CHRONIC MESENTERIC ISCHEMIA - DIAGNOSTIC CHALLENGES AND TREATMENT OPTIONS

Objectives. A description of the clinical presentation, diagnostic pro cedure and mode of therapy in three patients suffering from chronic me senteric ischaemia. Design and interventions. In all cases, the diagno sis was made on the basis of abdominal complaints in combination with angiographic findings. The primary treatment objective was restoration of blood flow via a revascularization procedure, for the patient in w hom this could not be accomplished an enteral feeding programme was un dertaken. Results. One patient had a panmalabsorption syndrome which w as treated with an aortomesenteric bypass operation, the second one pr esented with multiple gastric ulcerations which only improved after a percutaneous transluminal angioplasty. In the third patient, neither s urgery or angioplasty were feasible and a tentative enteral feeding pr ogramme was given, after which the ability to consume a normal oral di et without abdominal distress was regained. Conclusions. These three c ases illustrate the diverse clinical pictures by which chronic mesente ric ischaemia may present itself. This diagnosis should be kept in min d when other more common causes of a patient's abdominal complaints ca nnot be found, hence giving consideration to abdominal angiography as the next diagnostic procedure. With respect to therapy, restoring bloo d now through surgery or angioplasty is the primary form of treatment. However, if neither of these therapeutic options is feasible, it is s uggested that such patients may benefit from a nutritional training pr ogramme.