Chronic Mesenteric Ischaemia

Chronic mesenteric ischaemia (CMI): atherosclerotic narrowing of ≥2 of 3 mesenteric vessels (coeliac, SMA, IMA). Classic triad: • Post-prandial abdominal pain (15–60 min after meal, lasts 2–3h) — 'intestinal angina'. • Weight loss (food fear / sitophobia — fear of eating). • Abdominal bruit (50%). Risk: atherosclerosis (smoking, HTN, diabetes, hyperlipidaemia), age, female, polyvascular disease. Differentials: pancreatic cancer, peptic ulcer, IBS, gastric / oesophageal cancer, biliary disease. Workup: • Bloods: FBC, ESR, CRP, U&E, LFTs, glucose, lipids; usually unremarkable in CMI. • Doppler USS mesenteric vessels (operator-dependent). • CT angiography mesenteric vessels (gold standard). • MRA alternative. • Catheter angiography — diagnostic + therapeutic. • Exclude alternatives: OGD, colonoscopy, abdominal USS / CT (exclude pancreatic cancer).