Chronic Mesenteric Ischemia (CMI)

  • – <5% of all ischemic disease
  • – Commonly the result of advanced atherosclerotic disease of multiple mesenteric arteries
  • – Good collaterals circulation     Symptomatic CMI- rare
  • – The lesions are located proximally and at least 2of 3 major splanchnic vessels (celiac, sup. mesenteric, inf. mesenteric) usually re involved before ischemia ensues
  • – Pain produced by intestinal angina typically occur soon after eating, prior to food entering the small bowel
  • Cardinal features of CMI:
  •                 • Abdominal discomfort/pain occurring within 30 minutes after eating, gradually increases in severity
  •                 • Pain slowly abates over 1-3 hours
  •                 • Character of pain: Dull, gnawing, cramping
  •                 • Location of pain: Periumbilical/ umbilical
  • – Malabsorption seen in half of patients
  • – Features of GI dysmotility: bloating, nausea, episodic diarrhoea, constipation occur

 

  • Physical findings:
  • – Cachexia
  • – Weight loss
  • – Abdomen: soft, non-tender even during painful episode

* Many patients have systemic atherosclerosis- heart, CNS, peripheral vasculature

  • Investigations of CMI:
  • Angiography:
  • – Single vessel disease   ⇒    No ischemia
  • – At least 2 vessel need to be involved before the diagnosis of CMI
  • Duplex USG/MRI:
  • – To see blood flow in splanchnic vessels after meal
  • Studies of malabsorption:
  •           Fecal fat
  •           Urinary D-xylose

 

  •        Treatment:
  • – Surgical revascularisation
  • – Angioplasty: who are at risk of surgical revascularisation

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