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Chapter 87 - Treatment of chronic mesenteric ischemia
- from Section 19 - Vascular Surgery
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
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- Book:
- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 624-626
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- Chapter
- Export citation
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Summary
Owing to the rich blood supply to the intestines, symptoms of chronic mesenteric ischemia are estimated at 1/100,000 persons. The major vessels supplying the intestines are the celiac artery for the foregut, the superior mesenteric artery for the midgut, and the inferior mesenteric artery for the hindgut. Additionally, the inferior mesenteric artery receives a rich collateral flow from branches of both internal iliac arteries. With chronic mesenteric occlusion, the rich collateral network usually provides adequate collateral flow to the intestines. However, as stenosis or occlusion occurs in two or more of the three major vessels, patients become symptomatic.
The diagnosis of chronic mesenteric ischemia is usually suggested by the presenting symptoms, and it is confirmed by diagnostic tests. Postprandial pain is the most prevalent complaint, which may be accompanied by symptoms of bloating, weight loss, “food fear,” nausea, vomiting, diarrhea, and/or constipation. The pain is typically dull and crampy, poorly localized to the midepigastric region or midabdomen, and usually occurs within the first hour after eating. The symptoms are often severe enough to cause the patient to restrict food intake (“food fear”). The weight loss may be so acute as to result in cachexia and prompt a work-up for an underlying neoplasm. The outcome for patients with chronic mesenteric ischemia is dire, with 86% of the patients developing symptoms significant enough to warrant revascularization, or dying from bowel ischemia. Since acute mesenteric ischemia carries a mortality rate that can approach 70%, the timely diagnosis and treatment of patients with chronic mesenteric ischemia is crucial to limiting morbidity and mortality in this patient population.
79 - Treatment of chronic mesenteric ischemia
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- By Karthikeshwar Kasirajan, Emory University, School of Medicine, Atlanta, GA, Elliot L. Chaikof, Emory University, School of Medicine, Atlanta, GA
- Edited by Michael F. Lubin, Emory University, Atlanta, Robert B. Smith, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Nathan O. Spell, Emory University, Atlanta, H. Kenneth Walker, Emory University, Atlanta
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- Book:
- Medical Management of the Surgical Patient
- Published online:
- 12 January 2010
- Print publication:
- 10 August 2006, pp 623-626
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- Chapter
- Export citation
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Summary
Owing to the rich blood supply to the intestines, symptoms of chronic mesenteric ischemia are rare. The major vessels supplying the intestines are the celiac artery for the foregut, the superior mesenteric artery for the midgut, and the inferior mesenteric artery for the hindgut. Additionally, the inferior mesenteric artery receives a rich collateral flow from branches of both internal iliac arteries. In the event of chronic occlusion of one or more of the main arteries supplying the bowel, an extensive network of interconnecting branches ensures adequate collateral flow to the intestines. Hence, for symptoms of chronic mesenteric ischemia, stenosis or occlusion in two or more of the three major vessels is often necessary.
The diagnosis of chronic mesenteric ischemia can usually be suspected on clinical grounds alone. Postprandial pain is the most prevalent complaint, which may be accompanied by symptoms of bloating, weight loss, “food fear,” nausea, vomiting, diarrhea, and/or constipation. The pain is typically dull and crampy, poorly localized to the midepigastric region or midabdomen, and usually occurs within the first hour after eating. The symptoms are often severe enough to cause the patient to restrict food intake (“food fear”). The weight loss may be so acute as to result in cachexia and prompt a work-up for an underlying neoplasm. In the only available natural history study of chronic mesenteric ischemia, 86% of the patients developed symptoms significant enough to attempt revascularization or they died due to bowel ischemia.