Mesenteric Ischemia

Overview

What is the condition?

Mesenteric ischemia is an uncommon, dangerous condition that happens when parts of your digestive system don’t get enough blood flow. This usually happens because of a blockage in your blood vessels that provide blood to those areas. This condition is more common in people who are older, especially those with cardiovascular disease or blood clotting disorders.

Without enough blood flow, the affected organs and tissues don’t have enough oxygen and can’t function correctly. If the blockage is severe enough, the affected organs and tissues may start to die. This condition is often deadly, so a quick diagnosis and treatment are very important.

What does this condition’s name mean?

The mesentery (pronounced, “mess-ent-airy”) is an organ in your abdomen (belly) that holds several other organs in place, including your small and large intestines, colon and more. The mesentery also has a network of blood vessels that supply your organs inside.

Ischemia (pronounced, “iss-key-me-uh”) is when parts of your body aren’t getting enough blood flow. Mesenteric ischemia means that the lack of blood flow is affecting your mesentery and your organs inside.

What are the different types of this condition?

There are two types of mesenteric ischemia:

Acute mesenteric ischemia

Heart attacks and strokes often happen because of blockages in critical arteries, and acute mesenteric ischemia can happen in a similar way. This usually happens because of blood clots, which cause sudden and very severe symptoms. This condition is a medical emergency that needs immediate care.

Chronic mesenteric ischemia

Chronic mesenteric ischemia happens more gradually, usually because your mesenteric arteries start to narrow. This condition takes longer to develop, and the symptoms usually worsen over time.

Who does it affect?

Mesenteric ischemia is more common as people age. It usually happens along with heart and circulation conditions, especially ones that can cause blood clots.

Risk factors for mesenteric ischemia include:

How common is this condition?

Mesenteric ischemia is a rare issue. The estimated number of cases is 1 to 2 for every 1,000 cases where someone needs hospitalization.

How does this condition affect my body?

All of your cells, tissues and organs need a steady supply of blood and oxygen. Without that supply, they’ll start to die. What makes mesenteric ischemia so dangerous is that it affects your intestines, which contain trillions of bacteria.

Normally, those bacteria are good for you and help you digest the food you eat. But when your intestines start to die, those bacteria can spread to places they don’t belong and cause dangerous infections. That can lead to sepsis, a life-threatening condition that happens when your immune system’s overwhelming reaction to an infection ends up damaging your body, too.

Symptoms and Causes

What causes this condition?

Different types of mesenteric ischemia have different causes.

Acute mesenteric ischemia

A waxy substance called plaque can build up inside of your arteries, causing them to harden. This condition, atherosclerosis, happens commonly with cardiovascular disease. If an area of plaque breaks open, blood clots can form there.

Clots can cause blockages in the following ways:

  • A clot forming in your mesenteric artery (15% to 25% of cases). Certain conditions make it easier for clots to form in your blood vessels. If one forms in your mesenteric arteries, it can cause acute mesenteric ischemia.
  • A clot getting stuck in your mesenteric artery (50% of cases). This happens when a clot forms somewhere else in your body, breaks free and gets stuck in a mesenteric artery. Blood can’t get past the clot, causing acute mesenteric ischemia.
  • A clot forming in nearby veins of your mesentery (5% of cases). This often happens with disorders that make your blood clot too easily (including conditions you inherit from your parents). Clots in your mesenteric veins slow down blood flow overall, causing blood to back up behind the clot. This is more common in people who are younger.

Non-occlusive mesenteric ischemia (NOMI), which happens without a blockage, makes up about 20% of all cases of acute mesenteric ischemia. Acute NOMI happens when blood vessels constrict, or there are spasms in the muscles lining those vessels. This can happen for several reasons.

  • Drugs. Certain kinds of prescription heart medications can cause your blood vessels to narrow. It’s also possible with recreational drugs like cocaine.
  • Medical procedures. Some medical procedures, like dialysis or surgery, can cause constriction in mesenteric blood vessels.
  • Health conditions. Problems like sepsis, heart attack, dehydration and allergic reactions can all contribute to acute mesenteric ischemia. Low blood pressure, on its own or in connection with other health issues, can also make this worse.

Acute NOMI usually takes longer to become severe but is still dangerous.

Chronic mesenteric ischemia

Chronic mesenteric ischemia often happens because of circulatory diseases that cause blood vessels to narrow. This narrowing, known as stenosis, means that blood flow to your mesentery drops over time.

This condition can also happen because a blood clot forms in a mesenteric blood vessel. When this happens, the clot can grow over several days or even weeks, with symptoms getting worse as it gets larger.

While this condition isn’t usually life-threatening right away, about 40% of acute mesenteric ischemia cases happen after a person has chronic symptoms. That’s because early symptoms from narrow blood vessels suddenly become severe when a new clot blocks the narrowed blood vessels.

What are the symptoms?

The symptoms of mesenteric ischemia vary depending on the type.

Acute mesenteric ischemia

The symptoms of this condition tend to happen suddenly and include the following:

  • Abdominal pain. This symptom is the most common, happening in about 75% to 80% of cases. This usually happens after eating, isn’t in a specific place in your belly and can be very severe. In many cases, the pain is much worse than your healthcare provider might expect based on their examination. In cases of acute NOMI, this may be the only symptom.
  • Bloating, nausea and vomiting. These usually happen along with abdominal pain. Vomiting is especially common, happening in about 70% of cases.
  • Changes in bathroom habits. These changes affect how frequently you need to poop. One of these changes is constipation, which can make you poop less often.
  • Diarrhea. This happens in about 40% of cases, but it may happen off and on rather than consistently. Diarrhea may also be very intense, and severe pain can follow. In the late stages of this condition, bloody diarrhea is more common.
  • Weight loss. This symptom happens often, even in acute cases. It can indicate avoiding food because of pain or other symptoms that happen before this condition reaches a severe level.
  • Fever. This can be a sign of a dangerous infection.

It’s very common for this condition to happen after you have chronic mesenteric ischemia symptoms (seen immediately below). In about half of acute cases, chronic symptoms happen first.

Chronic mesenteric ischemia

Symptoms of this condition can happen slowly and usually worsen over time, including:

  • Abdominal pain. This pain is most noticeable for about one or two hours after a meal. The pain often feels similar to cramps and usually happens in the upper belly area or around your navel (belly button).
  • Food fear and weight loss. As this condition gets worse, the pain becomes more intense. That can cause “food fear,” which is when you want to avoid food because you anticipate pain after eating. This usually leads to unintentional weight loss.
  • Changes in bathroom habits. This includes needing to poop more or less often than you did before.
  • Diarrhea. This happens in about one-third of people with this condition, and is usually chronic (meaning it happens over a long period of time).

Diagnosis and Tests

How is it diagnosed?

Your doctor diagnoses mesenteric ischemia based on a combination of a physical examination, lab tests and imaging. Unfortunately, this condition is usually difficult to diagnose in its early stages. An additional challenge is that many people with this condition can’t talk or answer questions easily, especially if they’re in a lot of pain.

What tests will be done to diagnose this condition?

Many tests can help diagnose this condition, including:

Physical examination

A physical examination is where your doctor looks, feels and listens for signs that might mean you have a medical problem. With mesenteric ischemia, doctors can find signs in the following ways:

  • Signs they can see: One of the most visible signs is bloating in your belly area. Some people will show visible signs of weight loss. Many people will also have such severe pain that they go into the fetal position, with their knees pulled toward their chin.
  • Signs they can feel: Healthcare providers will use their hands to palpate (feel) your abdomen. Some people will have tenderness in their abdomen, helping healthcare providers find which areas hurt more. Many people will react or “guard” instinctively when their healthcare provider tries to feel their belly. In many cases, people will describe pain that’s much worse than it should be from simply having their belly felt.
  • Signs they can hear: Healthcare providers can use a stethoscope to listen to the sounds of your digestive tract. Those sounds, known as borborygmi (pronounced, “bore-bore-ig-me”), are often harder to hear with mesenteric ischemia. In more severe cases, there may be no digestive sounds at all. In some cases, they might also hear a sound called a bruit, which happens with some blood flow blockages.

Physical exams might not turn up major indicators until this condition is very advanced. That means this condition can take longer to diagnose, which is part of why it’s so dangerous.

Lab tests

Several lab tests can help diagnose mesenteric ischemia. The tests will look for changes in your blood, especially the amount of oxygen in it and your blood’s clotting ability. The tests will also look for signs that your immune system is reacting to an infection. Other tests will show if your blood contains chemical markers that appear because of damaged or dying cells and tissues.

Imaging and endoscopy

The best way for healthcare providers to diagnose mesenteric ischemia is to see where there’s little or no blood flow. Multiple imaging tests make that possible:

  • Ultrasound. This test uses ultra-high-frequency sound waves from a device held against the skin of your belly. The sound waves work similarly to how bats use sonar to “see,” creating an image that healthcare providers can use to find areas with low or no circulation. Different types of ultrasound can also measure how much blood is flowing through different blood vessels.
  • Angiography. This test is the best, most reliable way of diagnosing mesenteric ischemia. Angiography uses a dye, called contrast, injected into major blood vessels in your abdomen. Those vessels then stand out on an X-ray or computed tomography (CT) scan. It also shows partially or totally blocked vessels. In some cases, this can involve a catheter, a long, tube-shaped device inserted into a major blood vessel that allows healthcare providers to look at the problem from inside the affected blood vessels.
  • Endoscopy. This is a procedure where your healthcare provider inserts a device called an endoscope into your digestive tract to look for signs of ischemia. If they suspect the problem is closer to your stomach, they’ll insert an endoscope down your throat and down to your small intestine. If they suspect the issue is in your colon, large intestine or at the lower end of your small intestine, they’ll insert the scope into your rectum (the same approach as a colonoscopy). It’s common for the methods to involve anesthesia (either moderate sedation or general anesthesia) during the procedure. Endoscopy is more likely for people who can’t have a contrast injection, especially people with an allergy or kidney problem.

Management and Treatment

Is mesenteric ischemia treatable or curable?

Mesenteric ischemia is treatable and reversible when it’s caught early enough.

The first priority is always to restore circulation as quickly as possible. Because mesenteric ischemia becomes more dangerous over time, healthcare providers may recommend surgery more quickly.

After restoring blood flow, the next priority is checking to see if there’s any damaged or dead tissue. In cases where sections of your intestine or colon are dead because they didn’t have enough blood flow, removing those sections is the only way to fix the damage and prevent life-threatening complications.

What treatments and medications are used?

The likely treatments and procedures vary depending on the type of mesenteric ischemia and the location of its cause.

Acute mesenteric ischemia

The most effective treatment for acute mesenteric ischemia is surgery. That’s because your surgeon can directly access and remove any existing clots and widen some narrow blood vessels. They can also place a stent, a support frame device that holds a section of blood vessel wide open.

In cases where it isn’t possible to restore blood flow directly, your surgeon can take a section of blood vessel from another place in your body and use it to create a bypass. That bypass restores blood flow by making a detour around a previously blocked area.

After restoring blood flow, your surgeon can check nearby tissue for signs of damage. If they find dead or damaged areas, your surgeon can remove them and repair the surrounding area so it can function normally in the future. In many cases, this involves a second surgery because it can take up to two days before some dead or damaged tissue is visible.

The likely medications and other supportive therapies usually include:

  • Intravenous (IV) fluids. These can help in cases where low blood pressure or dehydration are part of the issue.
  • Blood transfusions. These are especially important with sufficient blood loss.
  • Oxygen. This reduces how hard your body has to work to circulate blood.
  • Antibiotics. These are crucial with any kind of intestinal or colon surgery because of the risk of infections from the bacteria normally found in those organs.
  • Blood thinners. These medications keep clots from forming, preventing not only a repeat of mesenteric ischemia, but also heart attacks, strokes and pulmonary embolisms. However, people at risk for dangerous bleeding might not receive blood thinners.

Non-occlusive mesenteric ischemia

While this is a subtype of mesenteric ischemia, surgery isn’t always necessary to correct this problem (and it usually isn’t helpful early on). That’s because NOMI usually involves blood vessels that constrict and narrow without an actual blockage.

The key with NOMI is to treat whatever’s causing those vessels to constrict and prevent it from happening again. This may mean stopping prescription medications or recreational drugs that caused those blood vessels to tighten up. If NOMI is caused by another illness, such as sepsis, treatment of that illness will improve blood flow to the mesentery as well.

If NOMI also involves the narrowing of blood vessels, a catheter-based procedure known as balloon angioplasty may help. This procedure involves inserting a catheter into a major blood vessel and steering that device to the affected area. Once there, your healthcare provider inflates a balloon on the tip of the catheter, widening the affected blood vessel.

Other likely treatments include:

  • Vasodilators. These medications cause your blood vessels to expand, making it easier for blood to flow through them.
  • Antibiotics. These are still important even without surgery because of the risk of infection whenever there’s potential for damage to your intestines or colon.
  • Oxygen. This reduces how hard your body has to work to circulate blood.

Chronic mesenteric ischemia

Chronic mesenteric ischemia may need some different treatments, depending on why it happens. But many of the possible treatments are the same as with acute mesenteric ischemia.

Surgery for this issue is common, especially when it involves a slow-growing clot or blood vessels that have become too narrow. It’s also more likely to happen when a person has internal bleeding, infections or sepsis, or other dangerous complications. Bypass surgery is also possible when other options can’t restore blood flow.

Balloon angioplasty and other catheter-based procedures are often considered with this condition. In many cases, healthcare providers will recommend catheter-based procedures over surgery whenever possible. That’s because surgery is harder on your body, and it’s easier to recover from a catheter procedure.

Medications that are likely with this are mostly the same as with acute cases. Clot-busting medications are also common when clots don’t move and grow into blockages.

What are the possible complications and side effects of this condition and its likely treatments?

The complications and side effects of this procedure depend on the treatments that you receive. Your healthcare provider is the best person to tell you the specific possible side effects and complications that are most likely for you.

In general, the following complications are possible with mesenteric ischemia:

  • Sepsis. This is an infection that spreads throughout your body, causing your immune system to overreact. That overreaction causes life-threatening damage to your body.
  • Tearing or rupture of your intestines or colon. This can happen when dead or dying sections of those organs start to break down.
  • Weight loss. This is more likely with chronic mesenteric ischemia but can also happen in acute cases (especially when someone has chronic symptoms before the condition suddenly becomes acute).

Complications that are possible with surgery for mesenteric ischemia include:

  • Issues with digestion after surgery.
  • Constipation or diarrhea.
  • Bleeding.
  • Infection.
  • Kidney failure.
  • Heart attack or stroke (within the following months of the surgery).

Nutrition problems are possible after the removal of parts of your small intestine. Losing sections of your small intestine means it’s harder to absorb nutrition from food. Many people who have this problem, known as short bowel syndrome, need special types of nutrition like a feeding tube.

How can I take care of myself or manage my symptoms?

If you have mesenteric ischemia, you need immediate medical attention (especially if you have the acute type, which happens suddenly). If you have chronic mesenteric ischemia, you should care for this condition according to your healthcare provider’s instructions and guidance. You shouldn’t try to care for this condition on your own, as it can turn into a life-threatening emergency.

How soon after treatment will I feel better and recover?

With quick diagnosis and treatment, most people will start to feel better when blood flow to the affected area improves. Others will likely start to feel better within days or weeks.

For those who undergo surgery, it usually takes longer for them to feel better and recover. That’s because surgery is a more intense procedure and recovery takes time.

Prevention

How can I reduce my risk?

There are several things you can do to reduce your risk of developing mesenteric ischemia. Most of them involve preventing or avoiding conditions that can make mesenteric ischemia more likely.

The things you can do include:

  • Get an annual checkup. Also known as a physical or wellness visit, this is a simple yearly visit with your healthcare provider, who can catch many of the early warning signs of heart disease, high blood pressure, high cholesterol and more. Catching these conditions before you have symptoms can make a huge difference in preventing much worse problems, including mesenteric ischemia.
  • Quit tobacco. This includes vaping and smokeless tobacco products. If you don’t use tobacco, don’t start. Tobacco use damages your blood vessels and makes problems like mesenteric ischemia much more likely to happen.
  • Take your medications. If you have high blood pressure, high cholesterol or diabetes, taking your medication helps prevent damage that can lead to mesenteric ischemia.
  • Eat a healthy, balanced diet. Many of the issues that can lead to mesenteric ischemia are related to your weight and your diet. Diets that are too high in fat or sodium can increase your cholesterol and blood pressure, both of which are risk factors for mesenteric ischemia.
  • Stay active. Physical activity is important for the health of your heart and circulatory system and for maintaining a healthy weight.

How can I prevent this?

Most of the actions that will help prevent mesenteric ischemia are the same steps that can reduce your risk. Unfortunately, there will be some cases — especially those involving injuries or conditions where your blood clots too easily — where prevention isn’t possible.

Outlook / Prognosis

What is the outlook for this condition, and what can I expect?

Unfortunately, mesenteric ischemia in any form is a difficult condition to diagnose. Waiting for a diagnosis can delay treatment, and when treatment doesn’t happen quickly, acute mesenteric ischemia is often deadly. The death rate for the acute version of this condition is between 50% and 80%, especially when there are delays in treatment. When treatment happens in under 12 hours from when the blockage started, the death rate can be as low as 14%. Chronic mesenteric ischemia can also have long-term negative effects, either because of the risk of follow-up blood flow problems or nutrition difficulties.

People with mesenteric ischemia also have a much higher risk of other ischemia-related conditions. These include heart attack, stroke, pulmonary embolism and more. Follow-up visits with your healthcare provider are very important to avoid long-term problems and reduce your risk for other life-threatening conditions.

How long does this condition last?

Acute mesenteric ischemia is a short-lived condition, as it’s usually deadly. Chronic mesenteric ischemia can take days or even weeks to develop. However, treatment for this condition — especially fast treatment — can usually resolve the condition within hours.

When can I go back to work/school?

Your healthcare provider can best explain the likely timeline of your recovery. Depending on the severity of your case and the treatments involved, many people can return to most or all of their usual activities within days or weeks. In more severe cases, especially those involving surgery, it may take longer.

Living With

How do I take care of myself?

After you have mesenteric ischemia, it’s important to follow your healthcare provider’s guidance. They’re the best person to guide you on how you can take care of yourself and avoid further problems. In general, you should do the following:

  • See your healthcare provider as recommended. Follow-up visits can make a big difference in catching complications or other issues that are happening in connection with this condition.
  • Take your medications as instructed. This is especially true with any medication that relates to your heart, circulatory system, diabetes, cholesterol or your blood’s ability to clot.
  • Stop using tobacco, or don’t start in the first place. Tobacco use is a major risk factor for mesenteric ischemia because of how it damages your blood vessels. It also makes it easier for clots to form, which can then block critical blood vessels.
  • Follow your healthcare provider’s guidance on diet and activity. These recommendations can help improve your health overall, not just reduce your risk for another case of mesenteric ischemia.

When should I see my healthcare provider or seek care?

You should see your healthcare provider if any symptoms of mesenteric ischemia return, change or start to get worse. You should also ask them about specific warning signs or symptoms that indicate you need to call their office or seek medical care.

When should I go to the emergency room?

You should seek immediate medical attention if chronic symptoms suddenly change or get worse, or if you have any symptoms of acute mesenteric ischemia. Acute symptoms include:

  • Abdominal (belly) pain, especially if it starts suddenly.
  • Bloating, nausea and vomiting.
  • Changes in bathroom habits (how often you poop).
  • Severe or frequent diarrhea.
  • Unintentional weight loss.

A note from Cleveland Clinic

Mesenteric ischemia can be a frightening condition, especially when it happens suddenly. Fortunately, modern medicine has made great advances when it comes to diagnosing and treating this condition quickly. There are also several steps you can take to reduce your risk of developing this condition or having it return after you recover from it. The best things you can do are to know and manage your risks. Your healthcare provider can be a big help for both of those goals and can help you recover from this condition or avoid it entirely.

Last reviewed by a Cleveland Clinic medical professional on 06/02/2022.

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