Intestinal ischemia (is-KEE-me-uh) describes a variety of conditions that occur when blood flow to your intestines decreases due to a blockage, usually in an artery. Intestinal ischemia can affect your small intestine, your large intestine (colon) or both.
Intestinal ischemia is a serious condition that can cause pain and make it difficult for your intestines to work. In severe cases, loss of blood flow to the intestines can damage intestinal tissue and lead to death.
Treatments are available for intestinal ischemia. To improve the chances of recovery, it's crucial to recognize the early symptoms and get medical help right away.
Signs and symptoms of intestinal ischemia can develop suddenly (acute) or gradually (chronic). The condition presents differently in different people, so no one set of signs and symptoms indicates intestinal ischemia, but there are some generally recognized patterns.
Symptoms of acute intestinal ischemia
Signs and symptoms of acute intestinal ischemia typically include:
- Sudden abdominal pain that may range from mild to severe
- An urgent need to have a bowel movement
- Frequent, forceful bowel movements
- Abdominal tenderness or distention
- Blood in your stool
- Nausea, vomiting
- Mental confusion in older adults
Symptoms of chronic intestinal ischemia
Signs and symptoms of chronic intestinal ischemia can include:
- Abdominal cramps or fullness after eating, usually within the first hour, and lasting one to three hours
- Abdominal pain that gets progressively worse over weeks or months
- Fear of eating because of subsequent pain
- Unintended weight loss
- Nausea, vomiting
When to see a doctor
Seek immediate medical care if you have sudden, severe abdominal pain. Pain that makes you so uncomfortable that you can't sit still or find a comfortable position is a medical emergency.
If you have other signs or symptoms that worry you, make an appointment with your doctor.
Intestinal ischemia occurs when the blood flow through the major arteries that supply blood to your intestines slows or stops. The condition has many potential causes, including a blockage in an artery caused by a blood clot, or a narrowing of an artery due to buildup of deposits, such as cholesterol. Blockages also can occur in veins, but they're less common.
Whatever the cause, diminished blood flow within your digestive tract leaves cells without enough oxygen, which causes the cells to weaken and die. If damage is severe enough, infection, gangrene and eventually a hole (perforation) in the wall of the intestines can occur. If untreated, intestinal ischemia can be fatal.
Intestinal ischemia is often divided into categories:
Colon ischemia (ischemic colitis)
This most common type of intestinal ischemia occurs when blood flow to the colon is slowed. It most often affects adults older than 60, although it can develop at any age.
Signs and symptoms of colon ischemia include rectal bleeding and the sudden onset of mild, crampy abdominal pain. The cause of diminished blood flow to the colon isn't always clear, but a number of conditions can make you more vulnerable to colon ischemia:
- Buildup of cholesterol deposits on the walls of an artery (atherosclerosis)
- Dangerously low blood pressure (hypotension) associated with heart failure, major surgery, trauma or shock
- A blood clot in an artery supplying the colon
- Twisting of the bowel (volvulus) or trapping of intestinal contents within a hernia
- Excessive bowel enlargement from bowel obstruction caused by scar tissue or a tumor
- Other medical disorders that affect your blood, such as inflammation of your blood vessels (vasculitis), lupus or sickle cell anemia
- Some medications, especially those that constrict blood vessels, such as some heart and migraine medications, and hormone medications, such as estrogen
- Cocaine or methamphetamine use
- Vigorous exercise, such as long-distance running
Acute mesenteric ischemia
This type of intestinal ischemia usually affects the small intestine. It has an abrupt onset and may be due to:
- A blood clot (embolus) that dislodges from your heart and travels through your bloodstream to block an artery, usually the superior mesenteric artery, which supplies oxygen-rich blood to your intestines. This is the most common cause of acute mesenteric artery ischemia and can be brought on by congestive heart failure, an irregular heartbeat (arrhythmia) or a heart attack.
- A blockage that develops within one of the main intestinal arteries and slows or stops blood flow, often as a result of fatty deposits (atherosclerosis) building up on the wall of an artery. This type of sudden ischemia tends to occur in people with chronic intestinal ischemia.
- Impaired blood flow resulting from low blood pressure due to shock, heart failure, certain medications or chronic kidney failure. This is more common in people who have other serious illnesses and who have some degree of atherosclerosis. You may hear this type of acute mesenteric ischemia referred to as nonocclusive ischemia, which means that it's not due to a blockage in the artery.
Chronic mesenteric ischemia
Chronic mesenteric ischemia, also known as intestinal angina, results from the buildup of fatty deposits on an artery wall (atherosclerosis). The disease process is generally gradual, and you may not require treatment until at least two of the three major arteries supplying your intestines become severely narrowed or completely obstructed.
A potentially dangerous complication of chronic mesenteric ischemia is the development of a blood clot within a diseased artery, causing blood flow to be suddenly blocked (acute mesenteric ischemia).
Ischemia that occurs when blood can't leave your intestines
A blood clot can develop in a vein draining deoxygenated blood from your intestines. When the vein is blocked, blood backs up in the intestines, causing swelling and bleeding. This is called mesenteric venous thrombosis, and it may result from:
- Acute or chronic inflammation of your pancreas (pancreatitis)
- Abdominal infection
- Cancers of the digestive system
- Bowel diseases, such as ulcerative colitis, Crohn's disease or diverticulitis
- Disorders that make your blood more prone to clotting (hypercoagulation disorders), such as an inherited clotting disorder or taking a medication such as estrogen that can increase clotting risk
- Trauma to your abdomen
Factors that may increase your risk of intestinal ischemia include:
- Buildup of fatty deposits in your arteries (atherosclerosis). If you've had other conditions caused by atherosclerosis, such as decreased blood flow to your heart (coronary artery disease), legs (peripheral vascular disease) or the arteries serving your brain (carotid artery disease), you have an increased risk of intestinal ischemia. Being older than 50, smoking, and having high blood pressure, diabetes or high cholesterol increases your risk of atherosclerosis.
- Blood pressure problems. Having blood pressure that is too high or too low increases your risk of intestinal ischemia.
- Heart problems. Your risk of intestinal ischemia is increased if you have congestive heart failure or an irregular heartbeat such as atrial fibrillation.
- Medications. Certain medications may increase your risk of intestinal ischemia, including birth control pills and medications that cause your blood vessels to expand or contract, such as certain allergy medications and migraine medications.
- Blood-clotting problems. Diseases and conditions that increase your risk of blood clots may increase your risk of intestinal ischemia. Examples include sickle cell anemia and anti-phospholipid syndrome.
- Illegal drug use. Cocaine and methamphetamine use have been linked to intestinal ischemia.
Complications of intestinal ischemia can include:
- Death of intestinal tissue. If blood flow to your intestine is completely and suddenly blocked, intestinal tissue can die (gangrene).
- Perforation. A hole through the wall of the intestines can develop. This results in the contents of the intestine leaking into the abdominal cavity, causing a serious infection (peritonitis).
- Scarring or narrowing of your colon. Sometimes the intestines can recover from ischemia, but as part of the healing process the body forms scar tissue that narrows or blocks the intestines.