Abstract
Chronic mesenteric ischemia (CMI) is a rare disease. The classic presentation is intermittent abdominal pain in an elderly female patient with long-term smoking history and extensive atherosclerotic disease. Due to inadequate blood flow to meet intestinal metabolic demands, chronic mesenteric ischemia often causes abdominal pain several hours after eating. As disease progresses, patients report diarrhea, weight loss, and large meal aversion. Chronic mesenteric ischemia is difficult to diagnose in the emergency department due to nonspecific symptoms and exam findings that trigger work-ups for other acute causes of abdominal pain in the elderly. CT angiography is the most common imaging modality used for diagnosis and is readily available in most emergency departments, making the diagnosis of CMI possible in the acute care setting. Patients diagnosed with chronic mesenteric ischemia can often be discharged with vascular surgery follow-up and dietary modification instructions, though patients with failure to thrive and/or symptoms at rest warrant admission for further treatment and evaluation.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Kolkman JJ, Geelkerken RH. Diagnosis and treatment of chronic mesenteric ischemia: an update. Best Pract Res Clin Gastroenterol. 2017;31(1):49–57.
Chandra A, Quinones-Baldrich WJ. Chronic mesenteric ischemia: how to select patients for invasive treatment. Semin Vasc Surg. 2010;23(1):21–8.
Debus ES, Muller-Hulsbeck S, Kolbel T, Larena-Avellaneda A. Intestinal ischemia. Int J Color Dis. 2011;26(9):1087–97.
Paterno F, Longo WE. The etiology and pathogenesis of vascular disorders of the intestine. Radiol Clin N Am. 2008;46(5):877–85.
Lainez R, Richardson W. Median arcuate ligament syndrome: a case report. Ochsner J. 2013;13(4):561–4.
Senadhi V. A rare cause of chronic mesenteric ischemia from fibromuscular dysplasia: a case report. J Med Case Rep. 2010;19(4):373.
Angle J, Nida B, Matsumoto A. Managing mesenteric vasculitis. Radiology. 2015;18(1):38–42.
Rheudasil JM, Stewart MT, Schellack JV, Smith RB III, Salam AA, Perdue GD. Surgical treatment of chronic mesenteric arterial insufficiency. J Vasc Surg. 1988;8(4):495–500.
Clair DG, Beach JM. Mesenteric ischemia. N Engl J Med. 2016;374(10):959–68.
Pecoraro F, Rancic Z, Lachat M, Mayer D, Amann-Vesti B, Pfammatter T, Bajardi G, Veith FJ. Chronic mesenteric ischemia: critical review and guidelines for management. Ann Vasc Surg. 2013;27(1):113–22.
Mastoraki A, Mastoraki S, Tziava E, Touloumi S, Krinos N, Danias N, et al. Mesenteric ischemia: pathogenesis and challenging diagnostic and therapeutic modalities. World J Gastrointest Pathophysiol. 2016;7(1):125–30.
Kolkman JJ, Mensink PB, van Petersen AS, Huisman AB, Geelkerken RH. Clinical approach to chronic gastrointestinal ischaemia: from ‘intestinal angina’ to the spectrum of chronic splanchnic disease. Scand J Gastroenterol Suppl. 2004;39(Suppl 241):9–16.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Owens, S., Ronan-Bentle, S. (2019). Chronic Mesenteric Ischemia: What Clinical Features Lead to the Diagnosis of CMI? Can This Diagnosis Be Made in the Emergency Department? What Is the Appropriate Disposition?. In: Graham, A., Carlberg, D.J. (eds) Gastrointestinal Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-98343-1_31
Download citation
DOI: https://doi.org/10.1007/978-3-319-98343-1_31
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-98342-4
Online ISBN: 978-3-319-98343-1
eBook Packages: MedicineMedicine (R0)