Dr Jason Toniolo

Mesenteric Angina

Mesenteric angina, also known as chronic mesenteric ischemia, occurs when narrowed or blocked arteries in the abdomen reduce blood flow to the intestines, causing pain after eating.

Symptoms

Abdominal pain occurs 30-60 minutes after meals, leading to fear of eating and weight loss. Pain typically comes on gradually and persists for months, leading to unintentional weight loss, which is not unexpected due to the massive drop in calories consumed.

Diagnosis

 Diagnosis is difficult. Usually, a CT angiogram and an arterial ultrasound (duplex) are required to conclude. The diagnosis is difficult, as there are many other causes of abdominal pain after eating (all these different causes are more common than blocked intestinal blood vessels)!

Other diagnoses to exclude before making a diagnosis of mesenteric ischaemia include ruling out gall, bladder issues, or issues with the stomach (such as hiatus hernias) or intestinal matters (such as Crohn’s disease, ulcerative colitis or irritable bowel syndrome)

treatment options

If the diagnosis has been accurately made, the treatment is generally a stent inserted in a minimally invasive manner. Younger patients with this condition (age < 60) should have open surgical bypass explored, as the repair is more durable than stenting, which can tend to narrow over the subsequent five years, and open surgery, whilst more invasive, can be safer in the longer term.