A 64-year-old woman has severe, gnawing abdominal pain starting 30 minutes after every meal, which has led her to deliberately stop eating. Over 10 months she has lost 14 kg. Examination shows generalised wasting with no peritoneal signs; stool occult blood is negative and gastroscopy is normal. She has atrial fibrillation and heavy atherosclerotic disease elsewhere. Which investigation best establishes the diagnosis?

• A Faecal elastase measurement
• B Colonoscopy with random biopsies
• C CT scan of the abdomen with oral contrast
• D Lateral view catheter aortography showing ostial stenoses of the coeliac axis and superior mesenteric artery ✓

Explanation

The triad of postprandial pain, fear of eating with profound weight loss, and widespread atherosclerosis defines chronic mesenteric ischaemia. Because the gut has rich collateralisation, symptoms usually require significant stenosis of at least two of the three mesenteric vessels, and these are ostial lesions best demonstrated on a lateral projection aortogram or CT angiography. CT with oral contrast may be normal, which is typical of this disease and contributes to diagnostic delay. Faecal elastase assesses exocrine pancreatic insufficiency, a competing cause of malabsorption.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.