Intestinal ischemia

Diagnosis

If after a physical exam your health care provider suspects intestinal ischemia, you may undergo several diagnostic tests. The choice of tests is based on your signs and symptoms and can include:

• Blood tests. Although there are no specific blood tests to indicate intestinal ischemia, certain general blood test results might suggest intestinal ischemia. An example of such a result is an increase in white cell count.
• Imaging tests. Imaging tests may help your health care provider see your internal organs and rule out other causes for your signs and symptoms. Imaging tests may include an X-ray, ultrasound, CT scan or MRI. To look at the blood flow in your veins and arteries you may have an angiogram using a specific type of CT scan or MRI or a catheter-directed angiogram done by an interventional radiologist.
• A scope to see inside your digestive tract. This technique involves inserting a lighted, flexible tube with a camera on its tip into your rectum to view your digestive tract from the inside. This is helpful when ischemia of the large intestine is suspected. When inserted in your rectum, the scope examines the last 2 feet of your colon (sigmoidoscopy) or your entire colon (colonoscopy).
• Dye that tracks blood flow through the arteries. During this test (angiography), a long, thin tube (catheter) is inserted into an artery in your groin or arm. The catheter is then passed to the largest artery in your body (aorta). A dye injected through the catheter flows directly to your intestinal arteries. As the dye moves through your arteries, narrowed areas or a blockage is visible on X-ray images. Angiography also allows the health care provider to treat a blockage in an artery by removing a clot, injecting medication or using special tools to widen an artery.
• Surgery. In some cases, you may need surgery to find and remove damaged tissue. Opening the abdomen allows diagnosis and treatment during one procedure.

Treatment

Treatment of intestinal ischemia involves restoring the blood supply to your digestive tract. Options vary depending on the cause and severity of your condition.

Colon ischemia

If there is evidence of severe colonic ischemia, your health care provider may recommend antibiotics to treat or prevent infections. Treating any underlying medical condition, such as congestive heart failure or an irregular heartbeat, is also important.

You'll likely need to stop medications that constrict your blood vessels, such as migraine drugs, hormone medications and some heart drugs. In most cases, colon ischemia heals on its own.

If your colon has been severely damaged, you may need surgery to remove the dead tissue. In some cases, you may need surgery to bypass a blockage in one of your intestinal arteries. If angiography is done to diagnose the problem, it may be possible to open up a narrowed artery with angioplasty.

Angioplasty involves using a balloon inflated 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 tube (stent) also may be placed in your artery to help keep it open. A blood clot may be removed or be treated with medication to dissolve the clot.

Acute mesenteric artery ischemia

Surgery may be necessary to remove a blood clot, to bypass an artery blockage, or to repair or remove a damaged section of intestine. Treatment also may include antibiotics and medications to prevent clots from forming, dissolve clots or dilate blood vessels.

If angiography is done to diagnose the problem, it may be possible to remove a blood clot or to open up a narrowed artery with angioplasty at the same time. A stent also may be placed in your artery to help keep it open.

Chronic mesenteric artery ischemia

Treatment requires restoring blood flow to your intestine. Your surgeon can bypass the blocked arteries or widen narrowed arteries with angioplasty or by placing a stent in the artery.

Ischemia due to mesenteric venous thrombosis

If your intestine shows no signs of damage, you'll likely need to take anticoagulant medication for about 3 to 6 months. Anticoagulants help prevent clots from forming.

You might need a procedure to remove the clot. If parts of your intestine show signs of damage, you might need surgery to remove the damaged section. If tests show you have a blood-clotting disorder, you may need to take anticoagulants for the rest of your life.

Preparing for your appointment

Go the emergency room if you have severe abdominal pain that makes you so uncomfortable that you can't sit still. You may be referred for immediate evaluation to diagnose and treat your condition, possibly with surgery.

If your abdominal pain is moderate and predictable — for example, it always begins soon after eating — call your health care provider for an appointment. When you call to set up an appointment, you may be referred to a specialist, such as a gastroenterologist or vascular surgeon.

Here's some information to help you get ready for your appointment.

What you can do

• Ask about pre-appointment restrictions. When you make your appointment, ask if there's anything you need to do in advance, such as restrict your diet. It's likely your health care provider will ask you not to eat after midnight the night before your appointment.
• Make a list of your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of other medical conditions, such as a blood clot, or procedures you've had.
• Make a list of all medications, vitamins, herbs and other supplements you take and the dosages. If you take birth control pills, note the drug's name.
• Take a family member or friend along, if you choose. Someone who accompanies you can help you remember what your provider says.
• Make a list of questions to ask your health care provider.

For intestinal ischemia, some questions to ask include:

• What's the most likely cause of my condition?
• Do you think my condition is temporary or will it be long lasting?
• What tests do I need?
• What treatments are available, and what do you recommend?
• If I need surgery, what will my recovery be like? How long will I be in the hospital?
• How will my diet and lifestyle need to change after surgery?
• What follow-up care and treatments will I need?
• Should I see a specialist?
• Is there a generic alternative to the medicine you're prescribing?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions that may occur to you during your appointment.

What to expect from your doctor

Your health care provider may ask:

• When did your symptoms begin?
• Have your symptoms stayed the same or gotten worse?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• How soon after eating do your symptoms begin?
• Do you tolerate small meals better than large ones?
• Are liquids easier to tolerate than solids?
• Does anything improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Do you or did you smoke? How much?
• Have you lost weight?