Sitophobia and Chronic Mesenteric Ischemia in Older Diabetic Man

The clinical presentation-crampy abdominal pain after meals, weight loss, and loose stools-is consistent with chronic mesenteric ischemia given this patient's history of diabetes.

A 74-year-old man with diabetes presents with a chief complaint of crampy abdominal pain, particularly following meals, that has been progressively worsening over the past 6 months. Since that time, he has unintentionally lost 8 lb. His stools have been loose, but otherwise unremarkable. Which of the following studies would reveal the most likely diagnosis?

A. Esophagogastroduodenoscopy
B. RUQ ultrasonogram
C. Colonoscopy
D. CT angiography of the abdomen

Answer: D

This patient has sitophobia-fear of eating due to pain induced by meals, which is suggestive of chronic mesenteric ischemia. His history of diabetes and his likely underlying vasculopathy are risk factors for this condition. A screening test for this would be CT angiography. Any weight loss in an elderly patient is concerning for malignancy, and endoscopic evaluation should be considered. However, the clinical presentation in this case is more consistent with chronic mesenteric ischemia. A right upper quadrant ultrasonogram would be low yield in this case.