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Intestinal ischemia and infarction

Definition

Intestinal ischemia and infarction is damage to (ischemia) or death of (infarction) part of the intestine due to a decrease in its blood supply.

Alternative Names

Intestinal necrosis; Ischemic bowel; Dead bowel; Dead gut

Causes, incidence, and risk factors

There are several possible causes of intestinal ischemia and infarction.

Hernia: If the intestine moves into the wrong place or becomes tangled, this can lead to intestinal ischemia.

Adhesions: The intestine may become trapped in scar tissue from past surgery (adhesions). This can lead to ischemia if left untreated.

Embolus: A blood clot from the heart or main blood vessels may travel through the bloodstream and block one of the arteries supplying the intestine. Patients with previous heart attacks or with arrhythmias, such as atrial fibrillation, are at risk for this problem.

Arterial thrombosis: The arteries that supply blood to the intestine may become so narrowed from atherosclerotic disease (cholesterol buildup) that they become blocked. When this happens in the arteries to the heart, it causes a heart attack. When it happens in the arteries to the intestine, it causes intestinal ischemia.

Venous thrombosis: The veins carrying blood away from the intestines may become blocked by blood clots. This blocks blood flow into the intestines. This is more common in people with liver disease, cancer, or blood clotting disorders.

Low blood pressure: Very low blood pressure in patients who already have narrowing of the intestinal arteries may also cause intestinal ischemia. This typically occurs in patients who are very ill for other reasons. It can be compared to losing water pressure in a hose with a partial blockage.

Symptoms

The hallmark of intestinal ischemia is abdominal pain. Other symptoms include:

• Diarrhea
• Fever
• Vomiting

Signs and tests

Laboratory tests may show a high white blood cell (WBC) count (a marker of infection) and increased acid in the bloodstream.

Other tests include:

• Angiogram
• CT scan of the abdomen

None of these tests are foolproof, however. Sometimes the only sure way to diagnose intestinal ischemia is with a surgical procedure.

Treatment

Treatment usually requires surgery. The section of intestine that has died is removed, and the healthy remaining ends of bowel reconnected.

In some cases, a colostomy or ileostomy is necessary. A blockage of arteries supplying the intestine is corrected if possible.

Support Groups

Expectations (prognosis)

Intestinal ischemia is a serious condition that can result in death if not treated promptly. The outlook depends on the cause. A good outcome may be achieved with prompt treatment.

Complications

Intestinal infarction may require a colostomy or ileostomy, either temporary or permanent. Peritonitis is common in such cases.

Severe illness with fever and bloodstream infection (sepsis) can result.

Calling your health care provider

Call your health care provider if you have any severe abdominal pain.

Prevention

Preventive measures include:

• Control risk factors, such as heart arrhythmias, high blood pressure, and high cholesterol
• Do not smoke
• Eat a nutritious diet
• Quickly treat hernias

References

Fry RD, Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM Jr, Beauchamp RD, Evers MB, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 50.

Hauser SC. Vascular diseases of the gastrointestinal tract. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 146.