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Updated: Sep 26, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Mesenteric ischemia affects young adults with predisposition
Bridget M Sanders1, Michael C Dalsing
1Department of Surgery, Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Insights
Mesenteric ischemia in young adults is rare and often delayed in diagnosis. This study highlights hypercoagulable states as a potential cause, suggesting screening and anticoagulation for prevention.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Hematology
Background:
- Arterial mesenteric ischemia is uncommon in patients aged 18-40.
- Diagnosis and treatment are often delayed in this demographic.
- Cocaine use is a known risk factor, but other causes exist.
Observation:
- A retrospective review identified three young patients with arterial mesenteric ischemia.
- Identified underlying conditions included protein C deficiency, afibrinogenemia, protein C deficiency, antithrombin III deficiency, and Takayasu's arteritis with elevated ESR.
- All patients experienced prolonged symptoms before diagnosis via angiography and surgical intervention (arterial bypass with/without bowel resection).
Findings:
- Three cases of arterial mesenteric ischemia in patients under 40 were identified.
- Hypercoagulable states were prevalent in these cases.
- All patients achieved positive outcomes with surgical treatment and survived.
Implications:
- Mesenteric ischemia in young adults, particularly without a history of cocaine use, necessitates a thorough investigation for underlying hypercoagulable disorders.
- Early identification of these conditions may lead to timely intervention and improved patient outcomes.
- Long-term anticoagulation therapy could be considered to prevent recurrent episodes.
Abstract:
An 8-year retrospective review of Indiana University Hospital records consisting of any patient age 18 to 40 years old who presented with arterial mesenteric ischemia was performed. Three patients were identified that met our criteria. The first patient was discovered to have a protein C deficiency. The second patient was afflicted with afibrinoginemia, a protein C and an antithrombin III deficiency. The third patient had been previously diagnosed with Takayasu's arteritis and had an elevated ESR. Each patient had a protracted course of symptoms before mesenteric disease was considered, confirmed by angiography, and treated by arterial bypass with/without bowel resection. All patients survived and are currently asymptomatic at an average of 2 years postoperatively. Mesenteric ischemia in patients under the age of 40, especially in the absence of cocaine use, is rare and often causes a delay in diagnosis and appropriate treatment. The high incidence of hypercoagulable states in our study cases suggests the need for a search for such disorders and the possible need for long-term anticoagulation therapy as a deterrent to recurrence.
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