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Small intestinal ischemia and infarction

Definition

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

Alternative Names

Intestinal necrosis; Ischemic bowel; Dead bowel; Dead gut

Causes

There are several possible causes of intestinal ischemia and infarction.

  • Hernia: If the intestine moves into the wrong place or becomes tangled, this can cut off blood flow.
  • 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. People who have had a heart attack or who have 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 or blocked from atherosclerotic disease (cholesterol buildup). 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 interrupts blood flow in 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 often occurs in people with other serious medical problems.

Symptoms

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

  • Diarrhea
  • Fever
  • Vomiting
  • Severe abdominal pain, even though the area is not very tender when touched

Exams and Tests

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

Other tests include:

These tests do not always diagnose the problem. Sometimes, the only sure way to diagnose intestinal ischemia is with a surgical procedure.

Treatment

In most cases, the condition needs to be treated with surgery. The section of intestine that has died is removed, and the healthy remaining ends of the bowel are reconnected.

In some cases, a colostomy or ileostomy is needed. The blockage of arteries to the intestine is corrected, if possible.

Outlook (Prognosis)

Intestinal ischemia is a serious condition that can result in death if not treated promptly. The outlook depends on the cause. Prompt treatment can lead to a good outcome.

Possible Complications

Intestinal infarction may require a colostomy or ileostomy, which may be short-term or permanent. Peritonitis is common in these cases. People who have a large amount of tissue death in the intestine can have problems absorbing nutrients. They can become dependent on intravenous nutrition.

Some people may become severely ill with fever and a bloodstream infection (sepsis).

When to Contact a Medical Professional

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

Prevention

Preventive measures include:

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

References

Hauser SC. Vascular diseases of the gastrointestinal tract. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 145.


Review Date: 2/21/2014
Reviewed By: Todd Eisner, MD, Private practice specializing in Gastroenterology, Boca Raton, FL. Affiliate Assistant Professor, Florida Atlantic University School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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