Mesenteric Ischemia

What is mesenteric ischemia?

Mesenteric ischemia is when blood flow to your intestine is decreased or blocked. The main blood vessels that send blood and oxygen to your intestines are called the mesenteric arteries. Ischemia means there is poor blood supply to the intestines.

When your intestines do not get enough blood and oxygen, you may have severe abdominal pain. If blood flow decreases too much, your intestines can stop working and start to die. This is a medical emergency.

What causes mesenteric ischemia?

There are two types of mesenteric ischemia:

• Chronic mesenteric ischemia. This type occurs when plaque builds up inside the walls of your mesenteric arteries. This is called atherosclerosis. It is also known as hardening of the arteries. As plaque builds, it starts to block blood flow through your artery. This type of ischemia may come and go for a while, and then become constant.

• Acute mesenteric ischemia. This type is a sudden and severe decrease in blood flow. A blood clot that forms in the heart and then breaks free and blocks the mesenteric arteries often causes this condition.

Who is at risk for mesenteric ischemia?

Risk factors for mesenteric ischemia include:

• Older age

• Low blood pressure

• High blood pressure

• Heart disease, including coronary artery disease, heart failure, heart valve disease, and atrial fibrillation

• High cholesterol and triglycerides in the blood

• Tobacco use and cigarette smoke

• Blood that easily clots

• Inflammatory conditions, such as pancreatitis and diverticulitis

• Rheumatologic conditions called vasculitis

• Injury

• Kidney failure

• Decompression sickness, a deep-water diving injury

• Recent heart attack

• Recent catheter studies of the blood vessels

• Use of cocaine

• Dialysis

What are the symptoms of mesenteric ischemia?

The main symptom of this condition is bad abdominal pain. The pain is usually in the middle or upper part of the abdomen at first and then spreads. If chronic, the pain usually starts within 1 hour after eating. It may last for 1 hour or more. People who have this type of pain may not eat. They may start to lose weight. Pain in acute mesenteric ischemia starts suddenly and continues. It is usually extremely severe.

Other symptoms include:

• Diarrhea

• Nausea

• Vomiting

• Gas

• Constipation

• Rectal bleeding

Later symptoms include:

• Low blood pressure

• Severe infection

• Shock

• Death

How is mesenteric ischemia diagnosed?

Your healthcare provider will check your abdomen and ask you about your pain. Your provider will also ask about any history of smoking, heart disease, or high cholesterol. You may have tests, such as:

• Mesenteric angiography. For this test, a long, thin tube called a catheter is put into an artery in the groin. It’s then threaded into the mesenteric arteries. Dye that shows up on X-rays is injected and images are taken. Once the blockage is found, treatment may be done through the catheter.

• CT angiography. This detailed X-ray test is like angiography, but uses 3-D images guided by a computer.

• MR angiography. This test is like other types of angiography, but the 3-D images are made with a computer and radio waves without the use of X-rays.

• Doppler ultrasound. This test uses sound waves to create images of blood vessels to see how well the blood is flowing through them.

• Blood tests. No single lab test can confirm the diagnosis. But this condition often causes elevated white blood cell counts, and lactate and amylase levels.

How is mesenteric ischemia treated?

Acute mesenteric ischemia is a medical emergency. You must get treatment quickly to prevent permanent damage to your intestines or death. The type of treatment will depend on how bad the blockage is. Choices include:

• Angioplasty. A healthcare provider does this procedure during an angiogram. A small balloon at the end of a catheter inflates to open up your artery and restore blood flow. Your healthcare provider may then put in a tiny support structure called a stent. It helps keep your artery open.

• Transaortic endarterectomy. During this procedure, a surgeon makes an incision into your abdomen and removes the plaque, or clot, from your artery.

• Bypass surgery. In this abdominal operation, a surgeon uses a small vein or a manmade blood vessel to make a detour around your blocked artery.

• Resection. If part of your small or large intestine has started to die and can't be saved, it may need to be removed.

• Medicines. Your treatment may include medicines that restore fluid, dissolve clots, and open blood vessels.

What can I do to prevent mesenteric ischemia?

The best way to prevent this condition is to make healthy lifestyle choices:

• Don’t smoke.

• Don't do illegal drugs.

• Eat a healthy diet.

• Exercise regularly.

• Work with your healthcare provider to manage problems like diabetes, heart disease, high blood pressure, and high cholesterol.

If you have stomach pain after eating, tell your healthcare provider. If you have severe abdominal pain, along with other symptoms of mesenteric ischemia, get medical care right away. If you have had mesenteric ischemia in the past, your healthcare provider may suggest you take anticoagulation or antiplatelet medicines to prevent future attacks. 

When should I call my healthcare provider?

If you have pain after eating, diarrhea, nausea, vomiting, or rectal bleeding, contact your healthcare provider. Severe abdominal pain may be an emergency, and you should get treatment right away.

Key points about mesenteric ischemia

• Mesenteric ischemia is decreased or blocked blood flow to your large or small intestine.

• It can be chronic, due to plaque buildup over time. Or it can be acute and happen suddenly, due to a blood clot. It can also happen from using certain illegal drugs like cocaine.

• Acute mesenteric ischemia is a serious medical emergency that needs immediate treatment.

• Chronic mesenteric ischemia develops over time and causes pain about 1 hour after eating.

• Acute mesenteric ischemia occurs suddenly and causes acute abdominal pain.

• Immediate medical care is needed to prevent permanent damage to your intestines or death.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are and when they should be reported.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends and holidays.