The term “blocked artery in the stomach” refers to mesenteric ischemia, a serious medical condition involving a reduction or complete blockage of blood flow to the small or large intestines. A lack of blood flow deprives the intestinal tissue of necessary oxygen, leading to oxygen deprivation, or ischemia. This can quickly cause tissue death, known as infarction or gangrene. The severity depends on the speed and extent of the blockage, presenting as either a sudden, life-threatening emergency or a more gradual, chronic issue.
Recognizing Acute and Chronic Symptoms
The symptoms of mesenteric ischemia are highly dependent on whether the blockage occurs suddenly (acute) or develops over a period of time (chronic). Acute mesenteric ischemia is a time-sensitive emergency characterized by an abrupt and overwhelming onset of discomfort. The most common symptom is severe abdominal pain that often appears disproportionate to what a physical examination of the abdomen might show.
This sudden, intense pain is typically diffuse, meaning it is not localized to a single spot, and it can be accompanied by nausea and vomiting. Patients may also experience an urgent need to pass stool or develop bloody diarrhea as the intestinal lining suffers damage. As the intestinal tissue starts to die, signs of shock, low blood pressure, and severe systemic infection can rapidly develop, indicating a worsening and potentially fatal stage.
Chronic mesenteric ischemia develops more slowly as the arteries gradually narrow over months or years. The hallmark symptom of this condition is a specific type of abdominal pain known as “intestinal angina,” which occurs predictably after eating a meal. Digestion requires a significant increase in blood flow to the intestines, and the narrowed arteries cannot meet this demand, leading to pain that typically begins within 30 to 60 minutes after eating.
This post-meal pain usually lasts for one to three hours before gradually subsiding. Because eating causes predictable pain, patients often develop a psychological avoidance of food. This aversion often results in significant, unintentional weight loss and can lead to malnutrition. Other chronic symptoms may include persistent diarrhea, nausea, or vomiting.
Underlying Mechanisms of Blockage
The restriction of blood flow to the intestines can arise from several distinct causes, which determine the type of mesenteric ischemia that develops. The most frequent cause of acute onset is an arterial embolism, where a blood clot forms elsewhere in the body, most commonly in the heart due to conditions like atrial fibrillation, and then travels to lodge in one of the mesenteric arteries. This abrupt lodging of a traveling clot accounts for approximately half of all acute cases.
Another mechanism is acute mesenteric arterial thrombosis, which occurs when a clot forms directly within a mesenteric artery already narrowed by atherosclerosis. Atherosclerosis, the buildup of fatty plaque within artery walls, is a common cause of chronic mesenteric ischemia. If a plaque ruptures, it can trigger clot formation and an acute blockage. Risk factors include a history of heart disease, high cholesterol, high blood pressure, and tobacco use.
A third major cause is non-occlusive mesenteric ischemia (NOMI), which happens without a physical blockage or clot in the artery. NOMI is often seen in critically ill patients, where severe low blood pressure or intense constriction of the blood vessels (vasospasm) reduces the blood flow so severely that the intestinal tissue is starved of oxygen. Certain medications and conditions like congestive heart failure or cardiogenic shock can lead to this low-flow state.
Medical Confirmation of Artery Blockage
Diagnosing mesenteric ischemia requires a high index of suspicion because the initial physical exam findings can be surprisingly mild despite the patient’s severe pain. Imaging studies are the most reliable way to confirm the presence and location of the blockage in the mesenteric arteries. Computed Tomography Angiography (CTA) is typically the standard imaging test used, as it provides detailed, three-dimensional images of the abdominal blood vessels after an intravenous contrast dye is injected.
The CTA can show the exact site of a clot or the extent of artery narrowing, helping physicians determine the underlying cause. In some cases, conventional catheter-based angiography may be performed, involving threading a thin tube through an artery to inject dye directly into the mesenteric vessels. Blood tests also provide supporting evidence, particularly elevated levels of lactate, which indicate that the intestinal tissue is lacking oxygen.
Emergency Treatment Approaches
Acute mesenteric ischemia requires immediate intervention to restore blood flow and prevent irreversible damage to the intestines. The primary goal of treatment is rapid revascularization, which can be achieved through endovascular or surgical procedures. Endovascular techniques often involve angioplasty, where a balloon-tipped catheter is used to open the narrowed vessel, sometimes followed by the placement of a stent to keep the artery open.
Surgical options include an open embolectomy, where a surgeon directly accesses the artery to remove the obstructing clot. If the blockage is due to extensive plaque buildup, a surgical bypass may be performed to reroute blood flow around the diseased segment. Medical management is started immediately with fluid resuscitation and blood thinners, such as heparin, to prevent further clotting.
If the ischemia has progressed to cause tissue death, the non-viable sections of the intestine must be surgically removed in a procedure called bowel resection. Because the window for saving the intestine is narrow, treatment must begin as soon as the diagnosis is suspected. Sometimes, a “second-look” operation is performed 24 to 48 hours later to assess the viability of any remaining bowel.