Mesenteric (small Bowel) Ischemia

Your Path

  • Mesenteric (small bowel) Ischemia


  • Atherosclerosis, embolus (a fib, ventricular thrombus), low flow (systemic hypo-perfusion)
  • Venous thrombosis, with RFs below
  • SMA Syndrome - very rare condition where SMA compressed by duodenum - associated w/rapid weight loss, scoliosis surgery--> change in anatomic relationships

Risk Factors

  • Female > male
  • Smoking
  • Older age
  • Known atherosclerosis or RFs (DM, HTN, hyperlipidemia)
  • Venous mesenteric thrombosis: hypercoaguable state→ factor 5 leiden defic, protein S/C/AT 3 defic, prothombin mutation, antiphoslipid antibody synd, parox noct hemoglobinuria; history of idiopathic dvt/pe, malignancy, other inflam process


  • Generalized abd/epigastric pain
  • Chronic ischemia causes progressive/persistent pain after meals→ angina of the gut→ food avoidance→ weight loss
  • With acute mesenteric ischemia/infarct, pain is severe and patients severely ill

Physical Exam Findings

  • Sometimes abdominal bruits
  • Abdominal exam often unremarkable (i.e. pain out of proportion to findings)
  • Sometimes guaiac +, rarely gross blood
  • May have other manifestations of vascular disease (e.g. diminished extremity pulses)