Chronic Mesenteric Ischaemia Due to Diffuse Atherosclerosis

In more than 95% of patients, the cause of mesenteric ischaemia is diffuse atherosclerotic disease which decreases the flow of blood to the bowel. As the atherosclerotic disease progresses, symptoms worsen. We present a case of a 76 year diabetic male who was on treatment for ischaemic heart disease for the last five years. He presented with recurrent, dull, diffuse post-prandial abdominal pain for two years. The pain was classical of mesenteric ischaemia, and would occur half to one hour after taking meals. It reached its peak in next one hour and would subside within 3-4 hours. CT angiogram was done which revealed diffuse atherosclerosis of abdominal aorta with plaques obstructing origin of superior mesenteric artery and extending into bilateral common iliac arteries. The atherosclerosis is most common cause of chronic mesenteric ischaemia (CMI) but such diffuse involvement is rare.