Mesenteric ischemia is a surgical emergency that results from insufficient mesenteric arterial or venous flow to the small intestine. It can be difficult to diagnose. In fact, when it’s diagnosed, it’s often too late.
Mortality from this condition is quite high, despite the great diagnostic and treatment-based scientific advances that have been made in recent years. Early diagnosis and bowel resection are essential to improve the patient’s odds of survival.
Those who survive the initial acute event and the main surgery usually have a short small intestine.
Causes of mesenteric ischemia
Many etiological factors are associated with the development of mesenteric ischemia. They can be divided into primary intravascular pathology and secondary extravascular pathology.
Regarding the former, it can occur due to an occlusion of the superior mesenteric artery, thrombosis of the superior mesenteric vein, or a low mesenteric flow (non-occlusive mesenteric ischemia). Artery occlusion can be caused by:
- Embolism
- Thrombosis formations on an atheromatous plaque
- Stenosis
On the other hand, secondary extravascular pathology causes blood flow obstruction to the bowel. It can occur as a result of the following:
- Volvulus of the intestine and/or mesentery
- Strangulated hernia of the abdominal wall
- Vascular trauma, including electrocution
Symptoms
The signs and symptoms of mesenteric ischemia can appear suddenly or gradually. The disorder manifests differently in each patient. Therefore, suffering these symptoms doesn’t necessarily mean that you have this condition.
However, experts have identified some similar characteristics. When it’s acute, and appears suddenly, some of the symptoms it causes are:
- Abdominal pain
- Feeling the need to have a bowel movement
- Frequent and forceful bowel movements
- Blood in the stools
- Nausea and vomiting
- Mental confusion in older adults
Regarding the symptoms, we can distinguish the following:
- Colic or feeling full after eating, usually in the first hour
- Abdominal pain that gets progressively worse
- Unintentional weight loss
- Diarrhea
- Swelling
Diagnostic tests
If the doctor suspects that the patient may be suffering from mesenteric ischemia, they may request various diagnostic tests based on their symptoms and signs. This way, they can confirm or rule out the diagnosis. Some of these examinations are:
- Blood test. Although no specific blood markers indicate mesenteric ischemia, a blood sample that indicates, for example, a high white blood cell count, could suggest this problem.
- Imaging tests. They can help the doctor visualize the internal organs and rule out other causes of the signs and symptoms. Some of these techniques are X-rays, ultrasound, CT scans, and MRIs.
- Endoscopy. By using a device called an endoscope, which a doctor inserts through the mouth, they’re able to observe the inside of the digestive tract through a camera. They can also insert it rectally.
- Using dye to track blood flow through the arteries. During an angiography, a medical professional inserts a long, thin tube into an artery in the groin or arm. Then, they pass it through the artery into the aorta and inject a dye that flows directly into the intestinal arteries.
Treatment of mesenteric ischemia
The treatment of this disease consists of restoring blood supply to the digestive tract. In this case, surgery may be necessary to remove a blood clot, unclog an artery, or repair or remove a damaged section of the intestine.
On the other hand, the treatment may also consist of taking antibiotics and other medications to prevent the formation of clots, dissolve them, or dilate the blood vessels.
If the doctor resorted to an angiography to diagnose the patient, they may remove the blood clot or open a narrowed artery at the same time.
This technique involves threading an inflated balloon through a catheter to compress fatty deposits and stretch an artery. This way, the blood can flow a lot better.
Ultimately, another technique is to place a metal mesh tube, called a stent, into the artery to try to keep it open. A doctor will evaluate all of these measures according to the severity of the patient’s situation.
