Diagnosis

If your doctor suspects intestinal ischemia, you may undergo several diagnostic tests, based on your signs and symptoms, including:

  • Blood tests. Although there are no specific blood markers to indicate intestinal ischemia, laboratory study of a blood sample that shows, say, an increase in white cell count, might suggest intestinal ischemia.
  • Imaging tests. Imaging tests may help your doctor see your internal organs and rule out other causes for your signs and symptoms. Imaging tests may include X-ray, ultrasound, CT scan and MRI.
  • Using a scope to see inside your digestive tract. This technique involves inserting a lighted, flexible tube with a camera on its tip into your mouth or rectum to view your digestive tract from the inside. The camera can be inserted in your mouth (endoscopy) to help see the upper portion of your small intestine. The camera can also be inserted in your rectum to view the last 2 feet of your colon (sigmoidoscopy) or to view your entire colon (colonoscopy).
  • Using dye to track blood flow through the arteries. During angiography, a long, thin tube (catheter) is inserted into an artery in your groin or arm, then passed through the artery to the aorta. A dye is injected that flows directly to your intestinal arteries. X-ray images are then taken that show the dye moving through your arteries.

    If you have intestinal ischemia, the images may show a blocked or narrowed artery. Angiography also allows the doctor to treat a blockage in an artery by injecting medication or using special tools to widen an artery.

  • Exploratory surgery. In some cases you may need exploratory surgery to find and remove damaged tissue. Opening the abdomen allows diagnosis and treatment during one procedure.

Treatment

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

Colon ischemia

Your doctor may recommend antibiotics to treat or prevent infections. Your doctors also can treat any underlying medical condition, such as congestive heart failure or an irregular heartbeat. You'll need to stop medications that constrict your blood vessels, such as migraine drugs, hormone medications and some heart drugs. Colon ischemia may also heal on its own.

If your colon has been damaged, you may need surgery to remove the dead tissue. Or you may need surgery to bypass a blockage in one of your intestinal arteries.

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 simultaneously remove a blood clot or 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.

Chronic mesenteric artery ischemia

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

Ischemia due to mesenteric venous thrombosis

If your intestines show no signs of damage, you'll likely need to take anticoagulant medication for about three to six months. If tests show you have a blood-clotting disorder, you may take anticoagulants for the rest of your life. Anticoagulants help prevent clots from forming. If portions of your bowel show signs of damage, you might need surgery to remove the damaged section.

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 surgery to diagnose and treat your condition.

If your abdominal pain is moderate and predictable — for example, it always begins soon after eating — call your doctor 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 doctor will ask you not to eat after midnight the night before your appointment.
  • Write down your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down other medical conditions, such as a blood clot, or procedures you've had.
  • List all medications, vitamins and supplements you take. If you take birth control pills, write down the drug's name.
  • Take a family member or friend along. Someone who accompanies you can help you remember what your doctor says.
  • Write down questions to ask your doctor.

For intestinal ischemia, some questions to ask your doctor include:

  • What is likely causing my condition?
  • What are the possible causes?
  • Do you think my condition is temporary or chronic?
  • What tests do I need?
  • What treatments do I need?
  • If I need surgery, what will my recovery be like? How long will I be in the hospital?
  • How will my diet and lifestyle 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.

What to expect from your doctor

Your doctor 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?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Do you or did you smoke? How much?
  • Have you lost weight?
Aug. 15, 2015
References
  1. Feldman M, et al. Intestinal ischemia. In: Sleisinger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed May 22, 2015.
  2. Intestinal ischemia. American College of Gastroenterology. http://patients.gi.org/topics/intestinal-ischemia/. Accessed May 22, 2015.
  3. Tendler DA, et al. Overview of intestinal ischemia. http://www.uptodate.com/home. Accessed May 22, 2015.
  4. Grubel P, et al. Colonic ischemia. http://www.uptodate.com/home. Accessed May 22, 2015.
  5. Hefaiedh R, et al. Ischemic colitis in five points: An update 2013. La Tunisie Medicale. 2014;92:299.
  6. Goldman L, et al. Intestinal ischemia. In: Goldman's Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com. Accessed May 22, 2015.
  7. Tendler DA, et al. Chronic mesenteric ischemia. http://www.uptodate.com/home. Accessed May 22, 2015.
  8. Tendler DA, et al. Mesenteric venous thrombosis in adults. http://www.uptodate.com/home. Accessed May 24, 2015.
  9. Rajan E. (expert opinion). Mayo Clinic, Rochester, Minn. June 2, 2015.