Intestinal Angina

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THE syndrome of intestinal angina is characterized by cramping abdominal pain that usually develops in from 15 to 30 minutes after eating, and persists for food ingested: the larger the amount of food ingested, the greater is the intensity and the longer is the duration of the pain. Initially, the pain may occur only after the largest meal. As weeks or months elapse, there is progressive, steady increase in the severity of symptoms. Nausea, vomiting, or diarrhea may occur. The “food-pain” sequence is the dominant feature, and soon leads to a reluctance to eat; loss in weight inevitably follows.1

Intestinal angina may be difficult to diagnose. Findings on physical examination, even in the presence of pain, are not diagnostic. Loss in weight is always evident, and mild abdominal distention may be present. In some patients a systolic bruit is audible in the upper part of the abdomen.2 When symptoms are mild and vague, the condition often is diagnosed as functional indigestion or the irritable bowel syndrome, especially after complete gastrointestinal roentgenograms show evidence of normal function. A diagnosis of disease more serious than functional indigestion, such as pancreatic carcinoma or pancreatitis, may be considered when symptoms are severe, and an exploratory abdominal operation may be advised. The true diagnosis may not be determined until postmortem studies reveal a gangrenous bowel.

The pathologic process producing intestinal angina is known to be the arteriosclerotic narrowing and obliteration of the ostia of the gastrointestinal branches of the abdominal aorta. When this occurs in . . .



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