MESENTERIC ISCHEMIA
The mesenteric arteries supply blood to your small and large intestine. Mesenteric ischemia is a rare disorder resulting due to the narrowing or blockage of one or more of the mesenteric arteries. The obstruction in blood flow leads to insufficient oxygen supply, which causes impaired functioning of your intestines and even tissue death if not treated promptly. It may also affect other organs of the digestive system like the stomach, liver and colon, and is characterized by severe abdominal pain. The condition can be chronic, lasting for a long period of time or acute, occurring abruptly and becoming worse in a short period of time. Mesenteric ischemia is commonly observed in people above the age of 60 years, smokers or those with high cholesterol levels.
Mesenteric ischemia may be caused due to atherosclerosis (plaque in the wall of the artery) or an embolus (blood clot) that obstructs the blood flow. Other conditions that may cause mesenteric ischemia include congestive heart failure, low blood pressure, blockage of veins in the bowel, arteritis (inflammation of medium-sized blood vessels), fibromuscular dysplasia (abnormal cell growth in artery walls), coagulation disorders and tears in the inner layer of the aorta.
Mesenteric ischemia is characterized by severe abdominal pain that lasts for 15-60 min after eating and then disappears until the next meal. Other symptoms include weight loss, nausea, diarrhea, vomiting, constipation and flatulence. These symptoms can be vague and common to other diseases as well, so an effective diagnosis is required to determine the condition.
Your doctor may analyse your medical history and conduct a thorough physical exam. Your doctor may recommend testing such as an angiogram (imaging test using contrast dye and X-rays), Doppler ultrasound, CT scan, MRA scan or blood tests. These diagnostic procedures confirm the severity of your condition and help your physician to decide the best treatment suitable for your situation.
Treatment for mesenteric ischemia is aimed at re-opening the blocked mesenteric artery to allow blood to flow adequately to your intestine before permanent damage occurs. Surgery is the standard treatment to manage mesenteric ischemia. Depending on the severity of your condition, your doctor may suggest one of the below methods to treat mesenteric ischemia:
- Chronic mesenteric ischemia can be treated either by trans-aortic endarterectomy or bypass surgery
- Trans-aortic endarterectomy: This procedure involves the removal of plaque that is blocking the mesenteric artery. Your surgeon makes a small incision on your abdomen and removes the plaque deposition sticking to the inner wall of the artery.
- Bypass surgery: Your surgeon creates a graft and attaches it above and below the blocked area to re-route the blood flow around the blockage. The graft can be a vein from another part of your body or a synthetically created tube.
- Treatment of acute mesenteric ischemia is considered an emergency procedure. Your doctor might suggest angioplasty, in which a catheter (thin tube) is inserted into the blood vessel. A balloon attached to the tip of the catheter is inflated to compress the plaque against the walls of the artery to widen it. Sometimes, a stent (metal mesh) or thrombolytic agents (clot-dissolving medication) are introduced through the catheter to prevent the walls from collapsing and to dissolve the clot respectively. In case of intestinal damage, your surgeon might decide to remove the clot surgically. In rare cases, it may even be necessary to remove the damaged region of the intestine as well.
The effectiveness and risk of the treatment for mesenteric ischemia depends on many factors. Your doctor will recommend the best treatment option suitable for your condition.
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