Chronic Abdominal Pain in the Elderly: Ischemic Pain

2018 ◽  
Author(s):  
Ashley Reed ◽  
Tariq M. Malik
Keyword(s):  
Abdominal Pain ◽  
Mesenteric Ischemia ◽  
Treatment Options ◽  
The Elderly ◽  
Chronic Abdominal Pain ◽  
Chronic Mesenteric Ischemia ◽  
Adjunct Treatment ◽  
Computed Tomography Angiogram ◽  
Abdominal Bruit ◽  
Pain In The Elderly

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.

scholarly journals Abdominal Pain in the Elderly: An Unusual Case of Chronic Mesenteric Ischemia in the Emergency Department

2019 ◽  
Vol 3 (3) ◽  
pp. 275-277
Author(s):  
Julieta Lacey ◽  
Robert Hughes ◽  
Vicki Noble
Keyword(s):  
Abdominal Pain ◽  
Mesenteric Ischemia ◽  
Unusual Case ◽  
Acalculous Cholecystitis ◽  
The Elderly ◽  
Severe Illness ◽  
Chronic Mesenteric Ischemia ◽  
Significant Morbidity ◽  
Chronic Ischemia ◽  
Pain In The Elderly

Chronic mesenteric ischemia (CMI) is a rare cause of abdominal pain with the potential for significant morbidity and mortality. An infrequently described complication of CMI is acalculous cholecystitis. Historically, acalculous cholecystitis is thought to be multifactorial and usually occurs in the setting of severe illness. In CMI, the etiology is more likely chronic ischemia to the gallbladder leading to inflammation. We present a case of acalculous cholecystitis that presented insidiously in a patient with CMI.

scholarly journals Chronic Mesenteric Ischemia: A Rare Cause of Chronic Abdominal Pain

2015 ◽  
Vol 128 (12) ◽  
pp. 1363.e1-1363.e8 ◽  
Author(s):  
Maximilien Barret ◽  
Chloé Martineau ◽  
Gabriel Rahmi ◽  
Olivier Pellerin ◽  
Marc Sapoval ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Mesenteric Ischemia ◽  
Chronic Abdominal Pain ◽  
Chronic Mesenteric Ischemia

scholarly journals Acute Abdominal Pain in the Elderly

2007 ◽  
Vol 1 (2) ◽  
pp. 77-82 ◽  
Author(s):  
Ching-Chih Chang ◽  
Sun-Sang Wang
Keyword(s):  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
The Elderly ◽  
Pain In The Elderly

Bouveret's syndrome: A rare cause of abdominal pain in the elderly

2014 ◽  
Vol 7 (1) ◽  
pp. 93-93
Author(s):  
Joana Carvalheiro ◽  
Sofia Mendes ◽  
Carlos Sofia
Keyword(s):  
Abdominal Pain ◽  
The Elderly ◽  
Bouveret’S Syndrome ◽  
Pain In The Elderly ◽  
Bouveret's Syndrome

Stenting of stenotic mesenteric arteries for symptomatic chronic mesenteric ischemia

VASA ◽  
2012 ◽  
Vol 41 (6) ◽  
pp. 425-431 ◽  
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.

Mesenteric Ischemia

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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