Acute Mesenteric Ischaemia

Written by Mr Panduka Jayawardena on 30.5.2021

Medically Reviewed by Dr. K. on 1.6.2021

What Is Acute Mesenteric Ischaemia?

Mesenteric ischemia (mez-un-TER-ik is-KEE-me-uh) occurs when blood flow to the small intestine is restricted by narrowed or blocked arteries. The small intestine may be irreversibly damaged by reduced blood supply.

Acute mesenteric ischaemia is a catastrophic abdominal and surgical emergency (1). Acute mesenteric ischaemia remains difficult to diagnose and is a time critical condition. In order to prevent bowel necrosis (death of bowel tissue) and death of patients, prompt diagnosis and treatment is extremely important.

Causes Of Acute Mesenteric Ischaemia

Acute mesenteric ischaemia is characterised by sudden interruption to the intestinal blood flow. They can be caused by the following (1)(3):

  • Embolus
    Embolus is a clot that is carried by the bloodstream to a smaller blood vessel from its point of origin from its point of origin and causes obstruction to the circulation. Embolus is the most common cause of acute mesenteric ischaemia. Superior Mesenteric Artery (SMA) is the most affected vessel due to acute angle of origin from the abdominal aorta (1)
  • Thrombus
    Thrombosis or fatty plaque occurs in patients with existing mesenteric atherosclerosis. The patient will often have a history of intestinal angina (postprandial pain – pain after eating) and significant weight loss. The prognosis is slightly worse in patients who develop a thrombus due to underlying vascular disease and extent of bowel involvement (blockage is more proximal, affecting more blood vessels).
  • Reduced blood flow
    This can be due to conditions such as sepsis, heart failure, bleeding, and myocardial infarction (heart attack).

Risk Factors Of Acute Mesenteric Ischaemia

Risk Factors for developing acute mesenteric ischaemia include the following:

  • Atrial fibrillation
  • Heart failure
  • Chronic kidney failure
  • Being prone to forming blood clots
  • previous myocardial infarction
  • High cholesterol
  • High triglycerides levels
  • Cigarette smoke

Symptoms Of Acute Mesenteric Ischaemia

The patient will typically experience the following symptoms (2):

  • severe acute abdominal pain
  • pain ‘beyond physical signs’
  • nausea
  • vomiting
  • bloody diarrhoea

Treatment Of Acute Mesenteric Ischaemia

Prompt diagnosis and treatment are paramount to increasing survival rates (4). Initially the patient will be resuscitated with intravenous fluids and antibiotics.

If the patient has signs of peritonitis (inflammation of the peritoneum – serous membrane lining the cavity of the abdomen and covering the abdominal organs) or non-viable bowel on CT, the patient warrants urgent surgery for resection of the dead bowel tissue.

In some cases, there may be options for revascularization (restoration of perfusion of blood to the organ or tissue that has suffered ischemia).

Those who have bowel resection often require a second surgical procedure following initial surgery (2).

Source:

Referenced on 31.5.2021

  1. Klar E, Rahmanian PB, Bücker A, Hauenstein K, Jauch KW, Luther B. Acute mesenteric ischemia: a vascular emergency. Dtsch Arztebl Int. 2012
  2. Wyers MC. Acute mesenteric ischemia: diagnostic approach and surgical treatment.
  3. Berland T, Oldenburg WA. Acute mesenteric ischemia. Curr Gastroenterol Rep. 2008 Jun;10(3):341-6
  4. Clair DG, Beach JM. Mesenteric Ischemia. N Engl J Med. 2016 Mar 10;374(10):959-68
  5. https://www.hopkinsmedicine.org/health/conditions-and-diseases/mesenteric-ischemia
  6. https://teachmesurgery.com/vascular/peripheral/mesenteric-ischaemia/

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