Quick Answer
- Mesenteric Artery Bleeding: A life-threatening vascular emergency causing rapid blood loss, haemodynamic instability, mesenteric ischemia and shock.
- Vascular Causes of Bleeding: Aneurysms, pseudoaneurysms, trauma, previous surgery, pancreatitis and tumour-related vessel injury cause arterial/GI bleeding.
- Advanced Diagnosis: CT angiography and digital subtraction angiography identify the bleeding vessel and guide treatment.
- Minimally Invasive Treatment: Endovascular embolisation or covered stent placement controls selected arterial bleeds while avoiding major open surgery.
- Surgical and Hybrid Options: Open or combined procedures are used when endovascular treatment cannot adequately control bleeding or bowel damage is present.
What Is a Mesenteric Artery Bleed?
Mesenteric artery bleeding occurs when an artery supplying the intestines or one of its branches ruptures, leaks or tears.
The bleeding can be intermittent or massive depending on the vessel involved, the size of the defect and the rate of blood loss.
Depending on where the bleeding occurs and its severity, it can remain within the abdominal cavity or enter the digestive tract, producing visible signs of GI bleeding.
Understanding the Mesenteric Arteries
The mesenteric arteries include the superior mesenteric artery, inferior mesenteric artery and their branches.
- Superior mesenteric artery (SMA): Supplies most of the small intestine and parts of the large intestine through its branches.
- Inferior mesenteric artery (IMA): Supplies portions of the distal colon and rectum.
- Celiac artery and its branches: Supply the stomach, liver, spleen and other upper abdominal structures and can be involved in upper GI arterial bleeding.
- Smaller arterial branches: Bleeding can originate from smaller vessels even when the main mesenteric artery itself appears normal.
Causes of Mesenteric Artery or GI Bleed
The underlying cause determines both treatment urgency and approach, including whether an endovascular procedure can control the bleeding vessel.
- Gastric ulcers, when they erode into a vessel
- Visceral artery aneurysms or pseudoaneurysms
- Abdominal trauma or vascular injury
- Previous surgery or endoscopic procedures
- Tumours and inflammatory conditions
- Blood-thinning medications
Gastric Ulcers
- Deep gastric ulcers can erode into nearby blood vessels and cause gastrointestinal bleeding.
- Severe arterial bleeding may occur when an ulcer damages a larger vessel.
Visceral Artery Aneurysm or Pseudoaneurysm
- A weakened arterial wall can form an aneurysm, while vessel injury can cause a pseudoaneurysm.
- Rupture of these vessels can result in massive internal or gastrointestinal bleeding.
Trauma and Vascular Injury
- Blunt or penetrating abdominal trauma can tear mesenteric arteries or their branches.
- Vascular injury may cause immediate bleeding or form a pseudoaneurysm that ruptures later.
Previous Surgery or Endoscopic Procedures
- Abdominal surgery or endoscopic procedures can occasionally injure nearby blood vessels.
- Delayed vascular complications can cause significant GI bleeding, including bleeding related to an aortoenteric fistula after aortic repair.
The Society for Vascular Surgery’s abdominal aortic aneurysm guidance specifically identifies GI bleeding after previous open or endovascular aortic repair as a reason to evaluate for an aortoenteric fistula.
Tumours and Inflammatory Conditions
- Tumours erode into adjacent vessels or develop abnormal feeding arteries.
- Pancreatitis erodes the arterial wall and causes pseudoaneurysm formation.
- Vasculitis weakens the arterial wall and predisposes to aneurysm formation or rupture.
Treatments address both the haemorrhage and the underlying condition when inflammation, malignancy or infection contributes to vessel damage.
Symptoms of Mesenteric Artery Bleeding or GI Bleed
Symptoms vary with the location and severity of bleeding. Rapid arterial haemorrhage can cause sudden deterioration and requires urgent medical assessment.
- Abdominal pain: Sudden or severe abdominal pain can occur, particularly when bleeding is associated with arterial injury or bowel ischemia.
- GI bleeding: Vomiting blood or passing black, tarry or bloody stools can indicate bleeding into the digestive tract.
- Signs of blood loss: Dizziness, fainting, weakness, rapid pulse, low blood pressure, pale or clammy skin and a sudden fall in haemoglobin can occur with significant blood loss.
- Severe haemorrhage: Heavy bleeding can progress to haemodynamic instability and shock, causing confusion, extreme weakness or loss of consciousness.
High-risk history: GI bleeding in a person with a known visceral artery aneurysm, pseudoaneurysm, or previous aortic or abdominal vascular surgery warrants urgent vascular assessment.
Diagnosis of Mesenteric Artery Bleed
Diagnosis focuses on identifying the bleeding source, assessing blood loss and determining whether bowel ischemia or other complications are present.
CT angiography (CTA)
Visceral Artery Digital subtraction angiography (DSA)
Blood tests
Endoscopy
Clinical assessment
Further imaging
Treatment of Mesenteric Artery Bleed or GI Bleed
Treatment first focuses on stabilising the patient, then controlling the bleeding source while preserving blood flow to the bowel and other vital organs.
The choice between endovascular, open or hybrid treatment depends on the bleeding vessel, vascular anatomy, haemodynamic status and presence of bowel injury.
Endovascular Embolisation
- A catheter is guided into the affected arterial branch through a small vascular access site.
- Angiography identifies the bleeding point or pseudoaneurysm.
- Coils, vascular plugs, particles, gelatin sponge or liquid embolic agents can be selected according to the vessel and lesion.
- Selective embolisation aims to stop bleeding while preserving blood flow through surrounding bowel and collateral vessels.
- In appropriately selected patients, the approach avoids a large abdominal incision.
A 2022 study of 15 patients undergoing transarterial embolisation for active mesenteric bleeding achieved a 93.3% success rate, with no procedure-related ischemic complications reported.
Covered Stent Placement
- A covered stent can exclude selected aneurysms or pseudoaneurysms from arterial circulation.
- It preserves blood flow through the treated parent artery rather than intentionally blocking it.
- This approach is useful when embolisation could compromise an important arterial supply to the bowel or another organ.
- Suitability depends on vessel diameter, lesion location, adequate landing zones and the available collateral circulation.
Open Vascular Repair
- Open repair is considered when endovascular treatment cannot safely control the bleeding.
- Surgery can involve vessel ligation, aneurysm repair or arterial reconstruction.
- Bowel resection is required when associated ischemia has resulted in irreversible bowel damage.
- Open surgery is particularly relevant when there is perforation, bowel gangrene, extensive vascular injury or failed endovascular treatment
Hybrid Treatment
- Hybrid treatment combines endovascular techniques with open surgical treatment.
- It can be useful when bleeding control, vascular reconstruction and assessment of damaged bowel are all required.
- The approach allows the treatment strategy to be adapted according to the vascular anatomy and the patient’s condition.
- It can provide an option when neither endovascular treatment nor open surgery alone adequately addresses the complete problem.
A mesenteric artery bleed sits at the intersection of specialities, but the vascular surgeon’s unique skill set often determines the outcome.
A vascular surgeon can proceed with an endovascular approach to embolise the bleeding vessel or convert to open repair, within the same setting. This hybrid approach (endovascular + open) means the treatment plan adapts in real time to anatomical demands, rather than scheduling the patient for a separate procedure.
FAQs
What Happens if Mesenteric Ischemia Goes Untreated?
Untreated mesenteric ischemia progressively reduces blood supply to the intestine, causing intestinal tissue damage and eventually bowel necrosis. It is a consequence of mesenteric /GI bleed and carries a mortality rate of up to 80% when not treated in time.
As the bowel wall loses its protective barrier, bacteria can enter the bloodstream, increasing the risk of sepsis, multi-organ dysfunction and shock. If necrotic bowel is not treated, the condition can become fatal.
What Are the Potential Complications of Mesenteric Artery Embolisation?
Potential complications include rebleeding, non-target embolisation, bowel ischemia, access-site complications and contrast-related adverse effects.
Risk depends on the bleeding vessel’s location, the collateral blood supply, and how selectively the responsible artery can be treated.
When Is Surgery Required for a Mesenteric Artery Bleed?
Open surgery is considered when endovascular treatment cannot control the bleeding, when the vascular lesion requires reconstruction, or when associated bowel perforation, necrosis or gangrene requires surgical treatment.
Surgery can also follow an unsuccessful embolisation attempt, making endovascular treatment and surgery complementary rather than mutually exclusive approaches.