Intestinal ischemia and infarction
Intestinal necrosis; Ischemic bowel; Dead bowel; Dead
Intestinal ischemia and infarction is the death of part of the intestine due
to its blood supply being cut off.
Causes, incidence, and risk factors
There are several possible causes of
intestinal ischemia and infarction.
Hernia: If the intestine moves into the wrong
place or becomes tangled, this can lead to intestinal ischemia.
Adhesions: The intestine may also become
trapped in scar tissue from previous surgery (adhesions), which can lead to
ischemia if left untreated.
Embolus: A blood clot from the heart or main
blood vessels may travel through the bloodstream and block one of the arteries
supplying the intestine. Patients with previous heart attacks or with
arrhythmias such as atrial fibrillation are at risk for this problem.
Arterial thrombosis: The arteries that supply
blood to the intestine may become so narrowed from atherosclerotic disease
(cholesterol buildup) that they become blocked. When this happens in the
arteries to the heart, it causes a heart attack. When it happens in the
arteries to the intestine, it causes intestinal ischemia.
Venous thrombosis: The veins carrying blood
away from the intestines may become blocked by blood clots. This is more common
in people with liver disease, cancer, or blood clotting disorders.
Low blood pressure: Very low blood pressure
in patients with pre-existing narrowing of the arteries may also cause
intestinal ischemia. This typically occurs in patients who are very ill for
other reasons and may be compared to losing water pressure in a hose with a
The hallmark of intestinal ischemia is abdominal pain. Vomiting, diarrhea,
and in some cases, fever, are also seen.
Signs and tests
Laboratory tests may show an elevated white
blood cell (WBC) count (a marker of infection) and increased acid in the
bloodstream. A CT scan (special x-ray) of the abdomen may show abnormalities of
An angiogram may be obtained. In this study,
dye is injected into the arteries that supply the intestine, and x-rays are
taken to show the location of the arterial blockage. None of these tests is
foolproof, however, and sometimes the only sure way to diagnose ischemic bowel
is with exploratory surgery.
Treatment usually requires surgery. The section of intestine that has died
is removed, and the healthy remaining ends of bowel reconnected. In some cases,
a colostomy or ileostomy is necessary. Blockage of arteries supplying the
intestine is corrected if possible.
Intestinal ischemia is a serious condition that can result in death if not
treated promptly. The outlook depends on the cause. A good outcome may be
achieved with prompt treatment.
Intestinal infarction may require a colostomy
or ileostomy, either temporary or permanent. Peritonitis is common in such
Severe systemic illness with fever and sepsis
(spread of infection to the blood stream) can result.
Calling your health care provider
Call your health care provider if you have
any severe abdominal pain.
Eating a nutritious diet and avoiding smoking can help prevent this disease.
Prompt treatment of hernias and control of risk factors such as heart
arrhythmias, high blood pressure, and cholesterol may also help.