Mesenteric Ischemia

Mesenteric ischemia, also known as mesenteric vascular disease, is a medical condition in which injury of the small intestineoccurs due to not enough blood supply. It can come on suddenly, known as acute mesenteric ischemia, or gradually, known as chronic mesenteric ischemia. Acute disease often presents with sudden severe pain.

Symptoms may come on more slowly in those with acute on chronic disease. Signs and symptoms of chronic disease include abdominal pain after eating, unintentional weight loss, vomiting, and being afraid of eating. There are four mechanisms by which poor blood flow occurs: a blood clot from elsewhere getting lodged in an artery, a new blood clot forming in an artery, a blood clot forming in the mesenteric vein, and insufficient blood flow due to low blood pressureor spasms of arteries.

It is difficult to diagnose mesenteric ischemia early.[17] One must also differentiate ischemic colitis, which often resolves on its own, from the more immediately life-threatening condition of acute mesenteric ischemia of the small bowel.

NG tube decompression, angiogram for diagnosis and treatment, heparin anticoagulation. Papaverine to decrease arterial vasospasm. "Surgical revascularisation remains the treatment of choice for mesenteric ischaemia, but thrombolytic medical treatment and vascular interventional radiological techniques have a growing role".

This is the most common cause of mesenteric ischemia accounting for 40 to 50% of cases. The prognosis is poor with a 70% mortality rate. Onset of symptoms is sudden due to the acute nature of an embolus lodging in the artery with little time for collaterals to form. Patients with mesenteric artery embolus will present with the classic abdominal pain out of proportion to exam.