Chronic mesenteric ischemia

The key to making the diagnosis is the worsening of her dull, crampy epigastric pain after eating. Given her known atherosclerotic disease, the most likely diagnosis at this point is chronic mesenteric ischemia. The disease is sometimes referred to as "intestinal angina" since it presents as abdominal pain when there is increased oxygen demand in the bowel after eating, much as patients with cardiac ischemia experience chest pain with increased myocardial oxygen demands. The pain may become so severe that patients avoid food and consequently lose weight. Due to the large number of collateral vessels supplying the bowel, multiple high grade stenoses are typically needed in the mesenteric vasculature before patients become symptomatic.

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