Mesenteric ischemia occurs when one or more of your mesenteric arteries become obstructed. As a result of the obstruction, your intestines do not receive an adequate amount of oxygen, and therefore cannot function properly. Over time, tissue in your intestines can die due to inadequate blood flow. Mesenteric ischemia usually affects your small intestine, but can also impact other organs such as your stomach, colon or liver.

Causes of mesenteric ischemia

Acute mesenteric ischemia often occurs when a blood clot (embolus), which usually forms in the heart, travels into one of the mesenteric arteries and blocks the blood flow. People with an irregular heartbeat are at a higher risk for acute mesenteric ischemia.

Chronic mesenteric ischemia is commonly caused by atherosclerosis (hardening of the arteries). This occurs when a sticky substance, called plaque, builds up in your arteries and causes them to narrow and stiffen.

Other risk factors that contribute to mesenteric ischemia include:

• Aortic dissection (a tear in the aorta's inner layer)
• Blood vessel disorders (such as fibromuscular dysplasia and arteritis)
• Coagulation disorders
• Congestive heart failure
• Low blood pressure
• Obstruction of the veins in the bowel

Symptoms of mesenteric ischemia

There are two categories of mesenteric ischemia: acute and chronic. Acute mesenteric ischemia is when your symptoms start abruptly and become serious very quickly.

Symptoms of acute mesenteric ischemia include:

• Nausea
• Sudden, severe abdominal pain
• Vomiting
• Diarrhea

Chronic mesenteric ischemia results from slowly progressive blockages that have been present for a long period of time. Chronic mesenteric ischemia can become acute quickly and without warning.

Symptoms of chronic mesenteric ischemia include:

• Severe abdominal pain after eating (begins 15 to 60 minutes after eating and lasts for 60 to 90 minutes)
• Weight loss

Why choose Ohio State for mesenteric ischemia treatment?

Since The Ohio State University Wexner Medical Center is an academic medical center, our patients benefit from innovative research, a depth of medical expertise and the newest technologies and treatment techniques available for cardiology.

At Ohio State, our vascular surgeons are experienced in diagnosing mesenteric ischemia, and in all forms of treatment for mesenteric ischemia, including minimally invasive angioplasty and stenting, and open surgical bypass for more complex cases.

How Ohio State diagnoses mesenteric ischemia

If you have sudden severe abdominal pain, you may have acute mesenteric ischemia or other abdominal problems, and should go to an emergency room immediately.

If you are diagnosed with chronic mesenteric ischemia, you may need to undergo tests to rule out other conditions that have similar symptoms to mesenteric ischemia. After performing an examination and discussing your symptoms, your physician may order one or more of the following diagnostic tests:

• Angiogram – An X-ray of blood vessels to identify blockage; it is performed by inserting a tube into an artery in the leg and injecting a contrast dye into the artery
• CT scan (computed tomography scan, also called CAT scan) – An imaging procedure that uses X-rays and computer technology to produce cross-sectional, detailed images of the body, including bones, muscles, fat and organs
• Duplex ultrasound – a painless, noninvasive test that shows how blood is moving through your arteries and veins. It examines the structure of your blood vessels and indicates if there are any blockages within your arteries.
• MRA (magnetic resonance angiography) – A noninvasive imaging procedure that uses large magnets, radiofrequencies and a computer to evaluate blood flow through arteries

How Ohio State treats mesenteric ischemia

Mesenteric ischemia is a serious condition that can begin and progress quickly. The sooner you receive medical treatment, the better your outcome is likely to be. The goal of treatment is to restore adequate blood flow to your intestines through your mesenteric arteries.

Procedures

Angioplasty and stenting is a minimally invasive procedure where your surgeon inflates a small balloon inside of your narrowed artery, causing the artery to expand. Once your artery expands, your surgeon inserts a stent (small, mesh tube) to support the artery walls so that they stay open to allow adequate blood flow.

Surgery

• Bypass surgery – Your surgeon uses one of your veins, or a man-made tube, to create a detour around the damaged section of your artery. The bypass provides a new, unobstructed path for blood to flow to your intestines.
• Clot removal surgery – Sometimes, with acute mesenteric ischemia, your blood clot must be removed surgically

If any part of your intestine has been damaged, you may need surgery to have the damaged sections surgically removed.