What are intestinal ischemic syndromes?

Intestinal ischemic syndromes -- also called visceral or mesenteric ischemic syndromes -- occur when blood flow to the bowel or gastrointestinal system (intestines) is decreased because of a blood vessel blockage.

intestinal ischemic syndrome, visceral and mesenteric ischemic syndrome

The three major abdominal blood vessels that may become blocked include the celiac artery, superior mesenteric artery or inferior mesenteric artery. Usually two or three of these arteries must be narrowed or blocked to cause intestinal ischemic syndromes.

What causes these syndromes?

In most cases, intestinal ischemic syndromes are caused by atherosclerosis (buildup of fatty matter and plaque on the blood vessel walls), leading to narrowing or blockage of the vessel. The conditions also can be caused by blood clots or aneurysms (an abnormal enlargement or bulging) in the vessels.

Are these conditions more common at a certain age?

Intestinal ischemic syndromes are more common after age 60 but can occur at any age.

Types of Intestinal Ischemic Syndromes

narrowed arteries

Intestinal ischemic syndromes can occur suddenly (acute) or over time (chronic).

Acute Mesenteric Ischemia: The arteries supplying oxygen-rich blood and nutrients to your intestines can become narrowed from atherosclerosis in the same way that coronary (heart) arteries become narrowed in heart disease. Mesenteric ischemia can develop if the narrowing or blockage become severe.

Another cause of acute mesenteric ischemia is a blood clot. If a blood clot forms or travels to the narrowed artery, the blood supply to the intestine is suddenly interrupted. The tissues below the blocked vessel will be starved for oxygen-rich blood and die. This event is a life-threatening condition.

Prompt diagnosis and treatment are necessary to save the patient’s intestine and life.

Symptoms

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

Diagnosis

An arteriogram is used to diagnosis acute mesenteric ischemia. An arteriogram is an invasive test of the blood vessels in which dye is injected and x-ray pictures are obtained.

Abdominal computed tomography (CT) scans 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 a bowel obstruction.

Treatment

Emergency surgery may be performed to remove the blood clot (embolectomy) or bypass the blocked vessel and restore blood flow to the intestines. The surgeon may use autologous bypass grafts (patient’s own blood vessels) or artificial 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 “clot busting” medication. With the aid of an arteriogram, a clot- busting medication may be injected to break up the clot in the artery.