Mesenteric Ischemia

What is it?

The mesentery is a thin, connective tissue that holds the small intestines (jejunum and ileum) in place. Ischemia is a decrease in the blood supply. Mesenteric Ischemia is a decrease in blood flow to the intestines, caused by a blockage in a blood vessel, spasm of the vessel or decreased blood flow overall. Because of the lack of blood supply, there can be serious problems such as tissue death of that part of the intestine.

Who gets it?

Risk factors for developing this disorder include:

Elderly age
Atherosclerosis; this is a hardening of blood vessels when fat and other substances build on the wall of the vessel
Low cardiac output, meaning the heart is pumping out less blood with each beat
Irregular heart rhythms such as atrial fibrillation
Severe heart valve disease
Recent heart attack
Cancer in the abdomen
Peripheral vascular disease
Clotting disorder
Blood disorders
Abnormal clotting factors
Certain drugs

Why does it happen?

This problem can be acute or happen fast and suddenly. Mesenteric Ischemia may be chronic or developing over time. The body typically has safeguards in place to protect from lack of blood flow by having multiple different blood vessels serve each area of the small intestine. Injury happens not only because of lack of blood flow, but also when blood starts flowing again. The blow flow can be reduced due to blockage with a clot or a traveling particle, spasm of the vessel, or decreased blood being pumped out by the heart.

What are the symptoms?

Rapid onset severe abdominal pain, usually around the belly button.
Nausea
Vomiting
Forceful bowel movements

Sometimes the symptoms are slower to develop over weeks or months and may include:

Nausea
Vomiting
Nonspecific abdominal pain, may be triggered by eating
Aversion to eating
Weight loss

How is it diagnosed?

Typically your health care professional must have a high level of suspicion for the disorder based on other health problems.

Endoscopy – directly looking at the inside of the intestine.
Imaging studies including X-ray and CT scans may be ordered.
Angiography. A special dye is injected into the blood vessels so they will show up on pictures that are taken. This can show the area where there is an issue with the blood vessel. Angiography can also open up the blood vessel by injecting medicines, using a balloon that can be inflated, or placing a stent.

How is it treated?

The goal is to return blood flow to the intestine.
Blood-thinning agents may also be given to prevent clots.
The underlying cause must be diagnosed.
The cause must be treated with medications. Medicines to open the blood vessel or to break down clots may be given, or stents to open up the blood vessel may be placed. If part of the tissue has died or perforated (a hole formed), occasionally surgery is needed.