MESENTERIC ISCHEMIA

-Vinsy Hannah Vinu

Shweta Sunil Ravi
INTRODUCTION

What does this condition’s name mean?

The mesentery (pronounced, “mess-ent-airy”) is an organ in your abdomen (belly) that holds several other
organs in place, including your small and large intestines, colon and more. The mesentery also has a
network of blood vessels that supply your organs inside.

Ischemia (pronounced, “iss-key-me-uh”) is when parts of your body aren’t getting enough blood flow.
Mesenteric ischemia means that the lack of blood flow is affecting your mesentery and your organs inside.

Mesenteric vascular disease is a condition that develops when the arteries in the abdomen that supply the
intestines with blood become narrowed due to the build-up of plaque (a process called atherosclerosis).
The result is a lack of blood supply to the intestines. The disease can come on suddenly with severe
abdominal pain or may develop over time.
Blood supply to the
intestines includes the celiac artery,
superior mesenteric artery (SMA),
inferior mesenteric artery (IMA), and
branches of the internal iliac artery
(IIA). Griffiths’ and Sudeck’s points,
indicated by shaded areas, are
watershed areas within the colonic
blood supply and common locations for
ischemia.
What are the different types of this condition?
There are two types of mesenteric ischemia:
Acute mesenteric ischemia
Heart attacks and strokes often happen because of blockages in critical arteries, and acute mesenteric
ischemia can happen in a similar way. This usually happens because of blood clots, which cause sudden
and very severe symptoms. This condition is a medical emergency that needs immediate care.
Acute MI (AMI) can occur as a result of
• arterial embolism
• arterial thrombosis
• mesenteric venous thrombosis
• non-occlusive causes.

Chronic mesenteric ischemia

Chronic mesenteric ischemia happens more gradually, usually because your mesenteric arteries start to
narrow. This condition takes longer to develop, and the symptoms usually worsen over time.
CMI is associated to diffuse atherosclerotic disease in more than 95% of cases, with all major mesenteric
arteries presenting stenosis or occlusion. Because of a lack of specific signs or due to its sometime quiet
presentation, this condition is frequently diagnosed only at an advanced stage.
INCIDENCE AND EPIDEMIOLOGY

Mesenteric ischemia is a rare issue. The estimated number of cases is 1 to 2 for

every 1,000 cases where someone needs hospitalization.
Mesenteric ischemia is more common as people age. It usually happens along with
heart and circulation conditions, especially ones that can cause blood clots.

Mean age = 70 years old (>70% of cases occur in women)

Causes
What causes this condition?
Different types of mesenteric ischemia have different causes.
Acute mesenteric ischemia
A waxy substance called plaque can build up inside of your arteries, causing them to harden. This condition,
atherosclerosis, happens commonly with cardiovascular disease. If an area of plaque breaks open, blood clots can form
there.
Clots can cause blockages in the following ways:
• A clot forming in your mesenteric artery (15% to 25% of cases).
• A clot getting stuck in your mesenteric artery (50% of cases).
• A clot forming in nearby veins of your mesentery (5% of cases). 
• Drugs.
• Medical procedures.
• Health conditions
Chronic mesenteric ischemia
Chronic mesenteric ischemia often happens because of circulatory diseases that cause blood vessels to narrow. This
narrowing, known as stenosis, means that blood flow to your mesentery drops over time.
This condition can also happen because a blood clot forms in a mesenteric blood vessel. When this happens, the clot can
grow over several days or even weeks, with symptoms getting worse as it gets larger.
While this condition isn’t usually life-threatening right away, about 40% of acute mesenteric ischemia cases happen after
a person has chronic symptoms. That’s because early symptoms from narrow blood vessels suddenly become severe when
a new clot blocks the narrowed blood vessels.
Symptoms
Acute mesenteric ischemia
Signs and symptoms of the acute form of mesenteric ischemia include:
•Abrupt, severe abdominal pain
•Urgent need to have a bowel movement
•Fever
•Nausea and vomiting
Chronic mesenteric ischemia
Signs and symptoms of the chronic form of mesenteric ischemia include:
•Abdominal pain that starts about 30 minutes after eating
•Pain that worsens over an hour
•Pain that goes away within one to three hours
Differential Diagnosis
Colitis
•Infectious colitis
•Ischemic colitis
•Ulcerative colitis
•CMV colitis
•Crohn's colitis

Diffuse Abdominal. pain
• Abdominal aortic aneurysm
• Aortocaval fistula
• Acute gastroenteritis
• Aortoenteric fisulta
• Appendicitis (early)
• Bowel obstruction
 COMPLICATIONS

• IF NOT TREATED PROMPTLY, ACUTE MESENTERIC ISCHEMIA CAN LEAD TO:

• SEPSIS. THIS POTENTIALLY LIFE-THREATENING CONDITION IS CAUSED BY THE
BODY RELEASING CHEMICALS INTO THE BLOODSTREAM TO FIGHT INFECTION.
IN SEPSIS, THE BODY OVERREACTS TO THE CHEMICALS, TRIGGERING
CHANGES THAT CAN LEAD TO MULTIPLE ORGAN FAILURE.
• IRREVERSIBLE BOWEL DAMAGE. INSUFFICIENT BLOOD FLOW TO THE BOWEL
CAN CAUSE PARTS OF THE BOWEL TO DIE.
• DEATH. BOTH OF THE ABOVE COMPLICATIONS CAN LEAD TO DEATH.
• PEOPLE WITH CHRONIC MESENTERIC ISCHEMIA CAN DEVELOP:
• FEAR OF EATING. THIS OCCURS BECAUSE OF THE AFTER-MEAL PAIN
ASSOCIATED WITH THE CONDITION.
• UNINTENTIONAL WEIGHT LOSS. THIS CAN OCCUR AS A RESULT OF THE FEAR
OF EATING.
• ACUTE-ON-CHRONIC MESENTERIC ISCHEMIA. SYMPTOMS OF CHRONIC
MESENTERIC ISCHEMIA CAN PROGRESS, LEADING TO THE ACUTE FORM OF
THE CONDITION.
 DIAGNOSIS
YOUR DOCTOR MIGHT SUSPECT THAT YOU HAVE CHRONIC MESENTERIC ISCHEMIA IF YOU HAVE PAIN
AFTER EATING THAT CAUSES YOU TO LIMIT FOOD AND LOSE WEIGHT. A NARROWING OF THE MAJOR
ARTERIES TO THE SMALL INTESTINE CAN HELP CONFIRM THE DIAGNOSIS.
TESTS MIGHT INCLUDE:
•ANGIOGRAPHY. YOUR DOCTOR MIGHT RECOMMEND A CT SCAN, MRI OR X-RAY OF YOUR ABDOMEN
TO DETERMINE IF THE ARTERIES TO YOUR SMALL INTESTINE HAVE NARROWED. ADDING A CONTRAST
DYE (MESENTERIC ANGIOGRAM, CT ANGIOGRAPHY OR MAGNETIC RESONANCE ANGIOGRAPHY) CAN
HELP PINPOINT THE NARROWING.
•DOPPLER ULTRASOUND. THIS NONINVASIVE TEST USES SOUND WAVES TO ESTIMATE BLOOD FLOW,
WHICH CAN DETERMINE NARROWING OF THE ARTERIES.
 TREATMENT
• IF A BLOOD CLOT CAUSES A SUDDEN LOSS OF BLOOD
FLOW TO THE SMALL INTESTINE, YOU MIGHT REQUIRE
IMMEDIATE SURGERY TO TREAT YOUR MESENTERIC
ISCHEMIA. MESENTERIC ISCHEMIA THAT DEVELOPS OVER
TIME MIGHT BE TREATED WITH A PROCEDURE THAT USES A
BALLOON TO OPEN THE NARROWED AREA.
• A MESH TUBE (STENT) MIGHT BE PLACED IN THE
NARROWED AREA. MESENTERIC ISCHEMIA CAN ALSO BE
TREATED VIA OPEN SURGERY THROUGH AN INCISION.
Risk factors