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 adecrease 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 happening fast and suddenly. Mesenteric Ischemia may be chronic, or developing over time. The body typically has safe guards 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, it 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 inside of intestine.
  • Imaging studies including X-ray and CT scan may be ordered.
  • Angiography. 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 which 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 dies or perforated (a hole formed), occasionally surgery is needed.

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