemia

  • Postprandial Pain: Pain that occurs after eating is a common symptom of chronic mesenteric ischemia. The pain typically starts 15-60 minutes after a meal and can last for several hours.
  • Weight Loss: Due to the pain associated with eating, patients often avoid food, leading to significant weight loss.
  • Diarrhea: Chronic mesenteric ischemia can also cause diarrhea, which may be accompanied by abdominal cramps.

How is It Diagnosed?

Mesenteric ischemia is diagnosed through a combination of patient history, physical examination, and diagnostic tests. Common tests include:

  • CT Angiography: This imaging test provides detailed pictures of the blood vessels and can quickly identify blockages or narrowing in the mesenteric arteries. It is the preferred diagnostic tool for mesenteric ischemia.
  • Magnetic Resonance Angiography (MRA): An alternative to CT angiography that uses magnetic fields and radio waves to produce images of the blood vessels. It is useful for patients who cannot undergo CT angiography due to contrast allergies or kidney issues.
  • Doppler Ultrasound: This test measures blood flow in the mesenteric arteries and can help detect blockages or reduced blood flow.
  • Blood Tests: Blood tests can help identify markers of ischemia, such as elevated lactate levels, and rule out other conditions that may cause similar symptoms.

What Treatments Are Used?

Treatment for Acute Mesenteric Ischemia

  • Surgery: Emergency surgery is often required to remove the clot and restore blood flow. This may involve open surgery to remove the clot or bypass the blocked artery. Along with this, if the bowel shows evidence of gangrene, the damaged part of bowel is resected and removed. 
  • Angioplasty: In some cases, thrombolysis followed by angioplasty with or without stenting can be used to open blocked arteries. This minimally invasive procedure involves inserting a balloon-tipped catheter into the artery and inflating the balloon to widen the artery.
  • Medications: Blood thinners may be administered to prevent further clotting. In some cases, thrombolytic agents (clot-busting drugs) may be used to dissolve the clot.

Treatment for Chronic Mesenteric Ischemia

  • Angioplasty and Stenting: This minimally invasive procedure can open narrowed arteries and improve blood flow. A stent (a small mesh tube) may be placed in the artery to keep it open.
  • Bypass Surgery: In severe cases, bypass surgery may be necessary to reroute blood flow around the blocked arteries. This involves creating a new pathway for blood to reach the intestines.
  • Medications: Medications to control risk factors such as high cholesterol, hypertension, and diabetes are also important. These may include statins, antihypertensives, and antiplatelet agents.

What are the Possible Complications and Side Effects of This Condition and Its Likely Treatments?

Complications of untreated mesenteric ischemia can include:

  • Bowel Necrosis: Death of intestinal tissue, which can lead to sepsis and death. Bowel necrosis is a life-threatening condition that requires emergency surgery to remove the dead tissue.
  • Peritonitis: Inflammation of the abdominal lining, often due to bowel perforation. Peritonitis is a serious complication that can lead to severe infection and requires immediate medical attention.

Side effects of treatments can include:

  • Bleeding: Both surgery and angioplasty carry a risk of bleeding. Patients may experience bleeding at the site of the incision or catheter insertion.
  • Infection: Any surgical procedure carries a risk of infection. Patients may develop infections at the surgical site or within the abdomen.
  • Restenosis: Narrowing of the arteries can recur after treatment, especially in patients with ongoing risk factors such as smoking or high cholesterol.

How Soon Will I Recover After Treatment?

Recovery time varies depending on the severity of the ischemia and the type of treatment received. Patients who undergo surgery may need several weeks to recover, while those who have angioplasty and stenting may recover more quickly. Follow-up care is crucial to monitor for any complications and to manage underlying risk factors.

How Can I Prevent This?

Preventing mesenteric ischemia involves managing risk factors:

  • Healthy Diet: Eating a diet low in saturated fats and high in fruits, vegetables, and whole grains can reduce the risk of atherosclerosis. Foods rich in omega-3 fatty acids, such as fish, can also help improve vascular health.
  • Regular Exercise: Exercise helps maintain healthy blood vessels and reduces the risk of blood clots. Aim for at least 150 minutes of moderate-intensity exercise per week.
    Also read – Best Workouts for blood Circulation
  • Avoid Smoking: Smoking cessation is critical in preventing vascular diseases. Smoking damages the blood vessels and increases the risk of atherosclerosis and blood clots.
  • Control Chronic Conditions: Managing conditions like diabetes, high blood pressure, and high cholesterol is essential. Regular check-ups with your healthcare provider and adherence to prescribed medications can help keep these conditions under control.

When Should I Seek Medical Care?

Seek immediate medical care if you experience sudden, severe abdominal pain, especially if you have risk factors for mesenteric ischemia. 

Early diagnosis and treatment are crucial to prevent complications. If you experience symptoms of chronic mesenteric ischemia, such as postprandial pain and weight loss, consult your healthcare provider for evaluation and management.

Conclusion

Mesenteric ischemia is a serious condition that requires prompt medical attention. Whether acute or chronic, recognizing the symptoms and seeking timely treatment can make a significant difference in outcomes. If you or a loved one are experiencing symptoms of mesenteric ischemia, it is essential to consult with a healthcare professional.

For those in Vadodara, Dr. Sumit Kapadia, a renowned vascular and endovascular surgeon, offers expert care and treatment for mesenteric ischemia and other vascular conditions. With his expertise and commitment to patient care, you can be assured of receiving the best possible treatment.

FAQs

The survival rate for mesenteric ischemia varies, with acute cases having a high mortality rate of 60-80% without prompt treatment, while chronic cases have a better prognosis with proper management.

Mesenteric ischemia typically affects older adults, with the average age of onset being over 60 years old. This is primarily due to the progressive nature of atherosclerosis and other vascular conditions that contribute to reduced blood flow to the intestines over time.

Consume a diet rich in fruits, vegetables, whole grains, lean proteins, and omega-3 fatty acids to support vascular health.

Avoid high-fat, processed foods, trans fats, excessive salt, and sugary foods to reduce the risk of atherosclerosis and blood clots.

Red flags include sudden, severe abdominal pain, postprandial pain, unintentional weight loss, nausea, vomiting, and bloody stools.

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