Volume 29, Issue 155, January 2025

Mesenteric ischemia - a rare but fatal cause of abdominal pain. A literature review

Aleksandra Jonkisz^1♦, Seweryn Rozalczyk¹, Gabriela Skurzyńska², Zuzanna Bałoniak³, Agnieszka Leszyńska¹, Julia Bałoniak¹, Michalina Doligalska⁴, Aleksandra Stremel⁵, Aleksandra Anioła¹, Sandra Ważniewicz¹

¹University Hospital in Poznań, Przybyszewskiego 49, 60-355 Poznań, Poland
²District Health Center in Otwock, Batorego 44, 05-400 Otwock, Poland
³Warsaw Southern Hospital, Rotmistrza Witolda Pileckiego 99, 02-781 Warszawa, Poland
⁴Medical Hospital in Garwolin, Lubelska 50, 08-400 Garwolin, Poland
⁵Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland

^♦Corresponding Author
University Hospital in Poznań, Przybyszewskiego 49, 60-355 Poznań, Poland

ABSTRACT

Mesenteric ischemia is an uncommon condition with unspecific symptomatology, making it difficult to diagnose. It arises from inadequate blood flow through the visceral arteries due to chronic or acute obstruction. The disease primarily affects women over the age of 60 with many other comorbidities. There is a division into chronic and acute depending on the onset of symptoms and timing of occlusion. The most common cause of chronic vascular insufficiency is atherosclerosis, which narrows or completely occludes the arteries. Clinical symptoms due to developed collateral circulation, occur scarcely in advanced atherosclerotic vascular disease. Patients suffering from chronic mesenteric ischemia complain of severe, postprandial abdominal pain. It usually is “out of proportion” to the physical examination. These patients lose weight as a result of fear of eating. Mesenteric ischemia can also be the result of an acute embolism or thrombosis. The symptoms of mesenteric ischemia are unspecific and can mimic many other more common conditions, including infectious, inflammatory, and malignant diseases. Its severity depends on the ability of collateral vascularisation to prevent malperfusion. As a result, diagnosis is often delayed or missed. Chronic as well as acute mesenteric ischemia can lead to multisystem organ failure, intestinal necrosis, and death. Treatment is based on surgical revascularization. The mortality rate of untreated disease remains high, and the chance of survival decreases over time. This article highlights the importance of including visceral ischemia in the differential diagnosis of abdominal pain and providing proper tests for its identification. Early recognition is crucial in decreasing mortality.

Keywords: Mesenteric ischemia, abdominal angina, atherosclerosis, embolism, thrombus

Medical Science, 2025, 29, e6ms3506

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DOI: https://doi.org/10.54905/disssi.v29i155.e6ms3506

Published: 09 January 2025