Learn about what happens when blood flow to part of the small or large intestine is blocked, and how this serious condition is treated.
Intestinal ischemia (is-KEE-me-uh) describes a variety of conditions that occur when blood flow to your intestines decreases. Ischemia can be due to a fully or partially blocked blood vessel, usually an artery, or low blood pressure leading to an overall reduced blood flow. Intestinal ischemia can affect your small intestine, your large intestine (colon) or both.
The decreased blood flow doesn't provide enough oxygen for the cells in your digestive system. Intestinal ischemia is a serious condition that can cause pain and make it difficult for your intestines to work properly. In severe cases, loss of blood flow to the intestines can damage intestinal tissue and possibly lead to death.
Treatments are available for intestinal ischemia. To improve the chances of recovery, it's crucial to recognize the early symptoms and get medical help right away.
The small intestine and colon are parts of your digestive tract, which processes the foods you eat. The intestines take nutrients from the foods. What isn't absorbed by the intestines continues along the digestive tract and is passed as stool during a bowel movement.
Signs and symptoms of intestinal ischemia can develop suddenly (acute) or gradually (chronic). Signs and symptoms may be different from one person to the next, but there are some generally recognized patterns that suggest intestinal ischemia.
Signs and symptoms of acute intestinal ischemia typically include:
Signs and symptoms of chronic intestinal ischemia can include:
Seek immediate medical care if you have sudden, severe abdominal pain. Pain that makes you so uncomfortable that you can't sit still or find a comfortable position is a medical emergency.
If you have other signs or symptoms that worry you, make an appointment with your health care provider.
Intestinal ischemia occurs when the blood flow through the major blood vessels that supply blood to (arteries) and from (veins) your intestines slows or stops. The condition has many possible causes. These can include:
Intestinal ischemia is often divided into categories. Colon ischemia (ischemic colitis) affects the large intestine. Types of ischemia that affect the small intestine include acute mesenteric ischemia, chronic mesenteric ischemia and ischemia due to mesenteric venous thrombosis.
This type of intestinal ischemia, which is the most common, occurs when blood flow to part of the colon is slowed or blocked. The cause of reduced blood flow to the colon isn't always clear, but a number of conditions can put you at risk of colon ischemia:
Mesenteric ischemia occurs when narrowed or blocked arteries restrict blood flow to your small intestine. Decreased blood flow can permanently damage the small intestine.
Acute mesenteric ischemia is the result of a sudden loss of blood flow to the small intestine. It may be due to:
Chronic mesenteric ischemia results from the buildup of fatty deposits on an artery wall (atherosclerosis). The disease process is generally gradual. It's also known as intestinal angina because it results in decreased blood flow to the intestines after eating. You may not require treatment until at least two of the three major arteries supplying your intestines become severely narrowed or completely blocked.
A possibly dangerous complication of chronic mesenteric ischemia is developing a blood clot within a narrowed artery. This can cause blood flow to be suddenly blocked, resulting in acute mesenteric ischemia.
This ischemia occurs when blood can't leave your small intestines. A blood clot can develop in a vein draining blood from your intestines. Veins carry blood that has had the oxygen removed back to the heart. When the vein is blocked, blood backs up in the intestines, causing swelling and bleeding. This may result from:
Factors that may increase your risk of intestinal ischemia include:
Complications of intestinal ischemia can include:
Other health conditions, such as chronic obstructive pulmonary disease (COPD), can worsen the severity of intestinal ischemia. Emphysema, a type of COPD, and other smoking-related lung diseases increase this risk.
In some cases, intestinal ischemia can result in death.
If after a physical exam your health care provider suspects intestinal ischemia, you may undergo several diagnostic tests. The choice of tests is based on your signs and symptoms and can include:
Treatment of intestinal ischemia involves restoring the blood supply to your digestive tract. Options vary depending on the cause and severity of your condition.
If there is evidence of severe colonic ischemia, your health care provider may recommend antibiotics to treat or prevent infections. Treating any underlying medical condition, such as congestive heart failure or an irregular heartbeat, is also important.
You'll likely need to stop medications that constrict your blood vessels, such as migraine drugs, hormone medications and some heart drugs. In most cases, colon ischemia heals on its own.
If your colon has been severely damaged, you may need surgery to remove the dead tissue. In some cases, you may need surgery to bypass a blockage in one of your intestinal arteries. If angiography is done to diagnose the problem, it may be possible to open up a narrowed artery with angioplasty.
Angioplasty involves using a balloon inflated at the end of a catheter to compress the fatty deposits and stretch the artery, making a wider path for the blood to flow. A spring-like metallic tube (stent) also may be placed in your artery to help keep it open. A blood clot may be removed or be treated with medication to dissolve the clot.
Surgery may be necessary to remove a blood clot, to bypass an artery blockage, or to repair or remove a damaged section of intestine. Treatment also may include antibiotics and medications to prevent clots from forming, dissolve clots or dilate blood vessels.
If angiography is done to diagnose the problem, it may be possible to remove a blood clot or to open up a narrowed artery with angioplasty at the same time. A stent also may be placed in your artery to help keep it open.
Treatment requires restoring blood flow to your intestine. Your surgeon can bypass the blocked arteries or widen narrowed arteries with angioplasty or by placing a stent in the artery.
If your intestine shows no signs of damage, you'll likely need to take anticoagulant medication for about 3 to 6 months. Anticoagulants help prevent clots from forming.
You might need a procedure to remove the clot. If parts of your intestine show signs of damage, you might need surgery to remove the damaged section. If tests show you have a blood-clotting disorder, you may need to take anticoagulants for the rest of your life.
Go the emergency room if you have severe abdominal pain that makes you so uncomfortable that you can't sit still. You may be referred for immediate evaluation to diagnose and treat your condition, possibly with surgery.
If your abdominal pain is moderate and predictable — for example, it always begins soon after eating — call your health care provider for an appointment. When you call to set up an appointment, you may be referred to a specialist, such as a gastroenterologist or vascular surgeon.
Here's some information to help you get ready for your appointment.
For intestinal ischemia, some questions to ask include:
Don't hesitate to ask other questions that may occur to you during your appointment.
Your health care provider may ask: