A 68-year-old woman reports severe cramping abdominal pain starting about 20 minutes after every meal, which she avoids by eating very little. She has lost 9 kg over four months. Examination reveals an epigastric bruit. CT angiography shows critical stenoses of both the coeliac axis and superior mesenteric artery. What is the classic symptom triad this presentation represents?
- A Postprandial pain, diarrhoea, and anaemia
- B Vomiting, colicky central pain, and absolute constipation
- C Postprandial pain, fear of food, and weight loss ✓
- D Night pain relieved by sitting forward, weight gain, and steatorrhoea
Explanation
Chronic mesenteric ischaemia classically produces postprandial abdominal angina, fear of eating (sitophobia), and progressive weight loss, usually in a vasculopath with an audible bruit. Because at least two of the three mesenteric vessels must be critically compromised to produce symptoms, collateral supply usually prevents infarction, so patients remain chronically malnourished rather than acutely septic. Revascularisation of the superior mesenteric artery is the definitive treatment. Option B describes mechanical obstruction and option D describes pancreatic pain.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.