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Intestinal Ischemia

Definition


Disease: Intestinal Ischemia Intestinal Ischemia
Category: Digestive diseases
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Disease Definition:

The digestive system needs a permanent supply of oxygen-rich blood to function properly just like other organs. Intestinal ischemia is the condition of a diminished blood flow to the small intestine or colon.


Intestinal ischemia can result in pain and make it difficult for the intestines to function. Loss of blood flow to the intestines in severe cases can lead to damaged or dead intestinal tissue, not unlike what happens to the heart during a heart attack. Intestinal ischemia can be fatal just like a heart attack.


But one can receive effective treatments for intestinal ischemia. The most critical factor in effectively treating intestinal ischemia is recognizing the early symptoms and getting immediate medical help.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Intestinal ischemia may develop abruptly (acute intestinal ischemia), usually as an outcome of a blood clot blocking the flow of blood to or from the intestines, or it may develop slowly over time (chronic intestinal ischemia) due to a variety of causes.


Acute Intestinal Ischemia
Signs and symptoms of acute intestinal ischemia typically include:

 

 

  • Frequent, forceful bowel movements
  • Fever
  • Blood in the stool
  • An urgent need to move the bowels
  • Abrupt abdominal pain that may range from mild to severe
  • Abdominal tenderness or distention
  • Nausea or vomiting

 

Chronic Intestinal Ischemia
Chronic intestinal ischemia, in which blood flow to the intestines is decreased with time, is characterized by:

 

  • Fear of eating due to subsequent pain
  • Abdominal cramps or fullness, starting within 30 minutes after eating and lasting 1 to 3 hours
  • Nausea or vomiting
  • Bloating
  • Abdominal pain that gets progressively worse over weeks or months
  • Diarrhea
  • Unintended weight loss


Chronic intestinal ischemia may progress to an acute episode. One might suffer from severe abdominal pain in case this takes place after weeks or months of bouts of intermittent pain after eating.
Emergency care should be sought right away in case of having abrupt, persistent abdominal pain, because delaying treatment for intestinal ischemia may make treatment more difficult.
Consulting a doctor is required right away when experiencing one or more of the following signs or symptoms:

 

  • Chronic abdominal pain after eating, especially when one’s also lose weight
  • Blood in the stool

Causes:

The aorta is the large artery that supplies the person body’s vessels with oxygen-rich blood pumped by the heart. The portion of the aorta extending below one’s diaphragm into the abdomen is the abdominal aorta. Three arteries branching off the abdominal aorta supply almost all of the blood to the digestive tract. These arteries are the:

 

  • Superior mesenteric artery
  • Inferior mesenteric artery
  • Celiac artery

 

Intestinal ischemia may result if the flow of blood through these arteries or their adjacent draining veins is altered, whether the change is acute or chronic.


Any or all of the arteries that serve one’s digestive tract may be affected by a accumulation of cholesterol particles, calcium, scar tissue and other cellular debris (atherosclerosis) as is the case with other arteries in the body that narrows those arteries and restricts the amount of blood moving through them. Atherosclerotic buildup can progressively decrease blood flow to one’s small, large intestine or both. Chronic intestinal ischemia is usually the outcome of atherosclerotic buildup.
Acute intestinal ischemia, most of the time, occurs because of the forming of the blood clot in the heart that then travels to one of the intestinal arteries. Other times a blood clot may develop in a vein leading away from the intestines, diminishing the outflow of deoxygenated blood. Intestinal ischemia occasionally occurs because a portion of the intestine becomes trapped due to a hernia (strangulated hernia) or due to adhesions from a previous abdominal surgery. Other times it occurs due to low blood pressure or heart failure.


Whatever the cause, diminished blood flow within the digestive tract leaves cells with insufficient oxygen. Under these circumstances, cells weaken and die. Inflammation and ulcers develop as more and more cells are damaged. This contributes to an inability to absorb food and nutrients, causing bloody diarrhea. Infection and gangrene may result in a damage that’s severe enough. Intestinal ischemia can be fatal when it isn’t promptly treated.
Intestinal ischemia is usually divided into several categories.


Colon ischemia (ischemic colitis)
The most common type of intestinal ischemia is disrupted blood flow to the colon. It most frequently occurs in older adults, even though it may develop in younger people.
Though severe complications are uncommon, yet signs and symptoms of colon ischemia are in general milder than with other types of intestinal ischemia. Colon ischemia for most people comes abruptly as onset of mild, crampy pain on the left side of the abdomen. The reason behind diminished blood flow to the colon isn’t always clear, but a number of conditions can make one more vulnerable to colon ischemia:

 

  • A blood clot in an artery supplying the colon
  • Atherosclerosis
  • Heart, blood vessel, intestinal or gynecologic operations
  • Dangerously low blood pressure (hypotension) related to congestive heart failure, trauma, life-threatening infection in the bloodstream (sepsis), shock or major surgery.
  • Bowel obstruction resulted from a strangulated hernia, a tumor or scar tissue
  • Vigorous exercise, like a long-distance running
  • Other medical disorders that affect the blood, like inflammation of the blood vessels (vasculitis), sickle cell anemia or lupus
  • Cocaine or methamphetamine use
  • Certain medications, especially those that constrict blood vessels, like some heart, hormone or migraine medications


Acute mesenteric ischemia
This type of intestinal ischemia often affects the small intestine. It has an abrupt onset and may be because of:

 

  • A blood clot that dislodges from the heart and travels through the bloodstream (emboli) to block an artery, often the superior mesenteric artery, leading to the intestines. This is the most common reason behind acute mesenteric artery ischemia and can be precipitated by congestive heart failure, an irregular heartbeat (arrhythmia) or a heart attack.
  • A blood clot that develops within one of the main intestinal arteries (thrombosis) and blocks blood flow, usually as an outcome of atherosclerosis. This type of acute ischemic episode seems to occur in people suffering from chronic intestinal ischemia.
  • Impaired blood flow resulting from low blood pressure because of heart failure or shock. This is more common in people who are critically ill and who have certain degree of atherosclerosis. One may hear this kind of acute mesenteric ischemia known as nonocclusive ischemia that means that it’s not because of a vascular obstruction.
  • Aortic dissection, a partial tear in the main artery from the heart (aorta), which results in a separation of the layers of the aortic wall and bleeding into and along the wall of the aorta, thus decreasing blood flow to the intestines.

 

Chronic mesenteric ischemia
Chronic mesenteric ischemia, also referred to as intestinal angina, caused by atherosclerosis. The disease process is commonly so gradual that at least two of the three major arteries supplying the intestines become severely narrowed or totally obstructed before one goes through symptoms. A possibly dangerous complication of chronic mesenteric ischemia is the development of a blood clot within a diseased artery, resulting in acute mesenteric ischemia.
Ischemia due to mesenteric venous thrombosis
Sometimes, a blood clot will develop in a vein draining deoxygenated blood away from the intestines. Intestinal congestion, bleeding and swelling results from the blockage of the vein. A blood clot in a mesenteric vein may result from:

 

  • Scarring of the liver (cirrhosis)
  • Trauma to the abdomen
  • Acute or chronic inflammation of the pancreas (pancreatitis)
  • Cancers of the digestive system
  • Abdominal infection
  • Hormone therapy that can result in a blood clot
  • Bowel diseases, like ulcerative colitis, diverticulitis or Crohn’s disease
  • Disorders that make one blood more prone to clotting (hypercoagulation disorders), like an inherited protein deficiency.

 

Many of the risk factors for intestinal ischemia are those related to atherosclerosis and clogging of the mesenteric arteries. These factors are:

 

 

  • Diabetes
  • Smoking
  • Age (Older than 50)
  • High levels of blood lipids or fats
  • hypertension (High blood pressure)

 

The risk increased when one has a history of atherosclerosis affecting blood flow in other areas of the body, like the heart (coronary artery disease), the arteries serving the brain (cerebrovascular disease) or legs (peripheral vascular disease).


Other factors that can increase the risk of intestinal ischemia include low blood pressure, irregular heartbeat, a hernia and previous abdominal surgery, a blood-clotting disorder and congestive heart failure.


Extended bed rest, certain types of cancer, smoking, obesity, a history of high blood pressure or heart disease, and birth control pills are included among the risk factors for ischemia to mesenteric venous thrombosis.

Complications

Complications:

Blood flow to the digestive tract is completely and abruptly cut off because of a blood clot that travels to the area, usually from the heart. The same is true when a clot develops in one of the three arteries that serve the digestive tract where there’s already certain atherosclerotic buildup. In addition, It’s possible that blood clots or atherosclerotic accumulation may be dislodged from a larger artery or the aorta by a catheter during a diagnostic operation that can result in a blockage of smaller arteries downstream. These are medical emergencies.


Blockage of the blood flow to the intestine may cause death of intestinal tissue (infraction or necrosis). If this life-threatening condition occurs, one will need surgery to clear the blockage and to remove the part of the intestine that has died. The surgeon may plan to operate again (second-look operation) to make sure that remaining bowel tissue is healthy in order to limit the amount of intestinal tissue removed.


The surgeon may be able to connect the healthy ends together after removing damaged intestinal tissue. In case that isn’t possible, the surgeon may need to do an operation known as ostomy, where an opening in the abdomen is created to pull a section of the intestine to the surface. A bag is then attached to this opening, and the waste is expelled into the bag.
Blockage of blood flow to the colon can lead to scarring and narrowing of the colon that may need surgical treatment.

Treatments:

Restoring enough blood supply to the digestive tract is involved in the treatment of intestinal ischemia. Options vary depending on the reason behind the severity of the condition:


Colon ischemia: Antibiotics are usually used to treat or prevent infections from occurring. Any underlying medical condition should be treated as well, like irregular heartbeat, congestive heart failure. One is required to stop any medications that constrict the blood vessels, like hormone medications, certain heart drugs and migraine drugs.
Surgery may be required to remove the dead (infracted) tissue when one’s colon has been damaged. Or, surgery may be required in order to bypass a blockage in one of the intestinal arteries. The operation is similar to what’s done when blocked coronary arteries of the heart are bypassed to redirect blood flow around a blockage. The doctor will likely consider a full colonoscopy after the symptoms get better since colon cancer is one of the reasons behind colonic ischemia.
Acute mesenteric artery ischemia: Usually surgery is necessary to remove a blood clot, bypass an artery blockage, or to repair or remove a damaged section of intestine. Treatment may additionally include medications to prevent clots from forming, dilate blood vessels or dissolve clots.
In case angiography is done to diagnose the problem, the radiologist may simultaneously be able to remove a blood clot, or open up the narrowed artery with angioplasty. An inflated balloon is used in angioplasty 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 coil (stent) may additionally be positioned in the artery to help keep it open.
Chronic mesenteric artery ischemia: Restoring blood flow to the intestine is involved in treatment. The surgeon can either widen narrowed arteries or bypass the blocked arteries with angioplasty therapy or stenting.
Ischemia due to mesesenteric venous thrombosis: In case one’s intestines show no signs of damage, one will probably need to take anticoagulant medication for about 3 to 6 months. Anticoagulants help prevent clots from forming. When parts of the bowel show signs of damage, one will still need surgery to remove the damaged part. After surgery, one may need to take an anticoagulant for a short time.

Prognosis:

Not Available

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