Blockage in intestinal blood vessel causes pain when eating

DEAR DR. ROACH: My wife, age 65, has been suffering from abdominal pain for over a year. The pain comes within minutes of eating a meal. She was diagnosed with abdominal angina, and had a stent placed to open the vessel that showed blockage. We were told that she’d get immediate relief if successful, but she did not get relief. We contacted the surgeon for a follow-up appointment, which we weren’t given. Instead, she was told to give it time and to be seen in six months, when he’d be “happy to do it again” if there was still a problem. Needless to say, we won’t be using his services again.

We’re not sure where to turn next. Can you shine some light on this malady and advise us on how to proceed? -- J.L.

ANSWER: Chronic mesenteric ischemia is caused by one or more blockages in the blood vessels to the intestines. (The word “mesentery” means “middle of the intestine,” and “ischemia” means “holding back of blood”). In angina pectoris (angina of the chest), pain occurs when demand for blood is greater than the supply, which is limited by the blockage. When demand is high, as in exercise, people develop chest discomfort. In the cause of mesenteric ischemia, demand for blood goes up with eating, and although not everyone will have symptoms, pain with eating is typical. The condition is most commonly diagnosed now by CT or MRI scan, with angiography less commonly used.

There are a great many blood vessels to the intestine, and often in mesenteric ischemia there is more than one blockage. That may be why the stent did not work. It certainly would be a question you would need to ask the vascular surgeon (or possibly another provider, like an interventional radiologist).

The other concern I have is that I have seen people with blockages in the arteries to their hearts develop abdominal pain after eating. The risk factors are similar to develop blockages in the arteries to the intestines as they are to the heart, so I would want to be sure your wife’s heart arteries were evaluated, perhaps with a stress test, angiogram or CT angiogram.

Finally, I don’t blame the surgeon for not curing your wife, but I do blame him for not seeing her again. If the story is as you told it (there are always two sides), I can’t understand the surgeon’s refusal to see her.