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Intestinal ischemia

Intestinal ischemia describes a number of syndromes characterised by reduced blood flow to the intestines.

A doctor holding a model of the intestines

There are three major arteries that serve the intestines: the superior mesenteric artery, the inferior mesenteric artery and the coeliac artery. When these blood vessels become blocked or narrowed, a condition known as intestinal ischemia (also sometimes called mesenteric ischemia) can set in. 

Intestinal ischemia can result in tissue damage and infarction (necrosis of the tissue). 

Causes of intestinal ischemia syndromes include: 

  • Atherosclerosis (a disease in which plaque builds up inside arteries) in the arteries supplying the bowels
  • Blockages due to blood clots (heart patients are at higher risk)
  • Hernia 
  • Very low blood pressure (also known as hypotension), resulting in impaired blood supply (more common in patients who already have atherosclerosis too)

What are its symptoms?

Intestinal ischemia symptoms vary somewhat, depending on whether the condition is acute (sudden onset) or chronic (gradual development). Acute symptoms include:

  • Abdominal pain, which usually comes on suddenly and severely
  • Nausea and vomiting
  • Presence of blood in the stool
  • Intense need for a bowel movement, usually diarrhoea
  • Fever

Chronic intestinal ischemia symptoms include:

  • Frequent abdominal cramps after meals, with pain getting more intense over a period of days or weeks
  • Bloating
  • Nausea and vomiting
  • Bloody stool
  • Diarrhoea or constipation

Tissue death and perforation of the intestine are possible complications of intestinal ischemia, so it’s important to treat these symptoms as an emergency.

How is it diagnosed? 

Several tests may be necessary for your doctor to reach an intestinal ischemia diagnosis. Abdominal X-rays, ultrasound and CT (computerised tomography) scans may be used to create an image of the gastrointestinal tract – these can help medical professionals rule out other conditions that may exhibit similar signs. 

An endoscopy or colonoscopy whereby a small camera is fed into the GI tract via the mouth or the anus can also be used to give doctors a view inside the bowel. 

For a better understanding of whether the blood vessels are narrowed or not, an angiogram will be performed. This procedure uses dye injected into the arteries to highlight any narrowing or blockages.

What are your treatment options? 

Oftentimes intestinal ischemia treatment will require surgery, both to restore blood flow to the colon by bypassing the blocked vessel, and to remove any dead tissue before it becomes gangrenous and risk of further complications and infection becomes potentially life threatening. 

Clot-busting medications may be prescribed to dissolve any blood clots that may be causing the problem and the patient may be put on blood thinners to prevent more clots from forming. 

In some cases a procedure called an angioplasty is performed, whereby a balloon on the end of a catheter is inflated within a narrowed artery to widen it again.

Can it be prevented? 

Intestinal ischemia cannot always be prevented but there are ways in which you are able to reduce your risk of developing the condition. This may include measures such as keeping cholesterol levels under control, as high cholesterol is linked to the development of atherosclerosis, avoiding smoking and effectively managing any other chronic health conditions.

IMAGE CREDIT: 123rf.com

The accuracy of this information was checked and approved by physician Dr Thomas Blake in July 2016