MESENTERIC ISCHAEMIA(ACUTE&CHRONIC)

Mesenteric ischaemia as such is not uncommon in any clinical setting.Unfortunately it goes unnoticed largely because of the symptoms with which the patient first presents to the clinician or else because of the clinical acumen of the physician .But clinicians are not to be blamed for this in totality for the simple reason that we really don’t have proper diagnostic facilities around to be sure what the patient is going through.Added to this is the disparity in the symptomotology and the signs with which the patient presents.By the time the diagnosis is made (generally on the operation table during laprotomy),the patient is already on death bed waiting for the final call.Acute mesenteric ischaemias generally present with severe pain abdomen which is “OUT OF PROPORTION TO CLINICAL FINDINGS”.Abdomen is generally soft and the pain the patient complains of is unexplainable .This delays the diagnosis and by the third or the forth day of presentation patient develops peritonitis and gangrene of the gut.The prognosis is dismal in such cases.Situation is no better in chronic mesenteric ischaemic patients.These patients are generally thin built for they have “FOOD FEAR”.Any small intake of food leads to pain abdomen and therefore these patients largely keep themselves fasting.The basic thing is to be strongly suspicious of a clinicopathological entity like this and when ever you come across a patient with unexplained pain abdomen with lean and thin built suspect mesenteric ischaemia and refer the patient to a vascular surgeon before its too late.

I present to you a similar case which we operated upon recently.This patient who was lean and thin came to us with unexplained pain abdomen,uncontrolled hypertension inspite of taking four antihypertensives and bilateral lower limb claudication.It was the strong clinical suspicion of chronic mesenteric ischaemia in him that clinched the diagnosis and probably saved him from an impending disaster.We got a conventional angio done in him which was suggestive of aorto-iliac block with ostial near total occlusions of the cealic axis,superior mesenteric artery and right renal artery.

We did an aorto-bifemoral bypass along with conventional “TRANSAORTIC ENDARTRECTOMY OF THE CAELIAC,SMA AND RIGHT RENAL VESSELS”.Patient did fine postoperatively and was discharged on the fifth post operative day.Presently he is on just one antihypertensive.

The plaque that has been removed has been displayed .Hope you can make out and appreciate the plaque extensions going into the caeliac,sma and renal arteries.

The carry home message is”BE STRONGLY SUSPICIOUS OF UNEXPLAINED PAIN ABDOMEN AND CONSIDER MESENTERIC ISCHAEMIA IN SUCH CASES UNLESS PROVED OTHERWISE”.