Intestinal Ischaemia is a term used to describe a variety of disorders caused by inadequate blood flow because of a blood vessel blockage. Venous blockages may occur but arterial blockages are more common. Three arteries that are predominantly affected are celiac artery, superior mesenteric artery and inferior mesenteric artery. It can affect both small and/or large intestine.
Depending upon the duration and location of the disease, it can be divided into:
Hernia: when a part of the intestine protrudes through the lower abdominal wall, most commonly into the inguinal canal (in the groin) This condition is more common in males.
Adhesions: These refer to the formation of scar tissue between the small or large intestine and inner lining of abdominal wall and organs in the abdominal cavity. Blood flow is obstructed due to the formation of these adhesions causing intestinal ischemia.
Embolus: It is composed of clotted blood cells that dislodges itself and moves in the bloodstream and can cause obstruction of the arteries, usually superior mesenteric artery. This is the most common cause of acute intestinal ischemia and can occur due to congestive heart failure or a cardiac arrhythmia (irregular heartbeat).
Atherosclerosis: It involves formation of an atheroma which forms due to fatty deposits in the blood vessels. It can slow down or block the blood flow depending on its size. This is seen in patients with chronic intestinal ischemia.
Venous thrombosis: It occurs due to formation of a thrombus or blood clot in the veins. This is less common as compared to arterial obstruction and is known to occur in patients with liver disease, cancer or clotting disorders.
Hypotension: Low blood pressure due to shock, heart failure or chronic renal disease may cause slow down of blood flow. This condition in presence of arterial insufficiency exaggerates the impaired blood flow and can cause an acute attack of intestinal ischemia.
Malignancy: Tumours which cause venous or arterial compression
Symptoms of the disease can be divided on its occurrence: acute or chronic
Blood tests: White blood cell count and Lactic acid level are determined. Increase in these identities may indicate intestinal ischemia.
Plain abdominal X-ray: Often show normal or non-specific findings. They can be used to rule out other possible causes.
Computed tomography (CT) scan: May show gas in the intestinal walls, portal vein or mesenteric vein. Bowel wall thickening or dilatation can be seen. Perforation in the bowel can also be seen. Mesentric oedema or swelling may be present depending on the duration of the disease.
It is the gold standard to diagnose the cause of the disease. It helps in determining whether the disease is of occlusive or non-occlusive nature. A thin, flexible tube called catheter is inserted into an artery in the groin area. Contrast dye is injected through this tube to visualize the abnormalities in the blood vessels and X-ray images are taken.
This technique is also used to treat blockages in an artery by injecting medication through the tube.
This test is done to assess the blood flow in the arteries and veins. It can also reveal any blockage in the blood vessels.
A wand called transducer is moved over the area to be examined. Sound waves sent by it are measured by the computer, which changes them into images.
It depends upon the underlying cause and severity of the disease.
Angioplasty: It involves use of an inflated balloon at the end of a catheter to compress the fatty deposits and to widen the blocked artery or vein. This improves blood flow in the blood vessel. A metallic stent may also be placed in the blood vessel to keep it stretched.
Embolectomy:Surgical removal of the embolus is done to improve the blood flow.
Aortomesenteric bypass and resection of bowel:This surgery is done in case, gangrene develops.
Transaortic endarterectomy: To remove plaque deposits from the celiac or mesenteric artery to remove the obstruction to bloodflow.
Bypass Surgery: Using graft from another area of the body to repair the blocked Blood vessel.