31st July 2023

Chronic Mesenteric Ischaemia

Also known as intestinal angina. Usually a consequence of atherosclerotic plaques in the large mesenteric vessels, leading to colicky, post-prandial abdominal pain. Typically, the pain commences around thirty minutes after eating and lasts approximately one hour. Other symptoms include weight loss (due to ‘fear’ of eating and/or malabsorption), nausea & vomiting and PR bleeding. Examination may reveal bruits of the mesenteric vasculature.

Patients will almost always have atheromatous disease elsewhere, thus enquire about features of cardiovascular disease, cerebrovascular disease, peripheral arterial occlusive disease and renovascular disease.

Diagnosis is usually made with CT or MR angiography, which will reveal atherosclerosis. Duplex ultrasound of the mesenteric arteries may aid in analysis of blood flow through a blockage in real time.

Conservative approaches target the underlying causes of atherosclerosis. Surgical options include angioplasty + stenting, or bypassing the blocked vessel with an open procedure.