Chronic intestinal ischaemia - Vascular disease of the bowel

Chronic intestinal ischaemia

Definition

Slow progressive ischaemia of the gut due to atheroma generally occurring in the elderly.

Aetiology

Atheroma within the mesenteric vessels causes reduced blood flow and ischaemia. Risk factors:

·        Fixed: Age, sex, positive family history, familial hyperlipidaemia.

·        Modifiable: Smoking (direct relationship to the number of cigarettes smoked), hypertension, diabetes mellitus, LDL and total cholesterol levels (HDL are protective).

Pathophysiology

Progressive atheroma occludes the lumen of the vessels causing reduced blood flow. The clinical presentation depends on the position and degree of occlusion and the presence of collateral blood supply.

Clinical features

Patients describe pain occurring after food, weight loss, malabsorption and signs of vascular disease.

Investigations

The diagnosis is made on angiography.

Management

Surgical revascularisation depends on the results of angiography. A variant of this condition is coeliac axis compression due to the median arcuate ligament of the diaphragm. This may be amenable to surgery.