Malabsorption and Mesenteric Ischemia

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ACUTE mesenteric ischemia is a catastrophic event if not treated. Chronic mesenteric ischemia is less dramatic but is just as lethal. The patient may have no symptoms or there may be gradations to and including those of typical abdominal angina. The occurrence of diarrhea, constipation, and weight loss, associated with cramping postprandial abdominal pain, may be misdiagnosed as evidence of functional gastrointestinal disease unless the possible presence of mesenteric arterial insufficiency is considered. Typical abdominal angina is characterized by excruciating abdominal pain that occurs from 20 to 30 minutes after eating and lasts from one to two hours. To avoid pain, the patient does not eat and severe weight loss ensues. Impaired gastrointestinal motility and malabsorption contribute to the loss in weight and cause diarrhea.

Although occlusive vascular disease as a cause of mesenteric infarction has been stressed for 25 years, nonocclusive causes such as polycythemia vera,1 congestive heart failure,2–4 acute hypotension,5 and aortic insufficiency,6 have been reported only in the last 10 years. Because relatively few cases of malabsorption associated with mesenteric insufficiency have been described in the literature,7–11 the following report of such a case is presented.

Report of a Case

A 44-year-old white man was admitted to the Cleveland Clinic Hospital on December 16, 1964. In March 1962, he had a posterior myocardial infarction, and after a three-week recovery period he had no symptoms of angina pectoris. In October 1964, he began to experience severe retrosternal pain associated with physical exertion and emotional stress, as . . .



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