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Mesenteric artery ischemia

Mesenteric vascular disease; Ischemic colitis; Ischemic bowel - mesenteric; Dead bowel - mesenteric; Dead gut - mesenteric; Atherosclerosis - mesenteric artery; Hardening of the arteries - mesenteric artery

Mesenteric artery ischemia occurs when there is a narrowing or blockage of one or more of the three major arteries that supply the small and large intestines. These are called the mesenteric arteries.

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Causes

The arteries that supply blood to the intestines run directly from the aorta.  The aorta is the main artery from the heart.

Hardening of the arteries occurs when fat, cholesterol, and other substances build up in the walls of arteries. This is more common in smokers and in people with high blood pressure or high blood cholesterol.

This narrows the blood vessels and reduces blood flow to the intestines. Like every other part of the body, blood brings oxygen to the intestines. When the oxygen supply is slowed, symptoms may occur.

The blood supply to the intestines may be suddenly blocked by a blood clot (embolus). The clots most often come from the heart or aorta. These clots are more commonly seen in people with abnormal heart rhythm.

Symptoms

Symptoms caused by gradual hardening of the mesenteric arteries:

Symptoms of sudden (acute) mesenteric artery ischemia due to a traveling blood clot include:

Exams and Tests

When symptoms begin suddenly or become severe, blood tests may show increased white blood cell count and changes in the blood acid level. There may be bleeding in the GI tract.

A Doppler ultrasound or CT angiogram scan may show problems with the blood vessels and the intestine.

A mesenteric angiogram is a test that involves injecting a special dye into your bloodstream to highlight the arteries of the intestine. Then x-rays are taken of the area. This can show the location of the blockage in the artery.

Treatment

When blood supply is blocked to a part of the heart muscle, the muscle will die. This is called a heart attack. A similar type of injury can occur to any part of the intestines.

When the blood supply is suddenly cut off by a blood clot, it is an emergency. Treatment can include medicines to dissolve the blood clots and open up the arteries.

If you have symptoms due to hardening of the mesenteric arteries, there are things you can do to control the problem:

Surgery may be done if the problem is severe.

Outlook (Prognosis)

The outlook for chronic mesenteric ischemia is good after a successful surgery. However, it is important to make lifestyle changes to prevent hardening of the arteries from getting worse.

People with hardening of the arteries that supply the intestines often have the same problems in blood vessels that supply the heart, brain, kidneys, or legs.

People with acute mesenteric ischemia often do poorly because parts of the intestine may die before surgery can be done. This can be fatal. However, with prompt diagnosis and treatment, acute mesenteric ischemia can be treated successfully.

Possible Complications

Tissue death from lack of blood flow (infarction) in the intestines is the most serious complication of mesenteric artery ischemia. Surgery may be needed to remove the dead portion.

When to Contact a Medical Professional

Call your provider if you have:

Prevention

The following lifestyle changes can reduce your risk for narrowing of the arteries:

References

Brandt LJ, Feuerstadt P. Intestinal ischemia. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 118.

Hauser SC. Vascular diseases of the gastrointestinal tract. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 143.

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Review Date: 1/12/2018  

Reviewed By: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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