Mesenteric Ischemia

An uncommon but serious health condition that negatively affects the digestive system and occurs due to a blockage or circulatory problem is called mesenteric ischemia. It may occur suddenly (acute) or over time (chronic). When a person develops an acute mesenteric ischemia, it is often difficult to diagnose and can be life-threatening. In people with this condition, the digestive system does not get enough oxygen-rich blood. As a result, organs and tissues in the digestive system cannot work properly. In more severe cases, affected organs and tissues may begin to die. Moreover, mesenteric ischemia is considered a medical emergency, which requires immediate treatment. Otherwise, it may lead to death.

Generally, this condition happens quite rarely and affects about 1 to 2 out of 1,000 people. In such cases, people are hospitalized.

Types of Mesenteric Ischemia

Healthcare professionals have divided this condition into 2 types based on how the symptoms occur. For example:

Acute mesenteric ischemia – This condition occurs similarly to a heart attack (myocardial infarction) or stroke when an artery is blocked. In this case, it happens due to a blood clot that causes sudden and severe symptoms. Furthermore, this type of condition is a medical emergency that requires immediate medical care.
Chronic mesenteric ischemia – People who develop this type of condition may not experience symptoms in the early stages. They often appear gradually over time. In most cases, it occurs when mesenteric arteries begin to narrow.

Symptoms

This condition often causes different symptoms among people who develop it because they depend on some factors. For example, the type of the disease, overall health, gender, and age. Check some symptoms below:

Acute Mesenteric Ischemia Symptoms

The following symptoms usually appear suddenly and can be severe. For example:

Abdominal (belly) pain – This is one of the most common symptoms of the acute form of mesenteric ischemia. It occurs in about 75% to 80% of people, and it appears after eating.
Bloating, nausea, and vomiting – These symptoms may occur along with belly pain, and vomiting occurs in about 70% of people with acute mesenteric ischemia.
Bathroom habit changes – In such cases, people may notice that they need to poop more frequently or have constipation (reduced or even a lack of bowel movements).
Diarrhea – This symptom affects about 40% of people with this type of mesenteric ischemia, and it can be very intense along with severe pain. In more advanced stages, people may have bloody diarrhea.
Weight loss – This is another common symptom in people with this form of the disease. You may also avoid food because of pain.
Fever – Sometimes, this symptom can indicate a serious infection.

In addition, it is common for people to develop acute mesenteric ischemia after chronic mesenteric ischemia. Approximately 50% of people with a chronic form of the disease develop the acute form.

Chronic Mesenteric Ischemia Symptoms

The symptoms in people with the chronic form often appear gradually and worsen over time. These include:

Pain in the abdomen – This is one of the most common symptoms that indicate mesenteric ischemia. It often occurs for 1-2 hours after a meal, and it is similar to cramps in the upper abdominal area.
Food fear and weight loss – When people begin to experience pain after eating, they may avoid foods, which often leads to weight loss.
Frequent or lack of bowel movements
Diarrhea – In people with the chronic form of the disease, diarrhea occurs in about 30% of people.

Immediately contact your healthcare professional if any of the previous symptoms occur. However, you should call 911 or go to the nearest emergency room (ER) if you experience sudden and severe abdominal pain.

Causes

In general, this condition occurs due to multiple reasons. Examples include:

Acute Mesenteric Ischemia Causes

In most cases, people develop this type of condition due to a waxy substance (plaque) that begins to build up in the arteries, causing them to harden and narrow. This is a serious condition that requires treatment, and it frequently causes cardiovascular problems if it is left untreated. It is called atherosclerosis, and sometimes an area of plaque may break and allow the formation of blood clots. As a result, a blood clot may block blood flow in the following ways. These include:

In about 15% to 25% of cases, the blood clot forms in the mesenteric artery.
Approximately 50% of people develop acute mesenteric ischemia because a blood clot gets stuck in the mesenteric artery, but it forms in another part of the body.
Rarely (in about 5% of cases), the blood clot forms in the nearby veins of the mesentery.

Sometimes, people may develop this condition without a blockage, NOMI (non-occlusive mesenteric ischemia). It accounts for about 20% of cases, and it happens when blood vessels constrict or there are spasms in the muscles that surround these blood vessels. Check some causes below:

Medications and recreational drugs – There are some prescription medications and recreational drugs (such as cocaine) that may cause your blood vessels to narrow.
Certain treatments – For example, surgery or dialysis may also affect mesenteric blood vessels, causing them to narrow.
Diseases – The following conditions may also contribute to the acute form of mesenteric ischemia. Examples include myocardial infarction, dehydration, sepsis, allergic reactions, and hypotension (low blood pressure).

While NOMI often does not cause sudden and severe symptoms, it is still dangerous.

Chronic Mesenteric Ischemia Causes

Most people develop the chronic (long-term) form of mesenteric ischemia due to circulatory diseases that cause blood vessels to narrow (stenosis). It means blood flow through certain blood vessels drops over time. However, it may also occur due to a blood clot that forms in one of the mesenteric blood vessels. When it occurs, the blood clot grows more slowly, and you begin to experience symptoms as it gets larger.

Most of the time, chronic mesenteric ischemia is not dangerous, but approximately 50% of people who develop the acute form of the disease have chronic symptoms.

Risk Factors

While this condition can affect anyone, doctors have identified some factors that could elevate your risk of developing it. Check some examples below:

Age – The risk of developing this condition increases with aging.
Diabetes
Coronary artery disease
Atrial fibrillation (this condition is a type of arrhythmia that causes irregular heart rhythms)
Heart failure
Hyperlipidemia (high cholesterol)
Hypercoagulation disorders (these are conditions that make you more prone to blood clots)
Recent surgeries
Smoking
Peripheral artery disease
Hypertension (high blood pressure)

What Are The Potential Complications of Mesenteric Ischemia?

People with this serious health condition may also experience some complications, especially if they leave it untreated. Check some of them below:

Sepsis and septic shock – These are very serious complications that, without immediate treatment, may lead to death.
Chronic malnutrition and weight loss – For example, severe pain after eating and significant weight loss.
Bowel perforation and peritonitis – Sometimes, the dead bowel wall can tear. Thus, it allows contents to leak into the abdominal cavity, which can cause a severe infection (peritonitis).
Intestinal necrosis (gangrene) – This complication occurs when the bowel dies due to a lack of oxygen. This is a medical emergency in which surgeons will remove the affected part of the bowel.
Death
Surgery complications – The surgical procedures used to treat problems caused by mesenteric ischemia may also cause some complications. For example, digestion problems, constipation, diarrhea, bleeding, kidney failure, infections, and an increased risk for heart attack or stroke
Nutritional problems – Sometimes, surgeons may remove a part of the intestine, which makes it harder to absorb nutrients from food.

The previous list does not contain all possible mesenteric ischemia complications, but you can consult with your healthcare professional about ways to reduce the risk or even prevent them.

How to Prevent Mesenteric Ischemia?

Unfortunately, it is not always possible to prevent this condition, but physicians often recommend the following tips to reduce the risk. Check some of them below:

Annual checkups – It is recommended to see a doctor each year for testing. It helps detect early signs of heart disease, hypertension, high cholesterol, and other serious conditions.
Stop smoking – Tobacco products cause damage to the blood vessels, which increases the risk of mesenteric ischemia. If you have problems with smoking cessation, discuss it with your healthcare provider.
Manage chronic health conditions – For example, diabetes, hyperlipidemia, hypertension, and others.
Adopt a healthy diet – It is recommended to eat more fresh fruits and vegetables, whole grains, and reduce the amount of processed foods or foods high in salt or sugar.
Physical exercise – In general, doctors often recommend aiming for 30 minutes of physical exercise per day, at least 5 days a week. This will help get or maintain a healthy weight, which is important for the health of your heart and circulatory system.

Diagnosis

Healthcare professionals often begin the diagnosis with a physical examination and questions about your symptoms and medical history. However, it is difficult to diagnose this condition in the early stages. To confirm or exclude mesenteric ischemia, physicians usually perform the following tests and procedures. Check some examples below:

Blood tests – These tests are done to check for the amount of oxygen in the blood and its clotting ability.
Ultrasound – This test uses sound waves to make images that allow doctors to identify areas with low or no circulation. Moreover, there are several types of ultrasound that can measure how much blood is flowing through blood vessels.
Angiography – This is one of the most reliable tests that help diagnose mesenteric ischemia. It involves a contrast dye that is injected into one of the major blood vessels in the abdominal area. Therefore, doctors use an X-ray or a CT (computed tomography) scan to determine which part of the blood vessel is partially or totally blocked.
Endoscopy – During this test, doctors will use a thin and flexible tube with a lighted camera on the end (endoscope) to examine the digestive tract and check for mesenteric ischemia signs.

Treatment

In most cases, doctors prescribe different treatments for people with this serious condition because they depend on the severity of the disease, existing health conditions, age, gender, your response to treatment, and preferences.

Acute Mesenteric Ischemia Treatment

The primary treatment for this type of mesenteric ischemia is surgery. During this procedure, surgeons can directly access and remove existing clots and widen narrowed blood vessels. They may also place a stent to keep a blood vessel open. When there is no way to restore blood flow directly, surgeons often use a section of blood vessel from another part of the body to make a bypass. As a result, the blood flow is restored. After physicians restore blood flow, they will check nearby tissue and organs for damage, and if they find dead or damaged tissue will remove or repair it. In addition, your doctor may also recommend the following supportive treatments along with surgery. For example:

IV (intravenous) fluids – These fluids often help with hypotension or dehydration that can be a part of the mesenteric ischemia.
Blood transfusion – This treatment is used to ensure sufficient blood.
Antibiotics – This group of medications is primarily used to treat bacterial infections.
Anticoagulants (also known as blood thinners) – These medications help treat or prevent blood clots, which may cause recurrent mesenteric ischemia, heart attacks, and other serious conditions.
Oxygen – Additional oxygen often helps the body to circulate blood.

Non-occlusive Mesenteric Ischemia Treatment

While this condition is a subtype of mesenteric ischemia, it does not always require surgery. It occurs when blood vessels constrict and narrow without a blockage. Therefore, doctors often find the cause and treat it. For instance, if your blood vessels become narrow due to a prescription medicine, doctors may reduce the dose or even change the medicine. However, some people may develop NOMI due to sepsis, which requires antibiotics. Moreover, physicians may also recommend the following treatments if you develop this subtype of mesenteric ischemia. For example:

Vasodilators – These are specific medications used to expand blood vessels and improve blood flow.
Oxygen – Doctors may give you additional oxygen through a mask to help the body circulate blood.
Balloon angioplasty – During this procedure, doctors will insert a catheter (a long and flexible tube) into a major blood vessel and inflate a balloon on the tip of the catheter to widen the affected blood vessel. It helps improve blood flow and reduce symptoms.

Chronic Mesenteric Ischemia Treatment

While people with the chronic form of mesenteric ischemia may need multiple treatments, they are often similar to those of acute mesenteric ischemia. Most people need surgery to remove the clot that grows slowly or to widen a narrowed blood vessel. Usually, it happens in people with internal bleeding, infections (such as sepsis), and other serious complications. Moreover, bypass surgery may also improve or restore blood flow.

Doctors may also prescribe balloon angioplasty to widen a narrowed blood vessel. In most cases, people with chronic mesenteric ischemia undergo catheter-based procedures.

Frequently Asked Questions

Is mesenteric ischemia curable?

Yes, this condition is treatable and reversible if it is found in the early stages. Unfortunately, most people are diagnosed in more advanced stages, which often causes chronic complications. First, doctors will restore blood flow and then will check for damaged or dead tissue.

How does this condition affect my body?

All cells and tissues in the body need oxygen to function properly. However, in people with mesenteric ischemia, a blockage or a narrowed blood vessel delivers reduced oxygen-rich blood to the tissues and organs. As a result, the body cannot function properly.

What does this condition’s name mean?

In general, the mesentery is an organ located in the abdominal area (belly). It holds multiple organs in place (including the small and large intestines, colon, and others). It also contains multiple blood vessels that supply the organs inside with oxygen-rich blood. Furthermore, ischemia is a medical term used to describe parts of the body that do not have enough blood flow. If you have any other questions, ask your healthcare provider.