Intestinal ischemic syndrome occurs when blood flow to the intestine or gastrointestinal system decreases due to the blockage of blood vessels.
The three main abdominal blood vessels that can become obstructed include the abdominal aorta, the superior mesenteric artery, and the inferior mesenteric artery. Usually, two or three of these arteries need to narrow or become blocked to cause intestinal ischemic syndromes.
What causes this syndrome?
In most cases, it is caused by atherosclerosis (accumulation of fatty substances and plaque on the walls of blood vessels), leading to narrowing or blockage of the vessel. Conditions can also result from blood clots or aneurysms (abnormal bulging or dilation) in the vessels.
Is this condition more common at a certain age?
It is more common after the age of 60, but it can occur at any age.
Types of Intestinal Ischemic Syndrome
It can occur suddenly (acute) or develop over time (chronic).
Acute Mesenteric Ischemia
The arteries that supply oxygen-rich blood and nutrients to your intestines can narrow due to atherosclerosis, similar to how coronary arteries narrow in heart disease. Mesenteric ischemia can develop if the narrowing or blockage becomes severe.
Another cause of acute mesenteric ischemia is a blood clot. If a blood clot forms or travels to the narrowed artery, blood supply to the intestine is suddenly interrupted. The tissues downstream from the blocked vessel will starve for oxygen-rich blood and die. This is a life-threatening condition.
Timely diagnosis and treatment are essential to save the intestine and the patient’s life.
Chronic Mesenteric Ischemia
Chronic mesenteric ischemia is characterized by narrowing of the blood vessels that supply the intestines with nutrients and oxygen-rich blood. This narrowing is also caused by atherosclerosis. Chronic mesenteric ischemia is more common in women than in men and occurs after the age of 60.
Risk Factors
Risk Factors
As with any form of vascular disease, factors that increase the risk of chronic mesenteric ischemia include:
- Smoking
- Diabetes
- Hypertension (high blood pressure)
- High lipid levels (cholesterol, LDL, triglycerides)
Acute Mesenteric Ischemia
Early signs and symptoms of acute mesenteric ischemia include:
- Severe abdominal pain, concentrated in one area of the abdomen
- Nausea and/or vomiting
- Bloody stools
- History of chronic atrial fibrillation or cardiovascular disease
Acute Mesenteric Ischemia
An angiogram is used to diagnose acute mesenteric ischemia. An angiogram is an invasive procedure of the blood vessels in which a dye is injected, and X-ray images are taken.
Abdominal computed tomography (CT) and chest X-rays, as well as other tests, may be performed first to rule out other conditions that may have similar symptoms, such as bowel obstruction.
Chronic Mesenteric Ischemia
Abdominal CT scans, gastrointestinal X-rays, and other tests can also be performed initially to exclude other conditions that may have similar symptoms, such as bowel obstruction.
When there is suspicion of chronic mesenteric ischemia, an angiogram is used to confirm the diagnosis and assess for atherosclerosis within the arteries.
Other tests may include ultrasound, computed tomography, or magnetic resonance angiography (MRA).
How is Acute Mesenteric Ischemia Treated?
Emergency surgery may be performed to remove the blood clot (embolectomy) or to bypass the blocked vessel and restore blood flow to the intestines. The surgeon may use autologous grafts (the patient’s own blood vessels) or synthetic grafts. In some cases, the surgeon may need to remove a portion of the intestine if tissue death has occurred.
Another option is the use of a thrombolytic medication. With the aid of an angiogram, a thrombolytic drug may be injected to dissolve the clot in the artery.
How is Chronic Mesenteric Ischemia Treated?
How is Chronic Mesenteric Ischemia Treated?
Treatment for chronic mesenteric ischemia is important to reduce the risk of blood clot formation or other damage to the intestines. Treatment options include:
- Anticoagulant medications, such as warfarin (a blood thinner), to reduce the risk of blood clots.
- Angioplasty and stenting: A balloon catheter is used to try to open the artery, and a small stent is placed inside the artery to keep it open.
- Surgery may be performed to remove plaque (endarterectomy), bypass the blocked vessel to restore blood flow to the intestines, or remove or repair an aneurysm. The surgeon may use autologous grafts (the patient’s own blood vessels) or synthetic grafts during the bypass procedure.
Monitoring
In addition to monitoring a low-fat diet, patients with chronic mesenteric ischemia are advised to eat small, frequent meals. Regular exercise is also recommended, along with management of blood pressure, cholesterol, and diabetes.
If you are prescribed warfarin:
You will need to have frequent blood tests, called PT-INR, to assess how well the medication is working. Keep all scheduled lab appointments so you can monitor your response to the medication. Your dosages may change or be adjusted based on the results of this test.
You may bleed or bruise more easily when injured. Call your doctor if you experience heavy or unusual bleeding or bruising.
Certain over-the-counter medications can affect the functioning of anticoagulants. Do not take any other medications without first consulting your doctor.
Ask your doctor for specific dietary guidelines while taking warfarin. Certain foods, such as those high in vitamin K (found in Brussels sprouts, spinach, and broccoli), can affect how the medication works.
You should not take warfarin if you are pregnant or planning to become pregnant. Ask your doctor about switching to a different type of anticoagulant medication.
Source: https://my.clevelandclinic.org/health/diseases/17136-intestinal-ischemic-syndrome
