Intestinal ischemia

In order to confirm diagnosis, the physician uses a combination of physical examination and testing based on your signs and symptoms. When you are referred to a vascular surgeon, they will go over your history of smoking, high blood pressure, diabetes, and heart disease, as well as details about your symptoms. Tests that may be completed include the following:

Blood testing: An increase in white blood cell count may indicate intestinal ischemia.

Imaging such as a doppler ultrasound or CT angiogram: These may identify problems with your arteries or abdominal organs.

Diagnostic angiogram: More invasive but preferred if diagnosis is very important. A long, thin tube is inserted into your groin or arm, then passed through an artery to your aorta. Dye is injected that can track the blood flow through the arteries and show if there are blockages.

In treating acute intestinal ischemia, it is important to stabilize the patient as rapidly as possible, while working to restore blood flow to their intestines. 

Typically, fluids are administered to restore and maintain blood circulation, pain control is achieved with opioids, antibiotics are given to try to prevent any leakage of intestinal bacteria into the abdominal cavity from producing peritonitis, and anticoagulant medication is given to prevent further blood clotting.

It is unfortunately common for some degree of intestinal infarction to occur with acute intestinal ischemia.

If signs of deterioration or of peritonitis should appear, surgery should be performed right away to remove the dying portion of intestine and to surgically restore blood flow through the occluded SMA or IMA. 

If emergency surgery is not required, options for restoring blood flow include anticoagulant drugs, bypass surgery, angioplasty and stenting, or administering "clot-busting" drugs. The optimal choice can be difficult, and often requires a team approach involving a gastroenterologist, cardiologist, and surgeon. 

In a person who has been diagnosed with chronic intestinal angina, that is, partial occlusion of the SMA or IMA caused by an atherosclerotic plaque, treatment can be accomplished either with bypass graft surgery, or with angioplasty and stenting. This treatment will make it easier to eat meals without symptoms and should help to prevent acute intestinal ischemia from occurring.