Mesenteric ischemia is caused by an interruption in blood flow to all or part of the small intestine or the right colon. You're losing weight, but not because you want to. Lately you've avoided eating regular meals. That's because a short time after eating a meal, you end up with belly pain that lasts for an hour or two. And as the pain has become worse, the thought of eating is not at all appealing.

It's possible you have a condition called chronic mesenteric ischemia - reduced flow of oxygen-rich blood to your gut.

The cause could be accumulation of fatty deposits in some of your arteries (atherosclerosis), which narrows those arteries and restricts the amount of blood moving through them. When atherosclerosis affects the arteries supplying blood to your intestinal tract, it causes pain and makes it more difficult for your intestines to do their job.

Undetected, chronic mesenteric ischemia could lead to a life-threatening blockage of the blood supply to your gut. Fortunately, once chronic mesenteric ischemia is recognized, it can often be successfully treated.

Complications

Sometimes blood flow to the digestive tract is completely and suddenly cut off due to a blood clot that travels to the area, often from your heart. The same is true if a clot develops in one of the three arteries that serve your digestive tract where there's already some atherosclerotic buildup. It's also possible that blood clots or atherosclerotic buildup may be dislodged from a larger artery or aorta by a catheter during a diagnostic procedure, which can cause a blockage of smaller arteries downstream. These are medical emergencies.

Blockage of the blood flow to your intestine may result in death of intestinal tissue (infarction or necrosis). If this life-threatening situation occurs, you'll need surgery to clear the blockage and to remove the portion of the intestine that has died. Sometimes, a surgeon can connect the healthy ends together. If that's not possible, the surgeon may need to perform a procedure called an ostomy. In this procedure, surgeons create an opening in your abdomen to pull a section of your intestine to the surface. A bag is then attached to this opening, and your waste is expelled into the bag.

Screening and diagnosis

If your doctor suspects intestinal ischemia, he or she may want to conduct a thorough medical evaluation because signs and symptoms of intestinal ischemia can be similar to those of other disorders, such as ulcers, as well as stomach, pancreatic or colon cancer.

You may undergo several diagnostic tests, based on your signs and symptoms, including:

• X-ray. This test uses radiation to allow your doctor to view your internal organs on film.

• Computerized tomography (CT). This X-ray technique allows your doctor to see thin sections of your body and to view internal organs with more clarity and detail than with a conventional X-ray. It may also provide images of portions of the intestinal arteries.

• Ultrasound. Ultrasonography uses sound waves to generate images of internal organs on a monitor. A special ultrasound (Doppler) of the celiac, superior mesenteric and inferior mesenteric arteries can help your doctor determine if there is decreased blood flow, which indicates a likelihood of chronic mesenteric ischemia.

• Endoscopy. This technique involves inserting a lighted, flexible tube with a camera on its tip (endoscope) through your mouth and into your esophagus, stomach and duodenum. You're usually sedated for this procedure.

• Colonoscopy and flexible sigmoidoscopy. A thin, flexible tube (catheter) is inserted into your rectum. A tiny camera on the end captures images of your colon. Colonoscopy allows your doctor to view your entire colon, while sigmoidoscopy allows your doctor to visualize the last two feet of your large intestine.

• Mesenteric arteriogram. To get an even better image of where the problem lies in the three arteries, you may undergo a mesenteric arteriogram. This test, also known as an angiogram, involves guiding a catheter through an artery in your groin up into the aorta and injecting a dye (radiographic contrast medium). The dye allows better visualization of your intestinal arteries.

In general, the diagnosis of various types of intestinal ischemia is as follows:

• Colon ischemia. This type is generally diagnosed by using colonoscopy or sigmoidoscopy.

• Acute mesenteric artery ischemia. This type is diagnosed by considering your symptoms and the results of blood tests, X-rays, ultrasound and angiography.

• Chronic mesenteric artery ischemia. Diagnosis of this type is usually made based on clinical symptoms, the lack of other existing gastrointestinal disorders and the results of an angiogram.

• Ischemia due to mesenteric venous thrombosis. This type can usually be diagnosed using CT scanning. Evaluation for blood clotting problems may also be done.

 

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