Symptoms

Signs and symptoms of intestinal ischemia may develop suddenly (acute intestinal ischemia) or they may develop gradually over time (chronic intestinal ischemia).

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
• Fever

Symptoms of chronic intestinal ischemia 
Signs and symptoms of chronic intestinal ischemia can include:

• Abdominal cramps or fullness, beginning within 30 minutes after eating 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
• Diarrhea
• Nausea, vomiting
• Bloating

Chronic intestinal ischemia may progress to an acute episode. If this happens, you might experience severe abdominal pain after weeks or months of bouts of intermittent pain after eating.

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.

Causes

Intestinal ischemia (is-KE-me-uh) occurs when the blood flow through the major arteries that supply blood to your intestines is slowed or stopped.

Intestinal ischemia 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.

Whatever the cause, diminished blood flow within your digestive tract leaves cells with insufficient oxygen. Under these conditions, cells become weak and die. If damage is severe enough, infection and gangrene may result. If untreated, intestinal ischemia can be fatal.

Intestinal ischemia is often divided into several categories:

Colon ischemia (ischemic colitis) 
The most common type of intestinal ischemia is colon ischemia, which occurs when blood flow to the colon is slowed. It most often occurs in adults older than 60, although it may develop at any age.

Signs and symptoms of colon ischemia include rectal bleeding and the sudden onset of mild, crampy pain on the left side of the abdomen. What causes 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
• Bowel obstruction caused by a hernia, scar tissue or a tumor
• Heart, blood vessel, intestinal or gynecologic surgeries
• 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 that dislodges from your heart and travels through your bloodstream to block an artery, usually the superior mesenteric artery, leading 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 vascular obstruction.

Chronic mesenteric ischemia 
Chronic mesenteric ischemia, also known as intestinal angina, results from the buildup of fatty deposits along the wall of an artery (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 away 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 protein deficiency
• Trauma to your abdomen
• Menopausal hormone therapy

Risk factors

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 slowed 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. You have an increased risk of atherosclerosis if you are older than 50, if you smoke, or if you have high blood pressure, diabetes or high cholesterol.
• 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.
• 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

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. If this life-threatening situation occurs, surgery is needed to clear the blockage and to remove the portion of the intestine that has died. After removing damaged intestinal tissue, your surgeon may be able to connect the healthy parts of the intestine together. If that's not possible, your surgeon may need to perform a procedure called an ostomy. In this procedure, the surgeon creates an opening in your abdomen to pull a section of your intestine to the surface. A pouch is then attached to this opening, and your waste is expelled into the pouch.
• 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. This may require surgery to remove the damaged portion of your intestine. The healthy portions of your intestine may be connected. Or a surgical opening (ostomy) may be created that allows you to expel waste through the opening.

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 immediately to a specialist, such as a gastroenterologist or vascular surgeon.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. It's likely that your doctor will ask you not to eat after midnight on the night before your appointment.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down other medical conditions or procedures you've had,including problems you were treated for in the past, such as a blood clot, and long-term health problems for which you're still being treated.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking. If you take birth control pills, write down the drug's name.
• Take a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time can help you make the most of your time together. List your questions from most important to least important in case time runs out.

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

• What is likely causing my symptoms or condition?
• Other than the most likely cause, what are possible causes for my symptoms or condition?
• Do you think my condition is temporary or chronic?
• What kinds of tests do I need?
• What treatments do I need right now?
• If I need surgery, what will my recovery be like? How long will I need to be in the hospital?
• How will my diet and lifestyle change after I have surgery?
• What follow-up care and treatments will I need?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions at any time that you don't understand something.

What to expect from your doctor 
Your doctor is likely to ask you a number of questions. Being ready to answer them may make time to go over points you want to spend more time on. Your doctor may ask:

• When did you begin experiencing symptoms?
• Have your symptoms stayed the same or gotten worse over time?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• If your symptoms appear after eating, have they caused you to fear or avoid meals?
• 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?

Tests and diagnosis

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

• 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, computerized tomography (CT) scan and magnetic resonance imaging (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 in your arm and then passed through the artery to the aorta. A dye is injected and it 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. This technique also allows the doctor to treat a blockage in an artery by injecting medication or using special tools to widen an artery.

  Another way of performing angiography involves injecting dye into a vein in your arm, where it can travel to the arteries that supply your intestines with blood. Images are then taken of your intestines using CT or MRI.

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

Treatment and drugs

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 
If you're diagnosed with 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 any 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 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 coil (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 may need surgery to remove the damaged section.

Prevention

You may be able to reduce your risk of intestinal ischemia by reducing your risk of atherosclerosis. For instance:

• Choose a diet full of fruits, vegetables and whole grains.Increase the number of fruits and vegetables you eat and reduce the amount of added sugar, cholesterol and fat.
• Don't smoke. If you don't smoke, don't start. If you do smoke, work with your doctor to find a strategy that will help you stop. Counseling, medications and nicotine replacement products may be options for you.
• Exercise most days of the week. Increase the amount of exercise you get each day. Aim for at least 30 minutes of exercise most days of the week.
• Maintain a healthy weight. If your weight is healthy, work to maintain it by exercising most days of the week. If you need to lose weight, work with your doctor to devise a plan that will help you lose weight slowly. Increase the amount of exercise you get each day and reduce the number of calories you eat.
• Work with your doctor to control other health problems. If you have high blood pressure, high cholesterol, diabetes or other conditions that increase your risk of atherosclerosis, work with your doctor to control these conditions.