Chronic mesenteric ischaemia: an overlooked cause of unintentional weight loss

Chronic mesenteric ischaemia (CMI) is a rare but potentially life-threatening condition, often underdiagnosed due to its vague and non-specific symptoms. We describe a patient who presented with progressive unintentional weight loss, anorexia and postprandial abdominal pain. Despite extensive investigations, no clear diagnosis was established until CT angiography revealed severe calcified stenosis of the coeliac trunk and superior mesenteric artery. The stenoses of two mesenteric vessels limited perfusion during periods of high metabolic demand, causing postprandial tissue ischaemia, which manifested as abdominal pain, reduced oral intake and consequent weight loss. A multidisciplinary approach led to the diagnosis of CMI and surgical revascularisation via iliomesenteric bypass was performed, resulting in complete resolution of symptoms and weight recovery. This case highlights the importance of considering CMI in older patients with unexplained weight loss and cardiovascular risk factors. Early recognition and timely intervention are crucial to prevent irreversible complications and ensure favourable outcomes.