Abdominal angina

Chest and abdominal pain are the most common reasons that persons aged 15 years and over visit the emergency department. Abdominal angina, like the cardiac angina, is due to ischemia of the mesenteric arteries.

Ischemic bowel

Other names

• Mesenteric vascular disease
• Ischemic colitis; Ischemic bowel - mesenteric
• Atherosclerosis - mesenteric artery

Histopathology of small bowel gangrene

Cause

Mesenteric artery ischemia occurs when there is a narrowing or blockage of one or more of the three major arteries that supply the small and large intestines. These are called the mesenteric arteries.

History and physical examination

Midepigastric or central abdominal pain within 10–15 minutes after eating in history. Also ask for smoking history, family history, and any history of other vascular disease such as coronary artery disease and or peripheral vascular disease.

Physical examination

The abdomen typically is scaphoid and soft, even during an episode of pain.

Other signs

Patients present with stigmata of weight loss and signs of peripheral vascular disease, particularly aortoiliac occlusive disease, may be present.

Risk factors

• Smoking is an associated risk factor.
• In most series, approximately 75–80% of patients smoke.

Pathophysiology

The underlying vascular pathophysiology is similar to that seen in angina pectoris and intermittent claudication with atherosclerosis.

Superior mesenteric artery

Mesenteric vessel atherosclerosis

The most common cause of abdominal angina is atherosclerotic vascular disease, where the occlusive process commonly involves the ostia and the proximal few centimeters of the mesenteric vessels.

It can be associated with:

• carcinoid
• aortic coarctation
• antiphospholipid syndrome

Epidemiology

• Internationally: Extremely rare. True incidence is unknown

• Race: No data available
• Sex: Females outnumber males by approximately 3 to 1
• Age: Mean age of affected individuals is slightly older than 60 years

Diagnosis

It is diagnosed with a combination of clinical history characterized by abdominal pain within 15-20 minutes of eating, and other studies such as the following:

• A Doppler ultrasound or CT angiogram scan may show problems with the blood vessels and the intestine.
• A mesenteric angiogram is a test that involves injecting a special dye into your bloodstream to highlight the arteries of the intestine.
• Then x-rays are taken of the area. This can show the location of the blockage in the artery.

Treatment

Vascular stents have been used in the treatment of abdominal angina.

See also

• Abdominal pain
• Ischemic colitis

Abdominal angina Resources
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