Back

Classically, the patient presents with complaints of post-prandial abdominal pain that is typically described as dull or crampy, located in the epigastric discomfort, and that occurs 30 minutes to 1 hour after eating and lasts about 4 hours (abdominal angina). The patient usually has early satiety. The chronicity of the pain leads to food fear and weight loss.

• Causes of chronic mesenteric ischemia include atherosclerosis, extrinsic compression (pancreatic neoplasm), and median arcuate ligament compression syndrome (MALS) caused by compression of the celiac axis by the median arcuate ligament of the diaphragm during expiration.
• An abdominal bruit may be heard on exam.
• If chronic, a gastrointestinal (GI) workup, including endoscopy, barium studies, abdominal ultrasound, and CT scan, may be done to rule out other causes such as ulcers, gastritis, and cholelithiasis, among others. A mesenteric duplex will demonstrate abnormal flows in the celiac axis and superior mesenteric artery. Angiography is the most reliable diagnostic tool.
• Treatment options include angioplasty and stent, median arcuate ligament release, visceral bypass, and endarterectomy of the affected vessel(s). Postoperatively, these patients should be monitored for return of bowel function and the ability to tolerate a diet without symptoms.