What Is Bowel Ischemia?

Overview

Bowel ischemia is a medical condition that occurs when the blood flow to the small intestine is significantly reduced or stopped altogether. It causes damage to the intestinal wall and can lead to serious complications that include sepsis, necrosis, and perforation. Bowel ischemia is a relatively rare condition that primarily affects the elderly and those with underlying medical conditions, but it can also affect infants.

This article explores the causes, symptoms, diagnosis, and treatment of bowel ischemia, as well as the long-term consequences of the condition

Causes of bowel ischemia

Causes vary, but they are generally the result of a reduction in the blood flow to the intestine. The most common type of bowel ischemia is mesenteric ischemia, which occurs when the vessels that supply blood to the intestines are blocked or narrowed. The narrowing or blockage of these vessels can be caused by a variety of factors, including atherosclerosis, blood clots, and embolisms. Other causes of bowel ischemia include volvulus, strangulated hernias, and acute hypovolemia.¹

Signs and symptoms of bowel ischemia

Symptoms include abdominal pain, nausea, vomiting, and diarrhoea. The pain is often crampy in nature and can be severe, with patients comparing it to labour pain. The pain is usually related to eating and can occur shortly after meals or several hours following a meal. The onset of symptoms can be gradual or sudden.

Management and treatment for bowel ischemia

The treatment of bowel ischemia depends on the patient's overall medical condition, the extent of the ischemia, and the cause. Treatment options include restoring blood flow to the intestine through endovascular or open surgery, decompression of the bowel, and antibiotics administration. It is essential to stabilize the patient's cardiovascular instability and sepsis during the initial phases of treatment. In severe cases, total parenteral nutrition (TPN) may be started.

Diagnosis of bowel ischemia

The diagnosis of bowel ischemia is based on the patient's clinical presentation, diagnostic imaging, and laboratory studies. Diagnostic imaging studies are essential in identifying the extent and severity of the ischemia. Computed tomography (CT) angiography is the most commonly used imaging method in diagnosing bowel ischemia. Laboratory studies such as serum lactate, D-dimer, and troponin levels are useful in evaluating the metabolic and ischemic state of the patient.²

Risk factors

The risk of bowel ischemia increases in people who have atherosclerosis which affects the blood supply to the heart, people who already have heart blood clotting disease, hypertension, and diabetes are more likely who develop bowel ischemia. Smoking and medication such as anti-allergy can affect the flow of blood. People who are more than 50 have more chances of developing bowel ischemia. 

Complications

Bowel ischemia leads to complications if not treated on time which include intestinal tissue death (gangrene) due to the blockage of blood flow to the intestine. Peritonitis infection may develop because of leakage of intestinal contents into the abdominal cavity. Scar tissue may form which causes blockage of the small intestine.

FAQs

How common is bowel ischemia?

Bowel ischemia has become much more common in recent years. The risk factors that contribute to the development of bowel ischemia include a history of vascular disease, heart and/or lung disease, and hypertension, among others. It is estimated that about 1 in 1,000 hospital admissions in the United States involve bowel ischemia, but the actual prevalence is likely higher due to underdiagnosis.³

How can I prevent bowel ischemia?

Bowel ischemia can be prevented by maintaining a healthy lifestyle and controlling your sugar and cholesterol levels, quitting smoking, cutting the amount of caffeine from your diet, and adding green vegetables and fruits. Avoid preservatives and fried items, and stay hydrated.⁴

When should I see a doctor?

If you feel extreme pain in the belly area and the pain remains the same, immediately contact a doctor to avoid any complications.

Summary

Bowel ischemia is a debilitating condition that requires prompt diagnosis and immediate treatment. It is essential to maintain suspicion of bowel ischemia in patients with abdominal pain, nausea, vomiting, and diarrhoea with risk factors. Early detection and treatment can prevent the extensive and life-threatening complications of bowel ischemia. The role of primary care physicians is vital in identifying high-risk patients and referring them for further management.