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Commentary and Observations from
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Acute Versus Chronic Mesenteric Ischemia

Acute Versus Chronic Mesenteric Ischemia

Acute mesenteric ischemia (AMI), also commonly called bowel or intestinal ischemia, refers to inadequate blood flow to the small intestine (arterial or venous) that can result in acute bowel infarction. The classic clinical picture for a patient with AMI is abdominal pain disproportionate to the physical examination; the onset and severity of pain depends upon the duration of occlusion and the effectiveness of the collateral circulation. Abdominal and pelvic CT with intravenous contrast has been proven to be highly accurate in the diagnosis of mesenteric ischemia.

 

AMI Symptoms:

  • Abrupt, severe abdominal pain
  • Urgent need to have a bowel movement
  • Fever
  • Nausea and vomiting

Patients who manifest symptoms of chronic mesenteric ischemia (CMI) are typically over the age of 60, are more likely to be female, have a history of smoking, and a history of coronary heart, cerebrovascular, or lower extremity peripheral artery disease. These patients often complain of recurrent abdominal pain after eating, which is caused by an inability to increase blood flow to meet the intestine's postprandial demands. Thus, these patients develop food fear and can lose a considerable amount of weightwhich leads most practitioners to look for malignancies instead of CMI.

Stenosis of two or more of the major mesenteric vessels is a requirement for the diagnosis of CMI. As with AMI, CT of the abdomen with intravenous contrast is the initial imaging study of choice, since it can reliably identify or exclude the presence of atherosclerotic vascular disease and rule out other abdominal pathologies as the source of symptoms.

CMI Symptoms:

  • Abdominal pain that starts about 30 minutes after eating
  • Pain that worsens over an hour
  • Pain that goes away within 1 to 3 hours
  • Significant weight loss
  • Food fear
  • Nausea
  • Vomiting
  • Diarrhea

Management of AMI and CMI is too broad to go into detail in a short post, but the primary premise is to consult a vascular surgeon to evaluate the patient and to schedule a revascularization procedure if required.

References
  • Acosta S, Ogren M, Sternby NH, et al. Clinical implications for the management of acute thromboembolic occlusion of the superior mesenteric artery: autopsy findings in 213 patients. Ann Surg. 2005;241:516.
  • Kozuch PL, Brandt LJ. Review article: diagnosis and management of mesenteric ischaemia with an emphasis on pharmacotherapy. Aliment Pharmacol Ther. 2005;21:201-215.
  • Pecoraro F, Rancic Z, Lachat M, et al. Chronic mesenteric ischemia: critical review and guidelines for management. Ann Vasc Surg. 2013;27:113.
  • White CJ. Chronic mesenteric ischemia: diagnosis and management. Prog Cardiovasc Dis. 2011;54:36.

Filed under: Gastroenterology, Miscellaneous

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