Overview.
Abdominal colic syndrome is a syndrome of postprandial epigastric or midabdominal pain caused by relative ischemia of the bowel. It is also known as visceral colic, intestinal colic, intermittent ischemic dysmotility, intermittent abdominal claudication, ischemic abdominal syndrome, chronic visceral ischemia syndrome, intermittent mesenteric artery ischemia, and abdominal vascular insufficiency syndrome. It is most common in middle-aged and elderly male patients with other manifestations of atherosclerosis. Abdominal colic often appears 15-30 minutes after a meal and lasts for 1-3 hours, and the duration and intensity of pain are related to the amount of food eaten.
Etiology
Stenosis or obstruction of the opening of the gastrointestinal branch of the abdominal aorta due to atherosclerosis and arteritis. Most of the affected arteries occur in the superior mesenteric artery. After the patient eats, the intestinal blood flow and need increases, causing relative ischemia, hypoxia, and intestinal spasm, producing significant abdominal colic.
Symptoms
1. Most commonly seen in middle-aged and elderly male patients with other manifestations of atherosclerosis.
2. Abdominal colic often occurs 15-30 minutes after a meal and lasts for 1-3 hours, with the duration and intensity of pain related to the amount of food eaten. Abdominal colic can be the precursor of intestinal vascular infarction.
3. Accompanied by nausea, vomiting, diarrhea, patients often fear of pain and reduce eating, resulting in weight loss.
4. Sometimes systolic vascular murmur can be heard in the upper abdomen.
5. Anemia, elevated white blood cells, and positive fecal occult blood may occur.
Examination
Abdominal X-ray, abdominal arteriography, abdominal ultrasound, CT and magnetic resonance are usually done.
Diagnosis
1. Clinical manifestations of abdominal colic syndrome.
2. No abnormal findings on abdominal X-ray.
3. Arterial stenosis >50% or more can be diagnosed.
4. Abdominal Doppler B-mode ultrasonography is helpful for diagnosis.
5. CT angiography, nuclear magnetic angiography.
Treatment
General treatment includes small meals, low-fat and low-protein diet, controlling blood pressure, blood sugar and blood lipids to prevent atherosclerosis. Surgical treatment is mainly abdominal artery or mesenteric artery reconstruction surgery. Dilation or recanalization of stenotic or obstructed segments or stent implantation can also be performed via arterial catheter balloon. Pharmacologic treatment may include vasodilators or anticoagulant therapy, antithrombotic pills or low-dose aspirin.
Prevention
Take care to increase appropriate physical activity and eat less food with high cholesterol and fat content.