Chronic mesenteric ischemia: Diagnosis & management

With rising rates of atherosclerotic disease and obesity worldwide, the prevalence of chronic mesenteric ischemia (CMI) has been progressively rising. Prompt diagnosis and early intervention are crucial to avoid bowel loss and mortality in optimising long-term outcomes for patients and achieving symptom relief.

This article aims to summarise relevant literature on CMI, enabling primary care physicians to make a timely diagnosis and intervention, improving outcomes of patients with CMI.

CMI is often mistaken for more common pathologies due to its non-specific history and physical examination findings. A missed diagnosis can end up in acute mesenteric infarction and bowel perforation which can cause severe morbidity and mortality. Thus, a thorough gastrointestinal disease work-up ruling out other conditions may be required. CT angiogram is the gold standard non-invasive investigation for confirming a CMI diagnosis. Referral to vascular surgery with early surgical intervention through angioplasty and stenting is crucial for improving patient outcomes. Long-term follow-up of patients through routine consultations and serial non-invasive imaging can monitor for recurrence and disease progression.