Chronic Mesenteric Ischemia: A Rare Cause of Chronic Abdominal Pain

Elderly patients with chronic abdominal pain are commonly misdiagnosed, most likely due to atypical symptom presentations. Chronic mesenteric ischemia is a rare cause of chronic abdominal pain in the elderly. Symptoms are postprandial abdominal pain, weight loss, and an abdominal bruit. The disease results from atherosclerotic plaques that reduce the bowel’s ability to increase blood flow after meals. Patients often are malnourished. Diagnosis can be made with various imaging modalities, although a computed tomography angiogram is likely needed when the syndrome is suspected. The mainstay of therapy for chronic mesenteric ischemia is surgical intervention. Interventional pain techniques, such as celiac plexus neurolysis or spinal cord stimulation, are promising adjunct treatment options.

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Dysplastic-Dependent Visceropathy and Syndrome of Chronic Abdominal Pain: the Hard Way to Diagnosis of Mesenteric Ischemia

Effective Pharmacotherapy ◽

10.33978/2307-3586-2019-15-28-58-61 ◽

2019 ◽

Vol 15 (28) ◽

pp. 58-61

Author(s):

S.V. Shchelochenkov ◽

◽

G.S. Dzhulay ◽

T.D. Shchelochenkova

Keyword(s):

Abdominal Pain ◽

Mesenteric Ischemia ◽

Chronic Abdominal Pain

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Stenting of stenotic mesenteric arteries for symptomatic chronic mesenteric ischemia

VASA ◽

10.1024/0301-1526/a000232 ◽

2012 ◽

Vol 41 (6) ◽

pp. 425-431 ◽

Cited By ~ 8

Author(s):

Aschenbach ◽

Bergert ◽

Kerl ◽

Zangos ◽

Neumeister ◽

...

Keyword(s):

Weight Loss ◽

Abdominal Pain ◽

Gastrointestinal Bleeding ◽

Mesenteric Artery ◽

Mesenteric Ischemia ◽

Celiac Artery ◽

Lower Gastrointestinal Bleeding ◽

Mesenteric Arteries ◽

Chronic Mesenteric Ischemia ◽

Technical Failure

Background: We report the results of our single center series of patients with chronic mesenteric ischemia (CMI) to determine the role of stenting in the management of patients. Patients and methods: We retrospectively reviewed all patients with CMI treated endovascularly with stent revascularisation from January 2008 to January 2011.CMI diagnosis was made according to clinical symptoms, including postprandial abdominal pain, food fear, and weight loss. Additionally, the diagnosis was confirmed by duplex ultrasonography and/or computed tomography angiography and/or contrast-enhanced magnetic resonance angiography. Results: All 45 patients presented with typical CMI symptoms: 45/45 (100 %) had postprandial pain, 31/45 (68.8 %) had a weight loss of more than 10 kilograms, and 11/45 (24.4 %) suffered from ischemic colitis combined with lower gastrointestinal bleeding. In three patients occlusion could not be crossed, therefore considered as technical failure. A total of 55 arteries were stented in the remaining 42 patients. Nineteen patients underwent SMA stenting alone, eight underwent celiac stenting, alone and three patients underwent stenting of inferior mesenteric artery (IMA) alone. We performed combined stenting of the celiac artery and superior mesenteric artery in ten patients, and one patient underwent a combined stenting of the celiac artery and the IMA. All three mesenteric arteries were stented in only one patient. Primary technical success was achieved in 42/45 (94.8 %) patients. Clinical symptom relief was achieved in 39/45 (86.6 %) patients with abdominal pain. Increased body weight was observed in 28/31 (90.3 %) patients with an average weight gain of 8.8 kilograms (5 - 12 kilograms), and 10/11 (90.9 %) patients recovered from ischaemic colitis/lower gastrointestinal bleeding. Conclusions: Stent revascularisation can be considered as the first-line therapy for patients with chronic mesenteric ischemia.

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Mesenteric Ischemia

10.2310/im.4713 ◽

2016 ◽

Author(s):

Ugo A. Ezenkwele

Keyword(s):

Abdominal Pain ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

Computed Tomographic Angiography ◽

Low Flow ◽

Chronic Mesenteric Ischemia ◽

Flow State ◽

Nonocclusive Mesenteric Ischemia ◽

Vasodilator Therapy ◽

Bowel Infarction

Acute mesenteric ischemia is interruption of intestinal blood flow by embolism, thrombosis, or a low-flow state. Bowel infarction is the end result of a process initiated by mediator release and inflammation. On clinical assessment, the early hallmark is severe abdominal pain but minimal physical findings. The abdomen remains soft, with little or no tenderness. Mild tachycardia may be present. Early diagnosis is difficult, but selective mesenteric angiography and computed tomographic angiography have the most sensitivity; other imaging studies and serum markers can show abnormalities but lack sensitivity and specificity early in the course of the disease, when diagnosis is most critical. Treatment is by embolectomy, anticoagulation, revascularization of viable segments, or resection; sometimes vasodilator therapy is successful. If diagnosis and treatment take place before infarction occurs, mortality is low; after intestinal infarction, mortality approaches 30 to 70%. For this reason, in the emergency department, clinical diagnosis should supersede diagnostic tests, which may delay treatment. This review contains 6 highly rendered figures, 4 tables, and 33 references. Key words: acute mesenteric ischemia; bowel necrosis; chronic mesenteric ischemia; mesenteric occlusive disease; mesenteric venous thrombosis; nonocclusive mesenteric ischemia; postprandial abdominal pain; superior mesenteric artery thromboembolism

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Chronic mesenteric ischemia with only mild abdominal pain and extreme weight loss

The American Journal of Gastroenterology ◽

10.1111/j.1572-0241.2000.03076.x ◽

2000 ◽

Vol 95 (9) ◽

pp. 2618-2619

Author(s):

Kanwarjit Arora ◽

Nazmul Hoque ◽

Bashar Attar M ◽

Anthony Williams D ◽

Muhammed Siddiq ◽

...

Keyword(s):

Weight Loss ◽

Abdominal Pain ◽

Mesenteric Ischemia ◽

Chronic Mesenteric Ischemia ◽

Mild Abdominal Pain

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Clinical implications of chronic mesenteric ischemia in elderly and senile patients

Terapevticheskii arkhiv ◽

10.26442/00403660.2020.02.000522 ◽

2020 ◽

Vol 92 (2) ◽

pp. 74-80

Author(s):

A. I. Dolgushina ◽

A. S. Kuznecova ◽

A. A. Seljanina ◽

V. V. Genkel ◽

A. G. Vasilenko

Keyword(s):

Weight Loss ◽

Abdominal Pain ◽

Mesenteric Artery ◽

Mesenteric Ischemia ◽

Clinical Manifestations ◽

Pain Syndrome ◽

Celiac Trunk ◽

Mesenteric Arteries ◽

Chronic Mesenteric Ischemia ◽

Clinical Criteria

Aim.To evaluate the sensitivity and specificity of the clinical criteria for the diagnosis of chronic mesenteric ischemia in elderly and senile patients with mesenteric atherosclerosis. Materials and methods.The study included 142 patients (82 men and 60 women). The median age of patients is 66.0 [62.0; 72.0] years. Results.According to MDCT atherosclerotic lesions of the abdominal aorta and its unpaired visceral branches were diagnosed in 105 (73.9%) patients. A combination of atherosclerosis of the celiac trunk and the superior mesenteric artery with the presence of hemodynamically insignificant stenosis was revealed. Hemodynamically significant atherosclerotic narrowing of at least one mesenteric artery was present in 15% of cases. Among them, a single vascular lesion was found in 6 patients (4.2%), a combination of hemodynamically significant lesions of two arteries in 15 (11%) patients. Depending on the clinical manifestations, all patients are divided into two groups: the first group 30 (21.1%) patients with the presence of symptoms characteristic of chronic mesenteric ischemia (CMI). The second group consisted of 112 (78.8%) patients without a characteristic triad of symptoms. The clinical symptom complex of СMI, including postprandial abdominal pain, intestinal dysfunction and progressive weight loss, as a diagnostic criterion showed low sensitivity 13.3% and specificity 77.9%. At the same time, the sensitivity of such a clinical combination as a combination of atherosclerosis of the arteries of the lower extremities, weight loss and abdominal pain syndrome with a severity of more than 5.5 points, with respect to the detection of hemodynamically significant stenoses of two or more mesenteric arteries was sensitivity 86.7%, specificity 74.0%.

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Percutaneous retrograde revascularization of chronic occlusions of the superior mesenteric artery via collaterals of the celiac artery

CVIR Endovascular ◽

10.1186/s42155-020-00170-x ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Wilhelm H. Kersjes ◽

Alexander Hesse

Keyword(s):

Abdominal Pain ◽

Clinical Outcome ◽

Superior Mesenteric Artery ◽

Abdominal Aorta ◽

Mesenteric Artery ◽

Mesenteric Ischemia ◽

Celiac Artery ◽

Chronic Mesenteric Ischemia ◽

Technical Success ◽

Chronic Total Occlusions

Abstract Purpose To evaluate the technical success of percutaneous retrograde revascularization of the superior mesenteric artery (SMA) via the celiac artery (CA) in patients with chronic mesenteric ischemia (CMI). Methods We performed a retrospective review of three patients with chronic total occlusions (CTOs) of the origin of SMA which were recanalized retrograde via collaterals of the CA after frustrating attempt of antegrade revascularization from the abdominal aorta in our institute between May 2019 and June 2020. Results All technical procedures of retrograde revascularization of CTOs of SMA via collaterals of the CA were successful. The clinical outcome resulted in a sustained resolution of abdominal pain in all cases. Conclusion Retrograde recanalization of SMA via collaterals from the CA seems to be a successful endovascular option for patients with CMI and a chronically occluded superior mesenteric artery when antegrade recanalization fails as far as it can be concluded from the small number of presented cases.

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Exertional Abdominal Pain as a Rare Presenting Manifestation of Chronic Mesenteric Ischemia from a Single Mesenteric Vessel Stenosis

Annals of Vascular Surgery ◽

10.1016/j.avsg.2018.01.105 ◽

2018 ◽

Vol 51 ◽

pp. 325.e1-325.e3

Author(s):

Heepeel Chang ◽

Neal C. Hadro ◽

Marc A. Norris ◽

Marvin E. Morris

Keyword(s):

Abdominal Pain ◽

Mesenteric Ischemia ◽

Chronic Mesenteric Ischemia ◽

Mesenteric Vessel ◽

Vessel Stenosis

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Ischemic Gastropathic Ulcer Mimics Gastric Cancer

Case Reports in Gastrointestinal Medicine ◽

10.1155/2016/9745854 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Saleh Daher ◽

Ziv Lahav ◽

Ayman Abu Rmeileh ◽

Meir Mizrahi ◽

Tawfik Khoury

Keyword(s):

Abdominal Pain ◽

Mesenteric Artery ◽

Mesenteric Ischemia ◽

Celiac Trunk ◽

Gastric Ulcers ◽

Chronic Mesenteric Ischemia ◽

Surgical Revascularization ◽

Medical Interventions ◽

Ischemic Gastropathy ◽

Medical Evaluation

Gastric ulcer due to mesenteric ischemia is a rare clinical finding. As a result, few reports of ischemic gastric ulcers have been reported in the literature. The diagnosis of ischemic gastropathy is seldom considered in patients presenting with abdominal pain and gastric ulcers. In this case report, we describe a patient with increasing abdominal pain, weight loss, and gastric ulcers, who underwent extensive medical evaluation and whose symptoms were resistant to medical interventions. Finally he was diagnosed with chronic mesenteric ischemia, and his clinical and endoscopic abnormalities resolved after surgical revascularization of both the superior mesenteric artery and the celiac trunk.

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