What can you tell me about mesenteric ischemia? My husband died from it after spending 20 hours in the hospital, and doctors didn't know what the problem was until an autopsy was performed. If it had been detected earlier might he have lived?

Jean

Acute mesenteric ischemia (AMI) occurs when the supply of blood to the small intestine is suddenly cut off. Because the small intestine is a rather large organ (about 20 feet long) and receives its blood supply from only two vessels, the intestine -- and eventually the entire body -- can be in grave danger if this blood supply is disrupted.

Patients with AMI are typically older people who have a history of blood-vessel disease elsewhere in the body, such as in the heart or the legs. The first symptom of AMI is usually severe abdominal pain. Often, the doctor will not detect any obvious abnormality when examining such patients. Also, early lab tests may not find any specific indication of AMI. However, as the bowel is deprived of blood for longer time periods, it will develop tissue damage and gangrene. At this stage, signs of infection and shock may show up in the patient. Eventually, blood tests and tissue samples may confirm the diagnosis. Sadly, at this point it is usually too late to save the patient, and even emergency surgery is often futile.

A patient's odds for survival are best if he is treated at a large, academic medical center because such facilities are more likely to have the following combination of resources: a gastroenterologist willing to consider the diagnosis early, a surgeon ready to perform emergency surgery, and the equipment needed to perform an emergency angiogram, which may be used to unblock the affected vessel via a small catheter.

However, the fact remains that up to 75 percent of AMI patients die because it is so difficult to diagnose this disorder soon enough to deliver appropriate treatment. Also, as was your husband's case, many AMI victims are not conclusively diagnosed until an autopsy is performed.