The diagnosis of chronic mesenteric ischemia should be suspected in the above patient. The barium enema demonstrates thumbprinting of the colonic wall, although nonspecific but seen in mesenteric ischemia- Treasure 21 (radiology) Most cases are due to atherosclerotic changes, especially in the background of smoking and coronary aery disease. Chronic intestinal ischemia clinically present as postprandial abdominal pain due to increased need of blood flow in the post prandial state to the intestine following meals (intestinal angina) Patients repo abdominal cramping and pain following ingestion of a meal. Weight loss and chronic diarrhea may be associated as well. Screening test : Duplex ultrasound Gold standard investigation: Mesenteric angiography MR-angiography (if administration of contrast dye is contraindicated) The management of chronic intestinal ischemia medical management (atherosclerotic disease) by exercise cessation of smoking anti-platelet and lipid-lowering medications.