Epistemis

Mesenteric angina (chronic intestinal ischemia)

Specialty: Cardiovascular.

  • intestinal claudication
  • postprandial abdominal pain of cardiovascular origin
  • postprandial dread of vascular cause

Why it occurs

  • Severe atherosclerosis of the superior and inferior mesenteric arteries or celiac trunk
  • Thromboangitis obliterans with involvement of visceral vessels
  • Fibromuscular dysplasia of mesenteric arteries
  • Extrinsic compression of the celiac trunk by the middle arcuate ligament
  • Medium vessel vasculitis (Polyarteritis nodosa)

Initial workup

Doppler ultrasound of mesenteric vessels to quantify peak systolic velocities in the celiac trunk (>200 cm/s) and in the superior mesenteric artery (>275 cm/s); Computed tomography angiography (CT-Angio) of the abdomen and pelvis with a three-phase arterial protocol to map stenosis of the digestive arteries and evaluate the presence of collaterals (such as the arcade of Riolano); Magnetic resonance angiography or invasive diagnostic mesenteric arteriography in case of discordance.

red flags

Intense and diffuse abdominal pain of a colicky nature that typically appears between 30 and 60 minutes after eating food, associated with "postprandial dread" (fear of eating because of the pain it generates) with consequent marked involuntary weight loss, diarrhea with steatorrhea or occult blood in feces, presence of a systolic abdominal murmur audible on auscultation in the epigastrium, or signs of acute abdomen of onset sudden (peritonitis, abdominal silence on auscultation, hypotension or endotoxic shock due to intestinal infarction). It represents a surgical medical emergency if it progresses to acute intestinal ischemia.

Standard management

  • Acetylsalicylic acid — antiplatelet agent indicated to prevent complete thrombosis in situ on mesenteric atherosclerotic lesions; 100 mg once a day orally
  • Atorvastatin — statin for metabolic control and stabilization of systemic atheroma plaque; 40 to 80 mg once daily orally
  • Unfractionated heparin — immediate choice if the chronic condition worsens and acute mesenteric ischemia is suspected; intravenous bolus of 80 IU/kg followed by continuous infusion
  • Nitroglycerin (indicated to temporarily relieve visceral vasospasm through continuous intravenous infusion under blood pressure monitoring in the hospital environment).

Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.

PreviousAcrocyanosis of peripheral vascular origin
Area
Cardiovascular
Listed causes
5
Treatment options
4
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