Mesenteric Ischemia

Your doctor diagnoses mesenteric ischemia based on a combination of a physical examination, lab tests and imaging. Unfortunately, this condition is usually difficult to diagnose in its early stages. An additional challenge is that many people with this condition can’t talk or answer questions easily, especially if they’re in a lot of pain.

What tests will be done to diagnose this condition?

Many tests can help diagnose this condition, including:

Physical examination

A physical examination is where your doctor looks, feels and listens for signs that might mean you have a medical problem. With mesenteric ischemia, doctors can find signs in the following ways:

• Signs they can see: One of the most visible signs is bloating in your belly area. Some people will show visible signs of weight loss. Many people will also have such severe pain that they go into the fetal position, with their knees pulled toward their chin.
• Signs they can feel: Healthcare providers will use their hands to palpate (feel) your abdomen. Some people will have tenderness in their abdomen, helping healthcare providers find which areas hurt more. Many people will react or “guard” instinctively when their healthcare provider tries to feel their belly. In many cases, people will describe pain that’s much worse than it should be from simply having their belly felt.
• Signs they can hear:Healthcare providers can use a stethoscope to listen to the sounds of your digestive tract. Those sounds, known as borborygmi (pronounced, “bore-bore-ig-me”), are often harder to hear with mesenteric ischemia. In more severe cases, there may be no digestive sounds at all. In some cases, they might also hear a sound called a bruit, which happens with some blood flow blockages.

Physical exams might not turn up major indicators until this condition is very advanced. That means this condition can take longer to diagnose, which is part of why it’s so dangerous.

Lab tests

Several lab tests can help diagnose mesenteric ischemia. The tests will look for changes in your blood, especially the amount of oxygen in it and your blood’s clotting ability. The tests will also look for signs that your immune system is reacting to an infection. Other tests will show if your blood contains chemical markers that appear because of damaged or dying cells and tissues.

Imaging and endoscopy

The best way for healthcare providers to diagnose mesenteric ischemia is to see where there’s little or no blood flow. Multiple imaging tests make that possible:

• Ultrasound. This test uses ultra-high-frequency sound waves from a device held against the skin of your belly. The sound waves work similarly to how bats use sonar to “see,” creating an image that healthcare providers can use to find areas with low or no circulation. Different types of ultrasound can also measure how much blood is flowing through different blood vessels.
• Angiography. This test is the best, most reliable way of diagnosing mesenteric ischemia. Angiography uses a dye, called contrast, injected into major blood vessels in your abdomen. Those vessels then stand out on an X-ray or computed tomography (CT) scan. It also shows partially or totally blocked vessels. In some cases, this can involve a catheter, a long, tube-shaped device inserted into a major blood vessel that allows healthcare providers to look at the problem from inside the affected blood vessels.
• Endoscopy. This is a procedure where your healthcare provider inserts a device called an endoscope into your digestive tract to look for signs of ischemia. If they suspect the problem is closer to your stomach, they’ll insert an endoscope down your throat and down to your small intestine. If they suspect the issue is in your colon, large intestine or at the lower end of your small intestine, they’ll insert the scope into your rectum (the same approach as a colonoscopy). It’s common for the methods to involve anesthesia (either moderate sedation or general anesthesia) during the procedure. Endoscopy is more likely for people who can’t have a contrast injection, especially people with an allergy or kidney problem.