Intestinal ischemia

Diagnosis

If your healthcare professional suspects intestinal ischemia after a physical exam, you may have several diagnostic tests based on your symptoms. Tests may include:

• Blood tests. Although blood tests alone can't diagnose intestinal ischemia, certain blood test results might suggest the condition. An example of such a result is a high white cell count.

• Imaging tests. Imaging tests let your healthcare professional see your internal organs and rule out other causes for your symptoms. Imaging tests may include an X-ray, an ultrasound, a CT scan or an MRI.

  To look at the blood flow in your veins and arteries, your health professional may use an angiogram using a certain type of CT scan or MRI.

• Use of a scope to see inside your digestive tract. This involves putting a lighted, flexible tube with a camera on its tip into your rectum to view your digestive tract. The scope can look at the last 2 feet of your colon, a test called sigmoidoscopy. When the test looks at your whole colon, it's called colonoscopy.

• Use of dye that tracks blood flow through the arteries. During this test, called angiography, a long, thin tube called a catheter goes into an artery in your groin or arm. A dye injected through the catheter flows to your intestinal arteries.

  The dye moving through the arteries lets narrowed areas or blockages show up on X-rays. Angiography also lets a healthcare professional treat a blockage in an artery. The health professional can remove a clot, put in medicine or use special tools to widen an artery.

• Surgery. In some cases, you may need surgery to find and remove damaged tissue. Opening the belly allows diagnosis and treatment during one procedure.

Treatment

Treatment of intestinal ischemia involves restoring the blood supply to the digestive tract. Choices vary depending on the cause of the condition and how bad it is.

Colon ischemia

Your healthcare professional may suggest antibiotics to treat or prevent infections. Other medical conditions, such as congestive heart failure or an irregular heartbeat, also must be treated.

You'll likely need to stop taking medicines that narrow your blood vessels. These include hormone medicines and some medicines to treat migraine and heart conditions. Most often, colon ischemia heals on its own.

For severe colon damage, you may need surgery to remove the dead tissue. You also may need surgery to bypass a blockage in one of your intestinal arteries. If you have angiography to diagnose the condition, it may be possible to widen a narrowed artery during the procedure.

Angioplasty uses a balloon inflated at the end of a catheter to press in the fatty deposits. The balloon also stretches the artery, making a wider path for the blood to flow.

Your healthcare professional may put a springlike metallic tube, called a stent, into your artery to help keep it open. Your health professional also can remove a blood clot or dissolve it with medicine.

Acute mesenteric artery ischemia

You might need surgery to remove a blood clot, to bypass an artery blockage, or to repair or remove a damaged part of the intestine. Treatment also may include antibiotics and medicines to prevent clots, dissolve clots or widen blood vessels.

If you have angiography to diagnose the condition, it may be possible to widen a narrowed artery or remove a blood clot during the procedure. Your healthcare professional also may put in a metal tube, called a stent, to help keep the narrowed artery open.

Chronic mesenteric artery ischemia

Treatment aims to restore blood flow to your intestine. Your surgeon can bypass the blocked arteries or widen narrowed arteries with angioplasty or by placing a stent in the artery.

Ischemia due to mesenteric venous thrombosis

If your intestine shows no damage, you won't need repair. But you'll likely need to take medicine that keeps your blood from clotting, called anticoagulant medicine, for about 3 to 6 months.

You might need a procedure to remove a clot. If parts of your intestine show signs of damage, you might need surgery to remove the damaged section. If tests show you have a blood-clotting disorder, you may need to take medicines called anticoagulants for the rest of your life.

Preparing for your appointment

Seek medical care right away if you have severe belly pain that makes you so uncomfortable that you can't sit still.

Maybe your belly pain isn't too bad and you know when it will start, such as soon after you eat. Then make an appointment with your healthcare professional. You may be sent to a doctor who specializes in digestive issues, called a gastroenterologist, or to a vascular surgeon.

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do before your appointment, such as not eat before certain tests. Also, ask a friend or family member to go with you, if possible, to help you remember the information you get.

Make a list of:

• Your symptoms. Include any that don't seem linked to the reason for which you scheduled the appointment and when they began.
• Your medical history. Include other medical conditions, such as a blood clot, or procedures you've had.
• All medicines, vitamins, herbs and other supplements you take. Include the doses. If you take birth control pills, note the name.
• Questions to ask your healthcare professional.

For intestinal ischemia, some questions to ask include:

• What's the most likely cause of my condition?
• Do you think my condition will go away or be long-term?
• What tests do I need?
• What treatments do you suggest?
• If I need surgery, what will my recovery be like? How long will I be in the hospital?
• What diet and lifestyle changes do I need to make?
• What follow-up care and treatments do I need?
• Are there brochures or other printed material I can have? What websites do you suggest?

Be sure to ask all the questions you have.

What to expect from your doctor

Your healthcare professional may ask:

• Have your symptoms stayed the same or gotten worse?
• Do your symptoms come and go?
• How bad are your symptoms?
• How soon after eating do your symptoms begin?
• Are your symptoms better if you eat small meals rather than large ones?
• Does anything make your symptoms better or worse?
• Do you or did you smoke? How much?
• Have you lost weight without trying?