Chronic visceral ischemia. An often overlooked cause of abdominal pain

Chronic intestinal ischemia is usually caused by atherosclerosis of the visceral branches of the abdominal aorta. It classically presents with severe postprandial abdominal pain, weight loss due to fear of eating, and altered intestinal motility. Aortography is the definitive diagnostic study and usually reveals occlusive disease of at least two major visceral vessels. Revascularization is indicated in symptomatic patients but should be undertaken in asymptomatic patients only when aortic reconstruction is indicated that would threaten intestinal collateral blood flow. Refinements in operative technique and perioperative management have improved the safety and effectiveness of visceral reconstruction procedures.