Abdominal angina

Abdominal angina
Classification and external resources
ICD-10	K55
ICD-9-CM	557.1

Abdominal angina is abdominal pain after eating that occurs in individuals with ongoing poor blood supply to their small intestines known as chronic mesenteric ischemia.^[1] The term angina is used in reference to angina pectoris, a similar symptom due to obstruction of the coronary artery. The American Heritage Stedman's Medical Dictionary defines abdominal angina as "Intermittent abdominal pain, frequently occurring at a fixed time after eating, caused by inadequacy of the mesenteric circulation. Also called intestinal angina."

Pathophysiology

The pathophysiology is similar to that seen in angina pectoris and intermittent claudication. The most common cause of abdominal angina is atherosclerotic vascular disease, where the occlusive process commonly involves the ostia and the proximal few centimeters of the mesenteric vessels. It can be associated with:

• carcinoid^[2]
• aortic coarctation^[3]
• antiphospholipid syndrome^[4]

Frequency

• Internationally: Extremely rare. True incidence is unknown
• Race: No data available
• Sex: Females outnumber males by approximately 3 to 1
• Age: Mean age of affected individuals is slightly older than 60 years

Clinical

• Hallmark of condition: Disabling midepigastric or central abdominal pain within 10–15 minutes after eating.
• Physical examination: The abdomen typically is scaphoid and soft, even during an episode of pain. Patients present with stigmata of weight loss and signs of peripheral vascular disease, particularly aortoiliac occlusive disease, may be present.
• Causes: Smoking is an associated risk factor. In most series, approximately 75-80% of patients smoke.

Treatment

Stents have been used in the treatment of abdominal angina.^[5][6]

See also

• Abdominal pain
• Ischemic colitis

References

1. Kapadia S, Parakh R, Grover T, Agarwal S (2005). "Side-to-side aorto-mesenteric anastomosis for management of abdominal angina". Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology 24 (6): 256–7. PMID 16424623.
2. deVries H, Wijffels RT, Willemse PH; et al. (2005). "Abdominal angina in patients with a midgut carcinoid, a sign of severe pathology". World journal of surgery 29 (9): 1139–42. doi:10.1007/s00268-005-7825-x. PMID 16086212.
3. Ingu A, Morikawa M, Fuse S, Abe T (2003). "Acute occlusion of a simple aortic coarctation presenting as abdominal angina". Pediatric cardiology 24 (5): 488–9. doi:10.1007/s00246-002-0381-3. PMID 14627320.
4. Choi BG, Jeon HS, Lee SO, Yoo WH, Lee ST, Ahn DS (2002). "Primary antiphospholipid syndrome presenting with abdominal angina and splenic infarction". Rheumatol. Int. 22 (3): 119–21. doi:10.1007/s00296-002-0196-9. PMID 12111088.
5. Senechal Q, Massoni JM, Laurian C, Pernes JM (2001). "Transient relief of abdominal angina by Wallstent placement into an occluded superior mesenteric artery". The Journal of cardiovascular surgery 42 (1): 101–5. PMID 11292915.
6. Busquet J (1997). "Intravascular stenting in the superior mesenteric artery for chronic abdominal angina". Journal of endovascular surgery : the official journal of the International Society for Endovascular Surgery 4 (4): 380–4. doi:10.1583/1074-6218(1997)004<0380:ISITSM>2.0.CO;2. ISSN 1074-6218. PMID 9418203.