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Mesenteric Ischemia is an attack on the gut (stomach and intestines) like heart attack. It has thrombus (blood clot) formation and narrowing of arteries in the stomach and intestines, reducing gut blood circulation and death of the stomach/intestinal cells. In India, mesenteric ischemia patients have higher complications & death rate than the western countries.
Causes -
- 50+ years age
- Tobacco – Smoking / chewing (Any age)
- Diabetes Mellitus
- High blood pressure
- High blood cholesterol levels/Obesity
- Pre-existing heart disease/valvular heart disease
- Individuals with blood clotting tendencies
Symptoms -
- Severe abdominal pain in spite of normal abdominal sonography
- Abdominal pain increases after food consumption.
- Food fear and weight loss
Negligence can cause -
For prolonged periods if the blood vessels remain blocked, intestine blackening develops, called ‘gangrene’ which is life threatening and causes loss of intestines
Diagnosis -
Consult a vascular surgeon as soon as possible to avoid intestine removal surgery.Computed tomography (CT) of your abdomen can help in the treatment
Treatment -
Initial Resuscitation and Critical Care is done :
- Fluid and electrolyte correction
- Antibiotics
- Anticoagulation
- Vital optimization
Patients with threatened bowel, regardless cause require surgery. If the bowel is not viable/gangrenous, then the surgeon removes the bowel segment before revascularization.
Reestablish Blood Flow To The Intestine
- Urgent thrombolysis (clot-dissolving procedure) – Flow Restoration must be accomplished within a few hours to avoid bowel necrosis and death. Recent advances in endovascular treatment of mesenteric ischemia are Catheter-guided thrombolysis or percutaneous mechanical thrombectomy. Their minimal invasive approach, lyses/removes the blood clot in emergency situations.
- Vascular stenting of mesenteric arteries- Angioplasty and stenting are well established for sub-acute/chronic presentations, specially in Patients at high operative risk or as a bridge to elective surgical bypass after the acute illness has resolved.
3. Vascular bypass of mesenteric arteries- Commonly performed for acute or chronic occlusion of mesenteric arteries. During a mesenteric artery bypass, a vein or prosthetic bypass is grafted onto your aorta and then onto the mesenteric artery, making a different route for blood to flow to the intestines.