Mesenteric Ischemia-Diagnosis and Outcomes
Intestinal ischemia-Abdominal Pain, CT scans, and Angiography
Jul 20, 2009
The Symptoms, Diagnosis, and Outcomes of acute and chronic mesenteric ischemia are discussed below. Other articles discuss the Pathophysiology, Causes, and Effects of mesenteric ischemia and the Treatment Options.
Symptoms of Mesenteric Ischemia
Acute Mesenteric Ischemia
The most common symptom is abdominal pain out of proportion to what is expected based on the degree of tenderness on examination. The patient may also have nausea, vomiting, and diarrhea. The patient can have bloody stools and signs of peritonitis if infarction of the intestines occurs.
Chronic Mesenteric Ischemia
Patients with chronic mesenteric ischemia gradually develop abdominal pain after eating and weight loss. This occurs because the intestines work harder to move and digest food after eating. This requires more blood and oxygen. In chronic mesenteric ischemia, the narrowed arteries (due to atherosclerosis) cannot deliver enough oxygen (see Part 1), so pain after eating occurs.
Diagnosis of Mesenteric Ischemia
Blood tests can reveal an elevated white blood cell count, acidosis, and later, elevated amylase and creatine kinase. However, laboratory studies are not very useful in diagnosing mesenteric ischemia before infarction (cell death) has occurred.
A CT scan can help to look for other causes of abdominal pain and can help to diagnose ischemia of the intestines and mesentery (fatty tissue around the intestines). CT scan can also detect a narrowing of the intestinal blood vessels.
Angiography, in which a contrast dye is injected into the blood vessels, allows the clinician to see exactly how narrowed the intestinal blood vessels are. This is the best test to diagnose mesenteric ischemia.
X-rays are usually not useful, and MRI and ultrasounds are occasionally useful in the diagnosis of mesenteric ischemia.
Treatment of Mesenteric Ischemia
Outcomes of Mesenteric Ischemia
Acute arterial mesenteric ischemia is a serious condition, and 59-93% of patients will pass away. Mortality for acute mesenteric venous thrombosis is 20-50%. If the patient is not treated with anticoagulation, 30% will have a recurrence of mesenteric ischemia, usually within 30 days. Mortality rates for surgery for chronic mesenteric ischemia range from 0-16%. There is less recurrence after surgical revascularization for chronic mesenteric ischemia (less than 10%) than there is for stenting (10-67%).
References
Acute mesenteric ischemia. Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Saunders, 2006.
Chapter 27: Small intestine. Brunicardi C et al., Eds. Schwartz’s Principles of Surgery. 4th ed. McGraw-Hill, 2005.
eMedicine: Mesenteric Ischemia
Levy, Angela D. Mesenteric ischemia. Radiologic Clinics of North America 2007. 45:593-9.
Vascular Web: Mesenteric Ischemia
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