Intestinal ischemia

Diagnosis

If your healthcare provider suspects intestinal ischemia after a physical examination, various diagnostic tests may be recommended based on your signs and symptoms:

• Blood tests: While there are no specific blood tests for intestinal ischemia, certain general results, like an elevated white cell count, may suggest the condition.
• Imaging tests: These tests help visualize internal organs and rule out other potential causes. Options include X-rays, ultrasounds, computed tomography (CT) scans, or magnetic resonance imaging (MRI). Angiograms, using specific CT scans or MRIs, or catheter-directed angiograms by interventional radiologists can assess blood flow in veins and arteries.
• Scope examination: A lighted, flexible tube with a camera, inserted through the rectum, allows visualization of the digestive tract. This is particularly useful when suspecting ischemia in the large intestine. Sigmoidoscopy examines the last 2 feet of the colon, while colonoscopy examines the entire colon.
• Angiography with dye: In this test, a catheter is inserted into an artery in the groin or arm, advancing to the aorta. Dye injected through the catheter highlights the intestinal arteries on X-ray images, revealing narrowed areas or blockages. Angiography also enables treatment of arterial blockages, such as clot removal or artery widening using special tools.
• Surgery: In certain cases, surgery may be necessary to locate and remove damaged tissue. This approach, involving opening the abdomen, allows for both diagnosis and treatment in a single procedure.

Treatment

Intestinal ischemia treatment aims to restore blood supply, with approaches varying based on the cause and severity.

• Colon ischemia: If severe colonic ischemia is detected, healthcare providers may recommend antibiotic therapy to address or prevent infections. Additionally, addressing underlying medical conditions, such as congestive heart failure or irregular heartbeats, is crucial. Discontinuation of medications that constrict blood vessels, including certain migraine drugs, hormone medications, and some heart medications, is often necessary. In the majority of cases, colon ischemia tends to resolve spontaneously.

However, if the colon has suffered significant damage, surgical intervention might be necessary to remove necrotic tissue. Alternatively, surgery may be required to bypass an arterial blockage in the intestine. Angiography, used for diagnosis, may enable the opening of a narrowed artery through angioplasty. This procedure involves inflating a balloon at the catheter’s end to compress fatty deposits and widen the artery, potentially aided by placing a stent to maintain its openness. Additionally, blood clot removal or treatment with clot-dissolving medications may be employed as part of the intervention.

• Acute mesenteric artery ischemia: In cases where a blood clot removal, arterial bypass, or repair of a damaged intestinal section is deemed necessary, surgical intervention becomes essential. Treatment strategies encompass the use of antibiotics and medications aimed at preventing clot formation, clot dissolution, or blood vessel dilation. When angiography is utilized for diagnosis, concurrent measures like blood clot removal or arterial expansion through angioplasty may be implemented. Additionally, the placement of a stent in the artery can be considered to maintain its openness and support vascular health.
• Chronic mesenteric artery ischemia: Effective treatment involves the restoration of blood flow to the intestine. This can be achieved through surgical methods where the surgeon either bypasses blocked arteries or expands narrowed arteries using angioplasty, often complemented by the placement of a stent in the affected artery.
• Mesenteric venous thrombosis: If there is no evidence of intestinal damage, a typical course of treatment involves a 3 to 6-month prescription of anticoagulant medication to prevent clot formation. In cases where a clot is present, a medical procedure may be required for its removal. However, if examinations reveal damage to specific sections of the intestine, surgical intervention to excise the affected area may be necessary. In instances where a blood-clotting disorder is identified through tests, a lifelong regimen of anticoagulants may be recommended for ongoing management.