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Dr. Neeraj Bhalla

Dr. Neeraj Bhalla
Director & Sr. Consultant
BLK Heart Centre
BLK Super Speciality
Hospital, New Delhi

Dr. Amit Pendharkar
Sr. Consultant
BLK Heart Centre
BLK Super Speciality
Hospital, New Delhi





Goodbye Pain

How a lasting solution was achieved from
Abdominal Angina

THE CASE

Ms. Geeta Devi, a 50-year old female patient, visited BLK with complaints of abdominal pain half-an-hour after every meal. This was occurring routinely for the past 6 months. Because of the pain, she was afraid to eat anything and started losing body weight and appetite. She was evaluated at many hospitals to ascertain the cause of her symptoms and underwent various investigations like ultrasound abdomen, endoscopies and other procedures. She was given medications but there was no relief in her symptoms. She continued to lose weight, had no appetite and suffered worsening abdominal pain after she consumed anything. Physicians and Gastroenterologists could not pin point the cause of her symptoms.

THE PROCEDURE

The patient was referred to BLK Super Speciality Hospital and immediately a contrast CT scan of the abdomen was taken. The result hinted at obstructions in two of the three major blood vessels (coeliac and superior mesenteric artery), which supply blood to the stomach, intestine and other abdominal organs. A condition called as ‘Mesenteric Ischemia’ was suspected as the cause of her symptoms and the pain she had was a form of ‘Abdominal Angina’. It is a condition where there is a severe lack of blood supply to the intestine when the demand was increased after intake of food to aid digestion.

Abdominal Aortography and selective Angiography of the abdominal vessels were done which confi rmed a 99% blockage at the origin of SMA. There were blockages in her lower aorta (75-80%) and right renal artery (75%) and also in coronary vessels. In view of her severe abdominal symptoms, she was taken up for restoration of the SMA. First, the abdominal aorta occlusion was dilated and then stented with E.Luminexx 14 x 40mm to provide a clear passage. Then the SMA was reconstructed by using balloon dilation and a metallic stent Omnilink Elite 7 x 29 mm was deployed from the origin to ensure that vessel became wide open and blood fl ow to the intestine was restored.

THE RESULT

After intervention, her abdominal pain started to resolve gradually and she regained her appetite and body weight on follow up.

DISCUSSION

Atherosclerosis is not only limited to coronary and carotid vessels but can affect intra-abdominal vessels causing significant abdominal symptoms. Physicians should keep in mind this rare entity while evaluating patients with complaints of abdominal pain.