What is Intestinal Ischemia?

Intestinal or mesenteric ischemia is a condition with a high mortality rate (up to 80%) that consists of the obstruction of blood circulation in the small intestine due to arterial narrowing or blockage, which can lead to irreversible intestinal damage.

When the affected blood circulation occurs abruptly, it is called acute mesenteric ischemia. This is caused by a blood clot, usually from the heart, and requires emergency surgical intervention.

On the other hand, chronic mesenteric ischemia develops progressively over a long period due to arterial narrowing caused by the accumulation of plaque on the artery walls. It is usually treated with open surgery or angioplasty.

Symptoms vary depending on the type of mesenteric ischemia:

Acute Mesenteric Ischemia

Acute mesenteric ischemia usually presents with sudden and severe abdominal pain that is often disproportionate to the physical findings on examination.

Other common symptoms include nausea, vomiting, diarrhea, or bloody stools. In advanced stages, signs of sepsis or shock may appear.

This condition is a medical emergency because the sudden interruption of intestinal blood flow can cause necrosis of the intestine within a few hours if not treated promptly.

The acute form of the disease can lead to severe complications that can be fatal if not treated in time, such as:

• Septicemia: The release of chemicals into the blood to fight an infection, causing widespread inflammation that leads to organ failure.
• Permanent intestinal damage: The lack of blood circulation causes the death of tissue (necrosis) in the intestinal areas without blood supply.

Chronic Mesenteric Ischemia

In its chronic form, symptoms usually develop progressively. The main symptom is crampy abdominal pain that typically appears after eating, known as intestinal angina. This leads the patient to avoid eating for fear of pain, causing significant weight loss.

It’s also possible to have a feeling of bloating, nausea, or changes in bowel habits.

Even though the chronic form of intestinal ischemia is less urgent than the acute form, it also requires medical attention because it can progress to acute ischemia.

Diagnosing intestinal or mesenteric ischemia requires a high degree of clinical suspicion, especially in patients with risk factors such as cardiovascular disease, atrial fibrillation, heart failure, or a history of thrombosis.

For acute ischemia, clinical findings such as severe abdominal pain and a lack of other physical signs, along with abnormalities in lab tests like leukocytosis, metabolic acidosis, or elevated lactate, can point to the diagnosis. However, these data are nonspecific and must be supplemented with imaging studies.

The preferred study is usually a CT angiogram with contrast, which allows for a detailed visualization of the mesenteric arteries and can detect occlusions, stenosis, or signs of intestinal damage.

In some cases, conventional mesenteric angiography may be used to both confirm the diagnosis and perform endovascular treatment.

For chronic ischemia, the findings usually include severe stenosis in at least two major mesenteric arteries, and the evaluation is typically done in patients with persistent postprandial symptoms.

Acute intestinal ischemia is a medical emergency that requires immediate treatment to restore intestinal blood flow and prevent intestinal necrosis. Treatment will vary depending on the cause and may include anticoagulation, thrombolysis, angioplasty, or open surgery to remove clots, repair affected vessels, and resect necrotic intestinal segments.

Intensive supportive measures must also be initiated, such as intravenous fluids, pain management, correction of metabolic disturbances, and, in cases of sepsis, broad-spectrum antibiotics. The prognosis improves significantly if treatment is started within the first few hours.

For chronic intestinal ischemia, treatment is usually planned and focuses on restoring blood flow through vascular interventions like angioplasty with stent placement or revascularization surgery.

These options are considered in symptomatic patients, especially if there is persistent weight loss and postprandial pain.

At the same time, it is essential to control cardiovascular risk factors such as hypertension, dyslipidemia, and diabetes.

Timely treatment not only improves symptoms but also prevents progression to acute ischemia.

At ABC Medical Center’s Vascular, Arterial, and Venous Disease department, we can provide you with specialized care. Contact us!