What is Intestinal Ischemia?
Intestinal ischemia is a serious medical condition caused by insufficient blood flow to a part of the intestine due to a blocked blood vessel, usually an artery. It can affect either the small intestine or the large intestine, or both.
Types of Intestinal Ischemia
The types of intestinal ischemia include:
- Colon Ischemia (Ischemic Colitis): The most common type of intestinal ischemia occurs when blood flow to the colon is reduced.
- Acute Mesenteric Ischemia: This is a condition in which symptoms occur abruptly. There is insufficient blood flow through the mesenteric arteries, resulting in ischemia and eventually bowel gangrene.
- Chronic Mesenteric Ischemia: The development of fatty deposits on the arterial wall (atherosclerosis) causes chronic mesenteric ischemia, often known as intestine angina. The illness progresses slowly, and treatment may not be needed until two of the three primary arteries supplying your intestines become severely constricted or completely obstructed.
What are the Causes of Intestinal Ischemia?
Intestinal ischemia occurs when the blood flowing through the major arteries that supply blood to your intestines slows or stops. This disorder can be caused by a blood clot blocking an artery or a narrowing of an artery due to a buildup of deposits, such as cholesterol.
Causes of colon ischemia include:
- Dangerously low blood pressure associated with heart failure, trauma, or shock
- A blood clot in a colon-supplying artery
- Excessive intestinal enlargement due to scar tissue or a tumor causing a bowel blockage.
- Other medical conditions that adversely influence your blood, such as blood vessel inflammation, lupus, or sickle cell anemia
- Medications that constrict blood vessels
- Uses of Cocaine or methamphetamine
- Vigorous exercise, such as long-distance running
Causes of acute mesenteric ischemia and chronic mesenteric ischemia include:
- Blood clot in the main mesenteric artery
- Low blood pressure as a result of shock, heart failure, some drugs, or chronic renal failure that impairs blood flow
- Plaque buildup narrowing the mesenteric arteries
What are the Symptoms of Intestinal Ischemia?
Signs and symptoms may vary from person to person and depend on the type of intestinal ischemia.
Signs and symptoms of acute intestinal ischemia include:
- Abdominal discomfort that comes on suddenly and might be mild, moderate, or severe
- Frequent and forceful bowel movements
- Abdominal tenderness
- Blood in your stool
- Mental confusion in older adults
- Nausea or vomiting
Signs and symptoms of chronic intestinal ischemia may include:
- Abdominal cramps after meals
- Fear of eating because of subsequent post prandial pain
- Unintended weight loss
- Diarrhea or constipation
- Nausea and vomiting
Diagnosis of Intestinal Ischemia
Your doctor will review your medical history and a physical examination will be performed. You may undergo several diagnostic tests, based on your signs and symptoms, including:
- Blood Tests: Blood tests are performed to look for certain substances in the blood that can indicate the presence of the disease.
- Imaging tests: Imaging studies may allow your doctor to visualize your organs and rule out other possible reasons for your symptoms. Imaging tests may include an X-ray, ultrasound, CT scan, and MRI.
- A Scope to Visualize Your Digestive Tract: To examine your digestive tract from the inside, a lighted, flexible tube with a camera on its tip is inserted into your mouth or rectum. The scope may be inserted into your mouth to examine the upper portion of your small intestine (endoscopy) or the scope may be inserted into your rectum to examine the last 2 feet of your colon (sigmoidoscopy) or the entire colon (colonoscopy).
- Angiography: During this test, a long, thin tube (catheter) is placed into an artery in your groin or arm, then passed through the artery to the aorta. A dye injected into the catheter flows directly to the arteries of your intestines. As the dye moves through your arteries, narrowed areas or blockages are visible on the X-ray images. An arterial blockage can also be treated using angiography by injecting medication or using special equipment to expand the artery.
- Exploratory Surgery: Exploratory surgery may be required to locate and remove damaged tissue. The abdomen is opened with a large incision to allow for diagnosis and treatment as one procedure.
What are the Treatments for Intestinal Ischemia?
Treatment of intestinal ischemia involves restoring the blood supply to your digestive tract. Depending on the nature and severity of your problem, you have a variety of treatment options.
Antibiotics may be prescribed to prevent or treat infections in people who have colon ischemia. It's also crucial to treat any underlying heart conditions. You may be instructed to stop medications that constrict blood vessels, such as migraine drugs, hormone medications, and some heart drugs. Colon ischemia can sometimes heal on its own just with making these medication changes.
Surgery to remove a blood clot, bypass an arterial blockage, or repair or remove a damaged piece of the intestine may be required for acute mesenteric artery ischemia. Antibiotics and medicines to prevent clot formation, dissolve clots and widen blood arteries may also be used.
For chronic mesenteric artery ischemia, blood flow to your intestine must be restored as part of the treatment. With angioplasty therapy or the placement of a stent in the artery, your surgeon can bypass blocked arteries or enlarge narrowed arteries.