Intestinal Ischemia

A group of conditions that happens when blood flow to the intestines is reduced or blocked is called intestinal ischemia. In most cases, intestinal ischemia occurs due to a fully or partly blocked artery. Sometimes, hypotension (low blood pressure) may reduce blood flow to the bowels. This condition may negatively affect both the small and large intestines.

Along with reduced blood flow less oxygen goes to the cells in all digestive tracts. However, this is a serious health condition that causes pain and affects the intestine function.

Long-term damage to the intestines may occur in severe cases when blood flow is blocked completely and sometimes may lead even to death.

In any case, there are different treatment options for people with intestinal ischemia. Early diagnosis and treatment increase the chances of recovery.

Symptoms

In people with intestinal ischemia, symptoms may occur suddenly (acute intestinal ischemia) or slowly appear (chronic intestinal ischemia) and usually differ among people. Check below some symptoms:

Acute Intestinal Ischemia Symptoms

People with this intestinal ischemia type usually experience the following symptoms. Examples include:

  • Abdominal tenderness or bloating (distention)
  • Bloody stools
  • Nausea
  • Vomiting
  • Mental confusion (most common in older adults)
  • Sudden abdominal pain
  • Forcefully passing stool frequently

Chronic Intestinal Ischemia Symptoms

  • Fear of eating due to pain that occurs after a meal
  • Unusual weight loss
  • Nausea
  • Vomiting
  • Bloating
  • Diarrhea
  • Pain in the abdomen that often worsens over weeks or months
  • Belly (abdominal) cramps

Immediately seek medical care if any of the previous symptoms happen or if you have sudden abdominal pain.

Causes

There are different factors that may reduce or block blood flow to the major blood vessels and cause intestinal ischemia. Check below some causes:

  • Blood clots that block the arteries
  • The buildup of fatty deposits (such as cholesterol) that narrows the artery
  • Reduced blood pressure that causes less blood flow
  • A vein blockage (it happens less commonly)

Commonly, intestinal ischemia is divided into certain groups. For example, colon ischemia (ischemic colitis) affects the large bowel. Other types impact the small intestine. These include acute mesenteric ischemia, chronic mesenteric ischemia, and mesenteric venous thrombosis ischemia.

Ischemic Colitis

This is the most common intestinal ischemia type and it occurs when blood flow to the colon is reduced or completely blocked. However, doctors cannot identify the exact cause that reduces blood flow to the colon every time. Check below some health conditions that may increase the risk of this intestinal ischemia type:

  • Hypotension (reduced blood pressure) may happen due to heart failure, major surgery, trauma, shock, or dehydration.
  • Blood clots that cause blockages in the arteries that supply the colon (also known as atherosclerosis)
  • Volvulus (twist of a bowel) or trapped intestinal contents within a hernia
  • Tumors that block the bowel
  • Enlarged intestine usually from scar tissue
  • Certain health conditions that negatively affect the blood. For example lupus, sickle cell anemia, and irritation and swelling (inflammation) of the blood vessels also called vasculitis.
  • Some medicines that narrow blood vessels (such as medications used to treat heart disease or migraine)
  • Medications that contain hormones (such as birth control pills)
  • Cocaine or methamphetamine
  • Intense physical exercise (including running for long distances)

Acute Mesenteric Ischemia

This type usually occurs due to narrowed or blocked arteries that reduce blood flow to the small bowel. In most cases, this intestinal ischemia type causes permanent damage to the small intestine. A sudden loss of blood flow that causes acute mesenteric ischemia often happens due to the following reasons:

  • A blood clot (called an embolus) usually goes from the heart and blocks an artery. Commonly, it blocks the superior mesenteric artery that is responsible for supplying the intestine with oxygen-rich blood. In addition, this is the most common cause of acute mesenteric ischemia.
  • Blockages in the main intestinal arteries often happen due to atherosclerosis.
  • Hypotension causes blood flow to slow down. Low blood pressure may appear due to shock, heart failure, some medicines, or kidney failure. This condition also is called nonocclusive ischemia.

Chronic Mesenteric Ischemia

The buildup of fatty deposits on the artery wall often causes this intestinal ischemia type. Sometimes, it is called intestinal angina because it happens due to reduced blood flow after eating usually.

The treatment commonly is required when at least 2 of 3 major arteries that supply intestines with blood become narrow or blocked. In some cases, people may develop a life-threatening complication is a blood clot within an artery that is narrowed.

Mesenteric Venous Thrombosis Ischemia

In such cases, the condition occurs when blood cannot leave the small intestine. It often occurs due to a blood clot in a vein that prevents the draining of the blood from the small bowel. Normally, the blood returns to the heart through veins when oxygen is removed. A blood clot in the vein may lead to swelling and bleeding of the intestines. Check below some causes:

  • Acute or chronic swelling (inflammation) and irritation of the pancreas (pancreatitis)
  • Abdominal infection
  • Digestive system cancers
  • Bowel conditions (including ulcerative colitis, Crohn’s disease, or diverticulitis)
  • Health conditions that make the blood clot easier
  • Medicines that may increase clotting risk (such as Estrogen)
  • Abdominal injuries

Risk Factors

The following factors may elevate your risk of intestinal ischemia. For example:

  • Atherosclerosis – This is a condition in which a buildup of fatty deposits occurs in the arteries. Some people may experience certain health conditions caused by atherosclerosis that increase the risk of intestinal ischemia. These include coronary artery disease, peripheral vascular disease, carotid artery disease, and others.
  • Age – Those who are over 50 years old are more likely to develop this condition.
  • Smoking – The use of tobacco products also increases the risk of intestinal ischemia.
  • Heart and blood vessel diseases – These include atrial fibrillation, congestive heart failure, vasculitis, and others.
  • Certain medicines – For example birth control pills, migraine medicines, allergy medications, and others.
  • Blood clots – There are some conditions that may increase the risk of blood clots as well as intestinal ischemia. Examples include genetic conditions (such as factor V Leiden mutation), sickle cell anemia, and others.
  • Other diseases – These include hypertension (high blood pressure), diabetes, high cholesterol, and others.
  • Illegal drugs

What Are The Potential Complications of Intestinal Ischemia?

If you ignore the symptoms and do not get treatment for intestinal ischemia, you may experience some complications. Examples include:

  • Gangrene (death of intestinal tissue) – This usually occurs due to sudden and full blockage in the blood flow to the intestines.
  • Perforation – This is a hole through the intestines wall that causes it to leak in the abdomen (belly).
  • Scarring or narrowing of the bowel – In some cases, people may recover from intestinal ischemia but a part of healing includes scar tissues that may narrow or block the intestines. Commonly, it occurs in the colon but may happen in the small intestine too.

There are some diseases that may worsen intestinal ischemia. These include chronic obstructive pulmonary disease (COPD) and emphysema (a type of COPD).

Diagnosis

Healthcare professionals usually perform a physical examination to check for intestinal ischemia symptoms. However, they may perform additional tests to confirm the condition. For example:

  • Blood tests – These tests are done to check for white cell count levels. While blood tests only cannot diagnose intestinal ischemia, a high white blood cell count may indicate intestinal ischemia.
  • Imaging tests – These include X-rays, ultrasound, CT, or MRI scans. These tests are done to get detailed images of the intestines veins and arteries.
  • Sigmoidoscopy and colonoscopy – These tests involve a small tube with a camera on the end that helps look inside the digestive tract.
  • Angiography – It involves a dye that tracks blood flow through the arteries. This test helps identify narrowed areas of blockages.
  • Surgery – In some cases, doctors need to perform surgery to identify damaged tissue. However, abdominal opening allows diagnosis and treatment at the same time.

Treatment

The treatment goal is to restore normal blood flow that supplies the digestive tract. However, physicians prescribe different treatments for people with intestinal ischemia because it depends on several factors. These include the severity of the condition, other existing health problems, and others.

Colon Ischemia

The treatment for colon ischemia usually includes antibiotics to prevent infections and medicines for other health conditions such as congestive heart failure or arrhythmia. You may need to interrupt using medicines that narrow blood vessels including hormone medicines, and others. Commonly, the colon ischemia goes away on its own.

In severe cases, people require surgery to remove damaged tissue. Moreover, you may need surgery to bypass a blockage in one of the arteries of the intestine. This procedure may be done during angiography.

Acute Mesenteric Artery Ischemia

In such cases, treatment usually involves surgery to remove blood clots, bypass an artery blockage, and repair or remove dead tissue. Doctors may also prescribe medications to prevent and dissolve clots and widen blood vessels.

Chronic Mesenteric Artery Ischemia

Treatment for this intestinal ischemia type focuses on restoring blood flow to the intestines.

Mesenteric Venous Thrombosis Ischemia

If tests show no damage to the intestinal tissue, you do not need surgery. However, physicians may prescribe some anticoagulants (blood thinners). The treatment with previous medication lasts between 3-6 months usually.

Frequently Asked Questions

What tests do doctors use to diagnose intestinal ischemia?

These include:

  • Colonoscopy
  • Angiograms
  • Blood tests
  • Imaging tests

Sometimes, physicians may perform surgery to identify damaged tissue in the intestines.

What foods are recommended for people with intestinal ischemia?

Those who suffer from this condition should eat a balanced diet high in heart-healthy fruits, vegetables, and fish.

Can intestinal ischemia be cured?

Usually, people recover from this condition within 2 weeks. However, in severe cases, intestinal ischemia may cause permanent damage to the intestines. That’s why it is important to get treatment as soon as possible. If you have additional questions, ask your healthcare provider.

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