3212 Weight Loss Due to Chronic Mesenteric Ischemia

Abstract

INTRODUCTION: Chronic Mesenteric Ischemia, also known as abdominal angina, is an uncommon condition defined by a state of attenuated blood circulation in the mesenteric vasculature affecting one or more abdominal viscera, and is more common in the female and elderly populations. CASE DESCRIPTION/METHODS: An 81-year-old woman presented with low blood pressure, she had a six month history of alternating constipation and diarrhea and lost 40 pounds. She appeared cachectic and abdominal examination revealed a bruit on auscultation, positive bowel sounds. Her blood work was unremarkable. Computed Tomography Angiography (CTA) of abdomen/pelvis showed chronic occlusion of the proximal celiac axis and proximal superior mesenteric artery. The distal portions of the vessels were reconstituted through large inferior mesenteric artery collaterals. CTA also revealed chronic occlusion of the proximal celiac axis and proximal superior mesenteric artery with reconstitution of the distal portions of the vessels via large inferior mesenteric artery collaterals. Patient was provided gentle hydration with intravenous fluids, and symptomatically treated with ondansetron and proton pump inhibitor. After the confirmation of diagnosis of mesenteric ischemia by CTA, cardiology was taken on board and patient underwent successful mesenteric artery bypass surgery. DISCUSSION: Chronic Mesenteric ischemia is a rare condition but can lead to considerable malnutrition and weight loss, and have fatal consequences such as bowel infarction, necrosis, perforation, sepsis and death. Timely diagnosis is associated with a better prognosis, which can be done with imaging or invasive angiography (gold standard).