Chronic mesenteric ischaemia

Chronic mesenteric ischaemia

Chronic mesenteric ischaemia is due to atherosclerotic narrowing at the origin of any of the three arterial trunks. Patients describe postprandial abdominal pain that can be severe, resulting in a fear of eating with progressive weight loss. The diagnosis requires CT angiography . Radiological stent placement may be successful, but surgical endarterectomy of bypass repair may be required. Venous ischaemia The venous drainage of the mesenteric domain is limited to the junction between the hepatic veins and the inferior vena cava. Narrowing or blockage of the lumen at this junction occurs in Budd–Chiari syndrome. It has major clinical implications. Most venous drainage of the mesenteric domain returns to the liver via the portal vein. Portal venous thrombosis impedes venous drainage of all abdominal digestive organs unless an alternative drainage route opens (i.e. a portosystemic shunt) or is created (see Chapter 69 ) ( 65.5 ).