Intestinal ischemia (is-KEE-me-uh) describes a variety of conditions that occur when blood flow to your intestines decreases due to a blocked blood vessel, usually an artery. Intestinal ischemia can affect your small intestine, your large intestine (colon) or both.
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 components of your digestive tract, which processes the foods you eat. The intestines extract nutrients from the foods. What isn't absorbed by the intestines continues along the digestive tract and is expelled 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 doctor.
Intestinal ischemia occurs when the blood flow through the major arteries that supply blood to your intestines slows or stops. The condition has many potential causes, including a blockage in an artery caused by a blood clot, or a narrowing of an artery due to buildup of deposits, such as cholesterol. Blockages also can occur in veins, but they're less common.
Intestinal ischemia is often divided into categories:
This type of intestinal ischemia, which is the most common, occurs when blood flow to the colon is slowed. The cause of diminished blood flow to the colon isn't always clear, but a number of conditions can make you more vulnerable to colon ischemia:
This type of intestinal ischemia usually affects the small intestine. It has an abrupt onset and may be due to:
Chronic mesenteric ischemia, also known as intestinal angina, results from the buildup of fatty deposits on an artery wall (atherosclerosis). The disease process is generally gradual, and you may not require treatment until at least two of the three major arteries supplying your intestines become severely narrowed or completely obstructed.
A potentially dangerous complication of chronic mesenteric ischemia is the development of a blood clot within a diseased artery, causing blood flow to be suddenly blocked (acute mesenteric ischemia).
A blood clot can develop in a vein draining deoxygenated blood from your intestines. When the vein is blocked, blood backs up in the intestines, causing swelling and bleeding. This is called mesenteric venous thrombosis, and it may result from:
Factors that may increase your risk of intestinal ischemia include:
Complications of intestinal ischemia can include:
In some cases, intestinal ischemia is fatal.
If your doctor suspects intestinal ischemia, you may undergo several diagnostic tests, based on your signs and symptoms, including:
Treatment of intestinal ischemia involves restoring the blood supply to your digestive tract. Options vary depending on the cause and severity of your condition.
Your doctor 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. Similarly, you'll need to stop medications that constrict your blood vessels, such as migraine drugs, hormone medications and some heart drugs. Sometimes, colon ischemia heals on its own.
If your colon has been damaged, you may need surgery to remove the dead tissue. Or you may need surgery to bypass a blockage in one of your intestinal arteries.
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 simultaneously remove a blood clot or 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.
Treatment requires restoring blood flow to your intestine. Your surgeon can bypass the blocked arteries or widen narrowed arteries with angioplasty therapy or by placing a stent in the artery.
If your intestines show no signs of damage, you'll likely need to take anticoagulant medication for about three to six months. Anticoagulants help prevent clots from forming.
If tests show you have a blood-clotting disorder, you may need to take anticoagulants for the rest of your life. If portions of your bowel show signs of damage, you might need surgery to remove the damaged section.
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 doctor 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 your doctor include:
Don't hesitate to ask other questions that may occur to you during your appointment.
Your doctor may ask: