The intestinal ischemia is the clinical condition that occurs when blood flow to the mesenteric territory is insufficient to meet the requirements of the intestine . Its prevalence has increased due to the progressive aging of the population and in some series it represents up to 5% of hospital mortality.
Summary
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- 1 Alternative names
- 2 Causes
- 3 Symptoms
- 4 Tests to detect
- 5 Treatment
- 6 Expectations (prognosis)
- 7 Complications
- 8 Prevention
- 9 Sources
Alternative names
Intestinal necrosis; intestinal tissue death; dead intestine; intestinal infarction.
Causes
There are several possible causes of ischemia and intestinal infarction.
- Hernia: If the intestine moves to the wrong place or becomes trapped, this can lead to intestinal ischemia.
- Adhesions: The intestine can also become trapped in scar tissue from previous surgery (adhesions), which can lead to ischemia if treatment is not performed.
- Plunger: A blood clot from the heart or major vessels can travel through the bloodstream and block one of the arteries supplying the intestine. Patients with previous heart attacks or arrhythmias , such as atrial fibrillation, are at risk for this problem.
- Arterial thrombosis: The arteries that supply blood to the intestine can become so narrowed from atherosclerotic disease ( cholesterol buildup ) that they become clogged. When this happens in the arteries that go to the heart, it causes a heart attack and when it occurs in the arteries that go to the intestine, it causes intestinal ischemia.
- Venous thrombosis: The veins that draw blood from the intestine can be blocked by blood clots. This blocks blood flow to the intestines and is more common in people with liver disease, cancer, or blood clotting disorders.
- Low bloodpressure: Very low blood pressure in patients who already have narrowed intestinal arteries can also cause intestinal ischemia. This occurs particularly in very sick patients for other reasons and can be compared to the loss of water pressure in a hose with a partial blockage.
Symptoms
The hallmark of intestinal ischemia is abdominal pain. Other symptoms include:
- Diarrhea
- Fever
- Vomiting
Tests done to detect
Laboratory tests can show a high white blood cell count (a marker of infection) and increased acid in the bloodstream. Other tests include:
- Angiography
- CT scan of the abdomen
However, none of these tests is a definitive test, so sometimes the only sure way to diagnose intestinal ischemia is with a surgical procedure.
Treatment
Treatment generally requires surgery. The part of the intestine that has died is removed, and then the remaining healthy ends of the intestine are connected. In some cases, a colostomy or ileostomy is necessary . If possible, clogged arteries supplying the intestine are corrected.
Expectations (prognosis)
Intestinal ischemia is a serious condition that can lead to death if it is not treated promptly. The prognosis varies according to the cause and can be encouraging with prompt treatment.
Complications
Intestinal ischemia may require a colostomy or ileostomy, either temporary or permanent, and in such cases, peritonitis is common. A severe illness with fever and bloodstream infection ( sepsis ) can also develop .
Prevention
Preventive measures include:
- Control risk factors, such as heart arrhythmias, high blood pressure, and high cholesterol
- No Smoking
- Eating a nutritious diet
- Quickly treat hernias
