Abdominal angina is abdominal pain that occurs in individuals after eating with ongoing poor blood supply to their small intestines known as chronic mesenteric ischemia.
Abdominal angina is defined as intermittent abdominal pain, frequently occurring at a fixed time after eating, caused by inadequacy of the mesenteric circulation resulting from arteriosclerosis or other arterial disease.
Symptoms of abdominal angina include postprandial pain, weight loss, diarrhea, nausea, vomiting, and an aversion or fear of eating caused by the pain associated with eating.
Abdominal anginal pain usually starts 30 minutes after eating and lasts for one to three hours.
The patient typically has pain that is a dull ache noted by clenching their fist over the epigastrium.
Patients may restrict food intake to prevent the pain of abdominal angina typically present with weight loss.
Patients may experience changes in their bowel habits: diarrhea from malabsorption or less frequently constipation.
Pathophysiology:
The most common cause of abdominal angina is atherosclerotic vascular disease.
The occlusive process commonly involves the ostia and the proximal few centimeters of the mesenteric vessels.
Abdominal angina can be associated with: carcinoid aortic coarctation antiphospholipid syndrome
Treatment:
If bowel has become necrotic, the only treatment is surgical removal of the dead segments of bowel.
In non-occlusive disease, where there is no blockage of the arteries supplying the bowel, the treatment is medical rather than surgical.
Surgical revascularization remains the treatment of choice for intestinal ischaemia related to an occlusion of the vessels supplying the bowel, but thrombolytic medical treatment and vascular interventional radiological techniques have a growing role.
Other options:
Open surgical thrombectomy Intestinal bypass Trans-femoral antegrade intestinal angioplasty and stenting Open retrograde intestinal angioplasty stenting Trans-catheter thrombolysis.