Mesenteric ischemia, or small bowel ischemia, involves a blockage of blood flow to the small intestine. Symptoms include pain and bloating. It often results from blood clots or atherosclerosis.
Mesenteric ischemia can appear suddenly (acute) or persist over time (chronic). Sudden or severe intestinal ischemia is a medical emergency.
Symptoms include abdominal pain and bloating soon after eating. Any case of mesenteric ischemia needs medical help. If it happens or worsens suddenly, it is a medical emergency.
Here, learn more about mesenteric ischemia, the different types, how to recognize it, and what to expect if it happens.
Small bowel or mesenteric ischemia occurs when the blood vessels leading toward or away from the small intestine become fully or partly blocked. This is often due to a blood clot, but it can happen for other reasons.
Types include:
- Acute mesenteric ischemia: Appears or develops suddenly.
- Chronic mesenteric ischemia: Develops over time.
- Mesenteric venous thrombosis (MVT): Less common. In MVT, the veins leading blood away from the intestine become blocked, causing blood to back up around the small intestine, reducing blood flow and oxygen supply. This can lead to swelling and bleeding in the intestines.
All types can involve abdominal pain and discomfort. Symptoms may range from mild to severe, but any case of mesenteric ischemia needs medical attention.
Without treatment, tissue death in the small intestine can lead to sepsis and other complications.
Acute mesenteric ischemia and mesenteric venous thrombosis are medical emergencies and need urgent attention.
The symptoms of chronic and acute small bowel ischemia can be similar. The main difference is that acute symptoms are sudden and severe, while chronic symptoms worsen over time.
A person with acute mesenteric ischemia may experience:
- sudden and severe abdominal pain, bloating, or both
- nausea, vomiting, or both
- a sudden need to pass feces
- sudden, forceful bowel movements
- blood in the stool
- fever, which suggests tissue death and possibly sepsis
- confusion
A person with chronic mesenteric ischemia may have:
- abdominal bloating and cramps
- abdominal pain that worsens over several weeks or months
- a feeling of fullness 10 to 30 minutes after eating, usually lasting 1 to 3 hours
- diarrhea
- nausea
- vomiting
- low appetite due to concerns about pain
- unexpected weight loss
Not all cases of acute mesenteric ischemia involve a total blockage.
Both acute and chronic mesenteric ischemia can result from:
- a blood clot in the arteries that bring blood to the intestine
- low blood pressure
- atherosclerosis
- scar tissue that develops after surgery, which can obstruct the bowel or blood vessels
- a hernia
An acute blockage involves a sudden drop in blood pressure and can result from:
- a traumatic injury
- a blood clot or scarring developing after surgery
- a worsening of chronic mesenteric ischemia
- low blood pressure due, for instance, to:
- trauma or recent cardiac or abdominal surgery
- heart failure
- dehydration
- drugs that reduce blood flow, such as Vasopressin
- sepsis
In chronic ischemia, a person may live with reduced blood flow to the bowel for some time. Symptoms may worsen gradually, or the person may be under treatment to manage a known risk.
Around 40% to 50% of acute mesenteric ischemia cases are due to embolism, and 25% to 30% of cases are due to thrombosis.
Those
- females
- older people
- those who have recently had surgery
- those with other health conditions, particularly cardiovascular disease
A person has a
- smoke
- are aged
50 to 70 years - have diabetes
- have high blood pressure
- have high cholesterol or fat levels in the blood, known as hyperlipidemia
To diagnose mesenteric ischemia, a doctor will likely:
Treatment options will depend on the cause and whether mesenteric ischemia is acute or chronic.
For acute mesenteric ischemia, options can
- rehydration to provide fluid and balance electrolytes
- surgery to identify the extent of damage and repair blood vessels
- surgical removal of all or part of the bowel in
84% of cases - addressing any underlying conditions
For chronic mesenteric ischemia, a doctor
- quitting smoking, if appropriate
- taking antiplatelet medication to lower the risk of a blood clot
- surgery to implant a stent or establish a bypass
- dietary changes, if necessary
Complications that can result from acute mesenteric ischemia include:
- tissue death (necrosis)
- intestinal rupture, where contents of the intestines leak into the abdominal cavity
- peritonitis, or inflammation of the abdominal cavity
- sepsis or septic shock
- ventilator-related pneumonia during treatment
- loss of
all or part of the small bowel, making an ileostomy necessary - scarring of bowel tissue after treatment, leading to bowel narrowing
- fatality, in some cases
People with chronic mesenteric ischemia have a higher risk of the
- worsening blockage
- intestinal bleeding
- sepsis
- difficulty eating and inability to absorb nutrients, leading to malnutrition
- colitis
- ileus, a temporary loss of movement in the bowels
- infections
- surgical complications, including infection and a risk of kidney failure
If a person has symptoms of sepsis, fever, or severe pain lasting
Mesenteric ischemia needs medical attention and can be a medical emergency.
A person needs medical help if they experience new pain, bloating, or blood in the stool.
They need emergency medical care if symptoms are sudden, severe, and occur with fever and other symptoms.
The outlook for mesenteric ischemia will depend on various factors, such as whether it is acute or chronic, the cause, and how soon a person receives medical care.
Acute mesenteric ischemia
Acute mesenteric ischemia has a high rate of fatality or ongoing health problems. Between
- older age
- the need for bowel removal during a second surgery
- metabolic acidosis, or high levels of acidity in the blood
- kidney problems
- having symptoms for a longer time
Seeking help as soon as symptoms arise can improve the outlook.
Chronic mesenteric ischemia
Chronic mesenteric ischemia
Mesenteric or small bowel ischemia is when the blood flow to the small intestine becomes reduced or blocked. It can be a medical emergency.
Possible causes include atherosclerosis, a hernia, a blood clot, scar tissue, and low blood pressure.
It is important for anyone experiencing severe or sudden intestinal symptoms to seek emergency medical help.