Chronic mesenteric ischaemia

Chronic mesenteric ischaemia is a form of intestinal ischaemia and is, like acute mesenteric ischaemia, also a disorder of the elderly. Like acute ischaemia, chronic ischaemia is also relatively rare.

The condition occurs due to slowly progressive atherosclerotic stenosis of two or more of the mesenteric arteries. People with chronic mesenteric ischaemia are at higher risk for acute-on-chronic ischaemia, leading to infarction.

Clinical features

Symptoms include intestinal angina, referring to dull, cramping, postprandial epigastric pain which occurs within the first hour of eating. The pain subsides over the next couple of hours. This usually leads to food aversion and weight loss. The oxygen demand of bowel increases while digesting, which explains the origin of the pain.

On auscultation, an abdominal bruit may be heard due to stenosis of the mesenteric arteries.

Diagnosis

In a patient with other clinical features of atherosclerosis (AMI, stroke, PAD), the diagnosis of chronic mesenteric ischaemia is likely in the case of typical symptoms. CT angiography will reveal the stenoses themselves.

Treatment

As for all atherosclerotic disorders, reducing the risk factors of atherosclerosis is essential. Revascularisation procedures (angioplasty, stenting, bypass surgery) is the definitive treatment and also reduces the risk for infarction.