Small bowel ischaemia

Small bowel ischaemia is a rare disorder that is characterised by the presence of abdominal pain after eating, which may be accompanied by diarrhoea. The association between eating and abdominal pain leads to weight loss, as people avoid eatingAmerican Gastroenterological Association, 2000van Dijk, 2019.

Small bowel ischaemia is caused by narrowing of the origins of the coeliac or superior mesenteric arteries—this is usually due to atherosclerosis. Very rarely, the narrowing is caused by pressure from the median arcuate ligament, fibromuscular dysplasia or vasculitis, or retroperitoneal fibrosisvan Dijk, 2019.

If small bowel ischaemia is suspected, refer the patient to a gastroenterologist for evaluation and management. Computed tomography (CT) angiography should be used as the first-line investigation. However, most people who have evidence of narrowing on imaging do not have small bowel ischaemia and do not require treatment. If treatment is required, antiplatelet therapy, direct-acting oral anticoagulant (DOAC) therapy, or revascularisation (using a stent or surgery) may be trialledvan Dijk, 2019.