From the Guidelines
Mesenteric ischemia is a serious condition characterized by reduced blood flow to the intestines, leading to tissue damage and potential bowel necrosis, and its causes include arterial occlusion, non-occlusive causes, and venous thrombosis, with symptoms such as severe abdominal pain, postprandial pain, and fear of eating. The underlying pathophysiology of mesenteric ischemia involves intestinal hypoperfusion, cellular damage, and inflammatory cascade activation, resulting from various causes, including:
- Arterial occlusion (embolism or thrombosis)
- Non-occlusive causes (low cardiac output)
- Venous thrombosis Risk factors for mesenteric ischemia include:
- Atrial fibrillation
- Atherosclerosis
- Heart failure
- Hypercoagulable states According to the most recent study 1, the diagnosis of mesenteric ischemia should be suspected in a patient with sudden, severe abdominal pain and high thromboembolic risk, and CT angiography (CTA) is the preferred imaging modality for evaluating the underlying cause of ischemia and guiding treatment decisions. The symptoms of mesenteric ischemia can vary depending on the severity and chronicity of the condition, but common symptoms include:
- Severe abdominal pain
- Postprandial pain
- Fear of eating
- Abdominal tenderness
- Nausea and vomiting Early diagnosis through CT angiography and prompt treatment are essential to prevent irreversible intestinal damage, and treatment depends on the cause and severity of the condition, but typically involves:
- Fluid resuscitation
- Broad-spectrum antibiotics
- Surgical intervention, such as embolectomy, thrombectomy, bypass grafting, or bowel resection
- Anticoagulation with heparin for embolic or thrombotic causes
- Endovascular stenting or surgical revascularization for chronic mesenteric ischemia.
From the Research
Causes of Mesenteric Ischemia
- Mesenteric ischemia can be caused by a critical reduction in intestinal blood flow, resulting in bowel necrosis 2
- The main causes of acute mesenteric ischemia include acute superior mesenteric artery thromboembolic occlusion, mesenteric arterial thrombosis, mesenteric venous thrombosis, and nonocclusive mesenteric ischemia 3
- Mesenteric ischemia can also be caused by non-occlusive factors such as low flow or vasospasm 4
- Underlying conditions such as atrial fibrillation can increase the risk of mesenteric ischemia 5
Symptoms of Mesenteric Ischemia
- Acute mesenteric ischemia can manifest as sudden, unusual, and intense abdominal pain requiring opioids 4
- Chronic mesenteric ischemia can be revealed by postprandial abdominal pain associated with significant weight loss 4
- The clinical presentation of mesenteric ischemia is nonspecific, making diagnosis challenging 4
- Symptoms can also include bowel loop dilation, organ failure, and serum lactate elevation, which are predictive of irreversible intestinal necrosis 4
Diagnosis and Treatment
- Diagnosis of mesenteric ischemia requires a high index of suspicion, attention to history and physical examination, and early contract CT scanning 3
- Treatment options include medical management, such as aggressive rehydration, antibiotics, anticoagulation, vasodilators, and inhibitors of reperfusion injury 2
- Endovascular therapy, including catheter-based thrombolysis, thromboembolectomy, and stenting, can be used as a primary treatment option for mesenteric ischemia 6
- Surgical management, including superior mesenteric artery embolectomy or visceral artery bypass, may be necessary in cases of bowel infarction or when interventional techniques are not possible 2