Postprandial Nitroglycerin: A Novel Approach for Chronic Mesenteric Ischemia

1Cleveland Clinic Foundation, Cleveland, OH

Meeting: Hospital Medicine 2007, May 23-25, Dallas, Texas

Abstract number: 129

Case Presentation:

A 69‐year‐old man was transferred from a community hospital with the complaint of postprandial abdominal pain for 1 year. The pain was described as dull, gradually increasing in severity over 1‐2 hours, often radiating to the back, and lasting 2‐3 hours afterfood intake. At its peak severity, he rated the pain as 9 out of 10. He noted associated nausea and rare vomiting after meals. He had lost 20 pounds over the preceding 3 months, and small amounts of food invariably led to abdominal pain. The pain increased in the decubitus position. A review of systems was otherwise negative.

An initial abdominal CT scan (without contrast because of his dye allergy) did not reveal a source of the pain. Magnetic resonance imaging with angiography (MRI/MRA) of the abdomen revealed 70%‐80% stenosis of the celiac artery. The superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) were patent.

At our institution a mesenteric artery ultrasound revealed 70%‐99% stenosis of the celiac trunk, 0%‐69% stenosis of the SMA, and a patent IMA. Repeat MRI/MRA showed borderline significant stenosis of 1 of 3 branches of the celiac artery. Liver, gallbladder, spleen, and pancreas were structurally normal, and no biliary tract abnormalities were noted. It was believed the patient suffered from chronic mesenteric ischemia and might benefit from elective intervention.

For both symptomatic relief and additional support of our diagnosis, the patient was given a trial of postprandial sublingual nitroglycerin with the onset of abdominal pain. This resulted in near complete resolution of symptoms. At discharge the patient was prescribed 0.4 mg sub‐lingual nitroglycerin after each meal for symptomatic control until the intervention. At the 1‐month follow‐up, the patient reported both symptomatic improvement and weight gain with postprandial nitroglycerin and was scheduled for an elective abdominal vascular intervention.

Discussion:

This case describes a novel approach to abdominal pain associated with mesenteric ischemia. Nitrates provided symptomatic relief, although they may not alter the subsequent prognosis or evolution of the mesenteric ischemia to acute ischemic events. Afinding of mesenteric ischemia should prompt an evaluation forfurtheratheroscleroticdisease if interventions are planned. Nevertheless, this strategy may improve nutritional status and overall health prior to surgery, augmenting wound healing and reducing postoperative complications.

Conclusions:

Postprandial nitroglycerin for chronic mesenteric ischemia may be a prudent management strategy to control symptoms and improve nutritional status, especially if definitive surgery is planned. Further studies are warranted to ascertain its effects on nutritional parameters and longer‐term surgical and overall outcomes. Hospitalists care for many of these patients and must be aware of such potential options for symptom control.

Author Disclosure:

R. Kedem, None; D. Ontaneda, None; C. M. Whinney, None.

To cite this abstract:

Kedem R, Ontaneda D, Whinney C. Postprandial Nitroglycerin: A Novel Approach for Chronic Mesenteric Ischemia. Abstract published at Hospital Medicine 2007, May 23-25, Dallas, Texas Abstract 129. Journal of Hospital Medicine. 2007; 2 (suppl 2). https://www.shmabstracts.com/abstract/postprandial-nitroglycerin-a-novel-approach-for-chronic-mesenteric-ischemia/. Accessed July 16, 2019.

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