Mesenteric Ischemia

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Introduction

There are four main causes of mesenteric ischemia:

Risk factors include:

Inferior mesenteric artery (IMA) is often the first to go, as it is lower down and can become involved in aortoiliac disease.

It can also be tied off during surgery, with little initial consequences.

Symptoms are typically:

Chronic symptoms can include:

Plain film and CT scan can show bowel wall thickening or pneumatosis intestinalis.

Mesenteric angiography is the most helpful, but is often unavailable. Often two vessels are occluded and the other stenosed.

Colonoscopy and doppler ultrasound is typically negative and therefore not helpful.

Minimally invasive, endovascular approaches can be taken by interventional radiologists or vascular surgeons.

Open repair

more durable and with higher clinical success
longer length of stay
more risk of complications
diarrhea can be disastrous if approaching anteriorly due to disruption of the celiac plexus
retrograde approach can be valuable for avoiding complications, traveling alongside the 11th rib.

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