Acute Mesenteric Ischemia (Mesenteric Vascular Occlusion)

A blockage in the blood supply to the intestines causes acute mesenteric ischemia. It may result in perforation and gangrene of the intestine.

  • Sudden appearance of acute abdominal pain is the usual symptom.
  • Angiography may help diagnose the block and its location.
  • Surgical correction of the blocked artery will help restore the blood flow and relieve the ischemia.

The reason behind the sudden onset of acute mesenteric ischemia may vary. An embolus or blood clot which originated in the heart or in the aorta may have traveled through the blood vessels to reach the artery supplying the intestine, causing a blockage there. Sometimes atherosclerotic plaques dislodged from the major arteries may reach the smaller arteries and cause blockage. Blood clots may develop in the intestinal arteries and veins too, without any apparent reason. Occasionally, ischemia develops from partially blocked arteries too, when the cardiac output is very low and inadequate to pump blood efficiently to reach the mesenteric arteries. Effect of drugs like cocaine, which causes vasoconstriction, may significantly reduce blood flow to the intestines. Acute mesenteric ischemia usually occurs in people above the age of 50 years.

Any blockage which interrupts the blood flow for over a period of ten to twelve hours, results in the death of that portion of intestine which was supplied by the blocked artery. To complicate the condition further, the intestinal bacteria may attack the damaged portion and enter into the blood stream. Life threatening situations such as shock and multiple organ failure may develop, which may eventually lead to death.

Symptoms

Sudden development of acute abdominal pain is the most common symptom of mesenteric ischemia. Slight tenderness in the affected area may be present. When the severity of the pain is disproportionate with the tenderness doctor finds during the physical examination, it gives a clue as to the probable cause. As the affected portion of the intestine begins to die, tenderness of the abdomen may increase.

 Diagnosis and Treatment

When the condition is diagnosed early enough, the chances of recovery are high. If the ischemia has already caused part of the intestine to die, the fatality rate becomes as high as 90%. When a patient reaches the hospital with the characteristic symptoms of mesenteric ischemia and on physical examination the abdomen feels tender to touch, immediate surgery is conducted without waiting for confirmatory tests.  The doctor may restore blood supply to the mesenteric artery by either removing the block or by doing a bypass surgery. Depending on the extent of damage, the affected portion of the intestine also may be removed to avoid further complications from infections.

When the tenderness of the abdomen is not present along with the other symptoms of mesenteric ischemia, further tests may be done to assess the condition. Angiography is done to detect the location and extent of blockage. A contrast dye is injected to get a clear picture of the arteries. If it is a small clot, clot-busting drugs may be injected into the artery to dissolve it. If it does not work, surgical removal may be necessary. To avoid a recurrence of mesenteric ischemia, the patient is put on a life-long medication of drugs which prevent blood clots.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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