Mesenteric Ischemia
Does mesenteric ischemia have a solution? All the information on the causes, symptoms, and treatments of this disease.
Symptoms and Causes
Mesenteric ischemia refers to the reduction of blood flow in a part of the small intestine due to a total or partial obstruction in the mesenteric arteries, which supply blood to most of the intestine.
There are two types of the disease:
- Acute mesenteric ischemia: sudden loss of blood flow. Requires immediate medical attention.
- Chronic mesenteric ischemia: the decrease in blood flow is progressive. It is very rare.
Early diagnosis and quick medical intervention are crucial in cases of acute mesenteric ischemia, as it is a serious abdominal emergency. The mortality rate among patients who are not surgically treated for the disease is between 60% and 85% of those affected.
Symptoms
The main symptoms of acute mesenteric ischemia include:
- Sudden and very intense abdominal pain.
- Diarrhea.
- Abdominal distension.
- Fever.
- Nausea and vomiting.
- Peritonitis.
The symptoms of chronic mesenteric ischemia include:
- Abdominal pain that occurs shortly after eating and lasts between one and three hours. The pain is more intense with heavy meals and those rich in fats.
- Weight loss.
- Persistent diarrhea.
- Early satiety.
Causes
In acute mesenteric ischemia, the reduction in blood flow is mainly caused by the presence of a blood clot in the mesenteric artery. The clot can form in the same artery or originate in the heart or aorta and travel to the intestine.
In chronic mesenteric ischemia, however, the blood flow is reduced due to the progressive narrowing of the arteries caused by the accumulation of fat deposits or plaque on the arterial walls (atherosclerosis).
Risk Factors
The risk of developing acute mesenteric ischemia increases under the following circumstances:
- Atrial fibrillation: irregular and very rapid heart rate.
- Heart failure.
- Valvular heart diseases.
- Coagulation disorders.
- Use of vasoconstrictor drugs such as cocaine or amphetamines.
- Recent heart attack.
- Recent catheterizations.
- Use of contraceptives.
- Inflammatory conditions such as pancreatitis and diverticulitis.
For the chronic type, the risk factors are as follows:
- Type 2 diabetes.
- Hypercholesterolemia.
- Hypertension.
- Coronary artery disease.
- Smoking.
- Obesity.
- Advanced age.
Complications
If the sudden obstruction of blood flow is not treated immediately, the lack of oxygen can lead to the death of the affected intestinal tissues. These dead tissues may release toxic substances into the body, triggering sepsis: the immune system reacts incorrectly to the infection, causing multiorgan failure, which can result in death.
Patients with chronic mesenteric ischemia, on the other hand, may develop a reluctance to eat due to the associated pain, leading to malnutrition and significant weight loss. Additionally, chronic symptoms may worsen and lead to the acute form of the disease.
Prevention
Some measures can be taken to control the main causes of mesenteric ischemia, the formation of blood clots, and the accumulation of plaque in the arteries:
- Follow a healthy diet rich in vegetables and whole grains, with a reduced content of sugars, cholesterol, and fats.
- Avoid tobacco.
- Exercise regularly.
- Do not consume drugs.
Which doctor treats mesenteric ischemia?
Mesenteric ischemia is diagnosed and evaluated by specialists in angiography and vascular surgery.
Diagnosis
After studying the symptoms and risk factors, several tests are conducted to confirm the diagnosis of mesenteric ischemia:
- Blood tests: the levels of leukocytes and lactate are measured, which are usually elevated in cases of acute ischemia.
- Abdominal Doppler ultrasound: ultrasound is used to generate images of the blood vessels and blood flow.
- Magnetic resonance angiography or computed tomography: a catheter is guided to the mesenteric arteries, where a contrast fluid is introduced to obtain 3D images where the clot or areas of arterial narrowing can be detected.
Treatment
The treatment for mesenteric ischemia is primarily surgical:
- Mesenteric endarterectomy: an open surgery procedure where, through an incision in the abdomen, access is gained to the damaged artery to remove plaque or the clot.
- Angioplasty: a catheter is inserted into the artery with a small balloon at its tip, which is inflated to widen the artery and restore blood flow. Additionally, a small metal mesh tube is placed to keep it open. Angioplasty is also performed to suction the clot using the catheter.
- Bypass revascularization: using a blood vessel from another part of the body or an artificial one, a new route is created for blood flow to bypass the blocked artery.
- Resection: in case of tissue death, the affected part of the intestine must be removed and the remaining healthy ends connected.
- Medication: surgical treatment can be combined with the administration of anticoagulant or vasodilator medications to prevent clot formation and relax the narrowed arteries.
