Mesenteric Ischemia

scan showing mesenteric ischemia

The cardiovascular system’s ability to deliver oxygen to all parts of the body is among its most important functions. When blockage occurs preventing this critical task, there are serious results. Ischemia refers to decreased circulation. The body’s mesenteric organs include the intestines, liver, stomach and colon. Mesenteric ischemia describes blockage in blood vessels that prevents the proper amount of oxygen from reaching these organs. Not only can ischemia prevent blood from flowing into the organs, it can restrict blood from leaving the intestines, creating swelling a bleeding. This is known as mesenteric venous thrombosis.

Chronic mesenteric ischemia affects the small and large intestines. The ischemia builds up over time and can be treated accordingly. Acute mesenteric ischemia can be sudden and is considered an emergency to be treated immediately. Both have a major impact on the functioning of these organs and quality of life.

Causes of Mesenteric Ischemia and Mesenteric Venous Thrombosis

The common cause for chronic mesenteric ischemia is atherosclerosis or hardening of the arteries. Plaque, caused by a buildup of fats and other substances, builds up on the artery walls, blocking proper blood flow. The arteries narrow and stiffen as a result.

Atherosclerosis may cause acute mesenteric ischemia but other issues also contribute to it. They include a dislodged blood clot caused by heart attack, arrhythmia or congestive heart failure. High blood pressure, clotting issues caused by kidney failure, heart failure or shock are also causes. Certain illegal drugs, such as cocaine and methamphetamine, may also cause acute mesenteric ischemia. An immune system disorder called antiphospholipid syndrome (APS) that causes blood clots can be another contributing factor.

Mesenteric venous thrombosis can be caused by pancreatitis, ulcerative colitis, Crohn’s disease or diverticulitis. Abdominal infection and trauma to the abdomen also create it, as does the use of certain medications that increase the risk of clotting.


Severe stomach pain, sometimes accompanied by nausea, diarrhea, or vomiting, is the most common symptom of acute mesenteric ischemia. This could be caused by a travelling blood clot and should be treated immediately.

With chronic mesenteric ischemia, stomach pain is sometimes felt between fifteen minutes and one hour after eating. The pain occurs after each meal and can last for up to two hours. Nausea, diarrhea, flatulence or vomiting may also occur, along with the pain. Because of the discomfort of post-meal pain, weight loss may be noticeable because the individual may avoid eating.

Symptoms of mesenteric venous thrombosis can not only include abdominal pain, diarrhea, nausea and vomiting, but bloating and fever may also occur. Gastrointestinal bleeding is also a characteristic.

Diagnosis and Treatment

A vascular surgeon may diagnose mesenteric ischemia by several methods. A blood test indicating increased white cells could indicate it. Imaging methods, including Doppler ultrasound, CT angiogram and MRI can also identify problems with the arteries and the intestines.

A diagnostic angiogram is more invasive but may be necessary to properly identify mesenteric ischemia. A thin tube is inserted that will allow dye to be inserted into the aorta and the arteries. The dye can track the flow of blood through the arteries and will reveal any blockage.

Treating acute mesenteric ischemia is usually an emergency procedure with the goal of dissolving a clot through thrombolytic therapy or surgery. If part of the intestine has been damaged by decreased blood flow, it may require removal.

Treatment of chronic mesenteric ischemia can include pain medication, balloon angioplasty or stent, or bypass surgery.

Mesenteric venous thrombosis treatment can include blood thinners for three to six months or longer, if a blood clotting disorder is determined. If a bowel shows signs of damage, surgical removal could be required.

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