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Mesenteric Ischaemia

The 3 main branches of the aorta are the:

  • Coeliac (Foregut) - supplies the stomach, proximal duodenum, biliary system, liver, pancreas, spleen

  • Superior Mesenteric (Midgut) - supplies the distal duodenum to 1/2 transverse colon

  • Inferior Mesenteric (Hindgut) - supplies the 2/2 transverse colon to rectum

The superior mesenteric artery and its branches - Henry Gray

Chronic Mesenteric Ischaemia

This occurs when there's atherosclerotic narrowing of mesenteric vessels, which results in intermittent abdominal pain when blood supply can’t keep up with the demand. Also known as Intestinal Angina. Patients here present with:

  • Diffuse, colicky abdominal pain after eating (starts 30 mins after, lasting 1-2 hrs)

  • Weight loss (due to food avoidance as it causes pain)


Risk factors - That of CVD e.g. age, smoking, diabetes, hypertension


Investigation - CT Angiogram (for diagnosis)


Management:

  • Reduce modifiable risk factors

  • Secondary prevention e.g. statins and antiplatelet

  • Revascularisation

    • Endovascular i.e. percutaneous mesenteric artery stenting is 1st line here

    • Open surgery


Acute Mesenteric Ischaemia

This occurs when there's a rapid blockage of blood flow through an intestinal artery, most commonly the SMA (superior mesenteric artery). It can lead to necrosis and perforation, which can then go on to cause peritonitis, sepsis, and shock. Patients here present with:

  • Acute, non-specific abdominal pain which is disproportionate to examination findings

  • Guarding

  • N+V


Risk factor - AF


Investigations:

  • ABG and Lactate - Will show Metabolic acidosis and Raised lactate due to the ischaemia

  • ECG - assess for AF

  • CT Angiogram - for diagnosis


Management:

  • Remove/bypass the clot

  • Surgery to remove necrotic bowel



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